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Souza CA, Gomes MM. Aerogenous Metastasis and Spread Through the Air Spaces - Distinct Entities or Spectrum of the Same Process? Thorac Surg Clin 2021; 31:477-483. [PMID: 34696860 DOI: 10.1016/j.thorsurg.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Clinicopathological and imaging studies indicate that metastatic spread of cancer cells through the airways may occur in primary lung cancer. The term aerogenous metastasis was been proposed years before the concept of spread through the airspaces (STAS) was introduced in the current World Health Organization classification. The pathogenesis of STAS has not been fully elucidated. The current definition of STAS is controversial and limited to early stage adenocarcinomas. In this article, existing knowledge on the pathogenesis, histology, imaging findings, and clinical and prognostic significance of these 2 entities is presented.
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Affiliation(s)
- Carolina A Souza
- Division of Thoracic Imaging, Department of Medical Imaging, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa K1H 8M2, Canada.
| | - Marcio M Gomes
- Department of Pathology and Laboratory Medicine, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa K1H 8M2, Canada
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CT Halo sign: A systematic review. Eur J Radiol 2020; 124:108843. [PMID: 32007819 DOI: 10.1016/j.ejrad.2020.108843] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The CT Halo sign or Halo sign (HS) refers to ground-glass opacity surrounding a nodule or mass in the lung parenchyma. We conducted a systematic review to find the etiological associations of HS. We also evaluated the diagnostic performances of HS for invasive fungal infections (IFI) in immunosuppressed patients. METHOD The systematic review was conducted as per PRISMA guidelines. We searched the PubMed and EMBASE database till June 2018 without any restrictions. Only case reports, case series and original articles published in English language were included. A database created from the electronic searches was compiled and subsequent analysis was done. [PROSPERO registration: CRD42018094739] RESULTS: 168 studies were eligible, which included 51 case reports, 15 prospective studies, 102 retrospective studies. A total of 1977 patients (out of 6371) with HS were identified with age range between <1year-94years. The most common diagnosis in the immunosuppressed, mixed, immunocompetent and not specified groups were IFI (86.9 %, n = 1194), Cryptococcosis (51.6 %, n = 124), Cryptococcosis (40 %, n = 20) and lung neoplasms (81.8 %, n = 36) respectively. 14 studies (11 retrospective, 3 prospective) were included in quantitative analysis. The pooled sensitivity(sn), specificity(sp) and odd's ratio (OR) of HS for diagnosing IFI were 50.4 %, 91 % and 6.61 respectively. Also, HS could not reliably differentiate IPA from mucormycosis in the pooled analysis. CONCLUSIONS HS can be seen in a large number of diverse conditions both in immunosuppressed and immunocompetent population. In immunosuppressed patients HS is specific for IFI but cannot rule it out. Additionally, it cannot reliably distinguish between IPA and mucormycosis.
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Koo CW, Lu A, Takahashi EA, Simmons CL, Geske JR, Wigle D, Peikert T. Can MRI contribute to pulmonary nodule analysis? J Magn Reson Imaging 2018; 49:e256-e264. [PMID: 30575193 DOI: 10.1002/jmri.26587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is no accurate method distinguishing different types of pulmonary nodules. PURPOSE To investigate whether multiparametric 3T MRI biomarkers can distinguish malignant from benign pulmonary nodules, differentiate different types of neoplasms, and compare MRI-derived measurements with values from commonly used noninvasive imaging modalities. STUDY TYPE Prospective. SUBJECTS Sixty-eight adults with pulmonary nodules undergoing resection. SEQUENCES Respiratory triggered diffusion-weighted imaging (DWI), periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) fat saturated T2 -weighted imaging, T1 -weighted 3D volumetric interpolated breath-hold examination (VIBE) using CAIPIRINHA (controlled aliasing in parallel imaging results in a higher acceleration). ASSESSMENT/STATISTICS Apparent diffusion coefficient (ADC), T1 , T2 , T1 and T2 normalized to muscle (T1 /M and T2 /M), and dynamic contrast enhancement (DCE) values were compared with histology to determine whether they could distinguish malignant from benign nodules and discern primary from secondary malignancies using logistic regression. Predictability of primary neoplasm types was assessed using two-sample t-tests. MRI values were compared with positron emission tomography / computed tomography (PET/CT) to examine if they correlated with standardized uptake value (SUV) or CT Hounsfield unit (HU). Intra- and interreader agreements were assessed using intraclass correlations. RESULTS Forty-nine of 74 nodules were malignant. There was a significant association between ADC and malignancy (odds ratio 4.47, P < 0.05). ADC ≥1.3 μm2 /ms predicted malignancy. ADC, T1 , and T2 together predicted malignancy (P = 0.003). No MRI parameter distinguished primary from metastatic neoplasms. T2 predicted PET positivity (P = 0.016). T2 and T1 /M correlated with SUV (P < 0.05). Of 18 PET-negative malignant nodules, 12 (67%) had an ADC ≥1.3 μm2 /ms. With the exception of T2 , all noncontrast MRI parameters distinguished adenocarcinomas from carcinoid tumors (P < 0.05). T1 , T2 , T1 /M, and T2 /M correlated with HU and therefore can predict nodule density. Combined with ADC, washout enhancement, arrival time (AT), peak enhancement intensity (PEI), Ktrans , Kep , Ve collectively were predictive of malignancy (P = 0.012). Combined washin, washout, time to peak (TTP), AT, and PEI values predicted malignancy (P = 0.043). There was good observer agreement for most noncontrast MRI biomarkers. DATA CONCLUSION MRI can contribute to pulmonary nodule analysis. Multiparametric MRI might be better than individual MRI biomarkers in pulmonary nodule risk stratification. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Chi Wan Koo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aiming Lu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Jennifer R Geske
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis Wigle
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tobias Peikert
- Department of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA
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Lee H, Joung JG, Shin HT, Kim DH, Kim Y, Kim H, Kwon OJ, Shim YM, Lee HY, Lee KS, Choi YL, Park WY, Hayes DN, Um SW. Genomic alterations of ground-glass nodular lung adenocarcinoma. Sci Rep 2018; 8:7691. [PMID: 29769567 PMCID: PMC5955945 DOI: 10.1038/s41598-018-25800-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/30/2018] [Indexed: 12/20/2022] Open
Abstract
In-depth molecular pathogenesis of ground-glass nodular lung adenocarcinoma has not been well understood. The objectives of this study were to identify genomic alterations in ground-glass nodular lung adenocarcinomas and to investigate whether viral transcripts were detected in these tumors. Nine patients with pure (n = 4) and part-solid (n = 5) ground-glass nodular adenocarcinomas were included. Six were females with a median age of 58 years. We performed targeted exon sequencing and RNA sequencing. EGFR (n = 10), IDH2 (n = 2), TP53 (n = 1), PTEN (n = 1), EPHB4 (n = 1), and BRAF (n = 1) were identified as driver mutations by targeted exon sequencing. Vasculogenesis-associated genes including NOTCH4 and TGFBR3 expression were significantly downregulated in adenocarcinoma tissue versus normal tissue (adjusted P values < 0.001 for both NOTCH4 and TGFBR3). In addition, five novel fusion gene loci were identified in four lung adenocarcinomas. However, no significant virus-associated transcripts were detected in tumors. In conclusions, EGFR, IDH2, TP53, PTEN, EPHB4, and BRAF were identified as putative driver mutations of ground-glass nodular adenocarcinomas. Five novel fusion genes were also identified in four tumors. Viruses do not appear to be involved in the tumorigenesis of ground-glass nodular lung adenocarcinoma.
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Affiliation(s)
- Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Je-Gun Joung
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - Hyun-Tae Shin
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - Duk-Hwan Kim
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Yujin Kim
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea
| | - D Neil Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Aerogenous metastases: a potential game changer in the diagnosis and management of primary lung adenocarcinoma. AJR Am J Roentgenol 2015; 203:W570-82. [PMID: 25415722 DOI: 10.2214/ajr.13.12088] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purposes of this article are to summarize the relevant literature on aerogenous metastasis, explain the putative pathogenetic mechanism of aerogenous spread, present the characteristic imaging and pathologic features, and review the importance of aerogenous spread to staging and clinical management. CONCLUSION Cumulative evidence suggests that aerogenous spread may exist and is underrecognized. Imaging features are helpful in differentiating possible aerogenous spread of tumor from hematogenous and lymphatic metastases and from synchronous primary tumors. The putative occurrence of intrapulmonary aerogenous metastasis of lung cancer has staging, management, and prognostic implications.
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Secrest S, Sakamoto K. HALO AND REVERSE HALO SIGNS IN CANINE PULMONARY COMPUTED TOMOGRAPHY. Vet Radiol Ultrasound 2014; 55:272-7. [DOI: 10.1111/vru.12132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/29/2013] [Indexed: 01/15/2023] Open
Affiliation(s)
- Scott Secrest
- University of Georgia College of Veterinary Medicine; Department of Veterinary Biosciences and Diagnostic Imaging 501 DW Brooks Dr; H310 Athens GA 30602-7382
| | - Kaori Sakamoto
- University of Georgia College of Veterinary Medicine; Department of Veterinary Biosciences and Diagnostic Imaging 501 DW Brooks Dr; H310 Athens GA 30602-7382
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Focal ground-glass opacities in non-small cell lung carcinoma resection patients. Eur J Radiol 2012; 81:139-45. [DOI: 10.1016/j.ejrad.2010.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 07/01/2010] [Indexed: 11/22/2022]
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Epidermal Growth Factor Receptor Mutation Status in Stage I Lung Adenocarcinoma with Different Image Patterns. J Thorac Oncol 2011; 6:1066-72. [DOI: 10.1097/jto.0b013e31821667b0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Cardinale L, Ardissone F, Novello S, Busso M, Solitro F, Longo M, Sardo D, Giors M, Fava C. The pulmonary nodule: clinical and radiological characteristics affecting a diagnosis of malignancy. Radiol Med 2009; 114:871-89. [DOI: 10.1007/s11547-009-0399-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 10/06/2008] [Indexed: 12/19/2022]
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Parrón M, Torres I, Pardo M, Morales C, Navarro M, Martínez-Schmizcraft M. Signo del halo en la tomografía computarizada de tórax: diagnóstico diferencial con correlación anatomopatológica. Arch Bronconeumol 2008. [DOI: 10.1016/s0300-2896(08)70453-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Parrón M, Torres I, Pardo M, Morales C, Navarro M, Martínez-Schmizcraft M. The Halo Sign in Computed Tomography Images: Differential Diagnosis and Correlation With Pathology Findings. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1579-2129(08)60066-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Chiles C, Aquino SL. Imaging of Thoracic Malignancies. Oncology 2007. [DOI: 10.1007/0-387-31056-8_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shiau MC, Bonavita J, Naidich DP. Adenocarcinoma of the lung: current concepts in radiologic diagnosis and management. Curr Opin Pulm Med 2007; 13:261-6. [PMID: 17534170 DOI: 10.1097/mcp.0b013e3281c9b107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Since the introduction especially of multidetector computed tomography scanners, detection of peripheral pulmonary nodules as small as 2-3 mm is now a frequent event even in individuals without a significant smoking history. This preponderance of small indeterminate nodules has necessitated reconsideration of the natural history of malignant lung tumors, in particular peripheral adenocarcinomas, as well as current clinical and radiologic guidelines to aid in the management of these lesions. RECENT FINDINGS New information within the radiologic, pathologic and surgical literature is currently redefining nodule characterization. Most important has been the growing awareness of the prevalence of 'so-called' sub-solid pulmonary nodules, with important implications for revising our understanding of the natural history of these lesions as it impacts guidelines for nodule management. SUMMARY Reassessment of our approach to small pulmonary nodules, while controversial, is now requisite as newer insights into the computed tomography appearance and natural history of small adenocarcinomas of the lung become apparent. Recognition of suspicious morphology and accurate measurements of volume doubling time, in particular, should aid in the management of these lesions.
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Affiliation(s)
- Maria C Shiau
- Department of Radiology, New York University Medical Center, New York City, New York 10016, USA.
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Gandara DR, Aberle D, Lau D, Jett J, Akhurst T, Mulshine J, Berg C, Patz EF. Radiographic Imaging of Bronchioloalveolar Carcinoma: Screening, Patterns of Presentation and Response Assessment. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)30005-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Radiographic Imaging of Bronchioloalveolar Carcinoma: Screening, Patterns of Presentation and Response Assessment. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200611001-00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Garfield DH, Cadranel JL, Wislez M, Franklin WA, Hirsch FR. The Bronchioloalveolar Carcinoma and Peripheral Adenocarcinoma Spectrum of Diseases. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)31593-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Hashimoto M, Tate E, Watarai J, Sasaki M. CT halo sign in cases of pulmonary metastasis from bone or soft tissue sarcoma. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.rmedx.2006.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maffessanti M, Dalpiaz G. Nodular Diseases. DIFFUSE LUNG DISEASES 2006. [PMCID: PMC7120551 DOI: 10.1007/88-470-0430-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nambu A, Araki T, Taguchi Y, Ozawa K, Miyata K, Miyazawa M, Hiejima Y, Saito A. Focal area of ground-glass opacity and ground-glass opacity predominance on thin-section CT: Discrimination between neoplastic and non-neoplastic lesions. Clin Radiol 2005; 60:1006-17. [PMID: 16124983 DOI: 10.1016/j.crad.2005.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Revised: 06/12/2005] [Accepted: 06/14/2005] [Indexed: 11/16/2022]
Abstract
AIM To reveal differences in thin-section computed tomography (CT) findings between lung neoplastic lesions and non-neoplastic lesions, which showed a focal area of ground-glass opacity or ground-glass opacity predominance. MATERIALS AND METHODS A total of 82 focal areas of ground-glass opacity and ground-glass opacity predominance, consisting of 38 neoplastic and 44 non-neoplastic lesions, were assessed retrospectively regarding their thin-section CT findings. RESULTS The frequency of wholly well-defined margin (p=0.001), spiculation (p=0.019), pleural indentation (p=0.016), air bronchograms (p=0.027), air-containing space (p=0.004) was significantly higher in neoplastic lesions than in non-neoplastic lesions. Thirty-four of 38 (89%) neoplastic lesions were well-defined in more than 50% of the circumference, of which nine had an air-containing space other than air bronchogram, whereas only one non-neoplastic lesion had these features. CONCLUSION A focal area of ground-glass opacity or ground-glass opacity predominance with a well-defined margin and air-containing space is more likely to be a neoplasm.
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Affiliation(s)
- A Nambu
- Department of Radiology, University of Yamanashi, Nakakoma-gun, Yamanashi Prefecture, Japan.
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Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioni T, McAdams HP. "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 2004; 23:1509-19. [PMID: 14615561 DOI: 10.1148/rg.236035101] [Citation(s) in RCA: 222] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The "crazy-paving" pattern is a common finding at thin-section computed tomography (CT) of the lungs. It consists of scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. This finding has a variety of causes, including infectious, neoplastic, idiopathic, inhalational, and sanguineous disorders. Specific disorders that can cause the crazy-paving pattern include Pneumocystis carinii pneumonia, mucinous bronchioloalveolar carcinoma, pulmonary alveolar proteinosis, sarcoidosis, nonspecific interstitial pneumonia, organizing pneumonia, exogenous lipoid pneumonia, adult respiratory distress syndrome, and pulmonary hemorrhage syndromes. Knowledge of the many causes of this pattern can be useful in preventing diagnostic errors. In addition, although the causes of this pattern are frequently indistinguishable at radiologic evaluation, differences in the location of the characteristic attenuation in the lungs, as well as the presence of additional radiologic findings, the patient's history, and the clinical presentation, can often be useful in suggesting the appropriate diagnosis.
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Affiliation(s)
- Santiago E Rossi
- Department of Radiology, Centro de Diagnostico Dr Enrique Rossi, Arenales 2777, Buenos Aires 1425, Argentina.
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Affiliation(s)
- Pedro S Pinto
- Department of Radiology, University of California, San Diego, USA
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Wislez M, Massiani MA, Milleron B, Souidi A, Carette MF, Antoine M, Cadranel J. Clinical characteristics of pneumonic-type adenocarcinoma of the lung. Chest 2003; 123:1868-77. [PMID: 12796162 DOI: 10.1378/chest.123.6.1868] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
PURPOSE To analyze diagnostic approaches, survival predictors, and treatment efficacy in pneumonic-type adenocarcinoma (P-ADC). PATIENTS AND METHODS Fifty-two patients with P-ADC diagnosed between January 1986 and December 2000 were studied. P-ADC was defined as histologically or cytologically proven pulmonary adenocarcinoma with a pneumonia-like consolidation, in a patient with no prior diagnosis of thoracic or extrathoracic adenocarcinoma. RESULTS Sixty percent of the patients were men (n = 31), and 65% (n = 34) were current or former smokers. Mean (+/- SD) age at diagnosis was 66 +/- 1.4 years. P-ADC was diagnosed by routine chest radiography in 17% of cases (n = 9). Bronchorrhea was present in 31% of cases (n = 16), and crepitant rales in 58% (n = 30). The primary tumor appeared as consolidations, which could not be assessed and were thus classified Tx, in 83% of the patients (n = 43). Ten percent of the patients (n = 5) had a satellite tumor within the lobe containing the primary tumor (T4), and 63% (n = 33) had a satellite tumor in another lobe (M1). Extrathoracic metastases were present in 5% of cases (n = 3). Bronchial biopsy, transbronchial biopsy, bronchial aspiration, and BAL were positive in 21%, 80%, 44%, and 66% of cases, respectively. The median survival time after diagnosis was 10.5 months (range, 1 to 150 months). The outcome of patients treated by lobectomy or bilobectomy was significantly better than that of patients treated with pneumonectomy, chemotherapy, or best supportive care (p < 0.01). Bronchorrhea and crepitant rales were independent predictors of shorter survival when the treatment modality (surgery vs no surgery) was not entered as a risk factor. CONCLUSIONS P-ADC is characterized by aerogenous propagation, as emphasized by the results of multivariate analysis showing that bronchorrhea and crepitant rales were the only two independent factors of shorter survival. Surgery remains the most effective treatment in P-ADC, especially when lobectomy is feasible. As CT is not sensitive enough to detect multifocal lesions, new tools are required to evaluate pulmonary involvement and thereby to refine the surgical strategy.
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Affiliation(s)
- Marie Wislez
- Laboratoire de Biologie Cellulaire et d'Immunopathologie Pulmonaire, UPRES EA 3493, Université Paris VI, UFR Saint-Antoine, Paris, France
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Abstract
The ability to identify and characterize pulmonary nodules has been dramatically increased by the introduction of multislice CT (MSCT) technology. Using high-resolution sections, MSCT allows considerable improvement in assessing nodule morphology, enhancement patterns, and growth. MSCT also has facilitated the development and potential of clinical application of computer-assisted diagnosis.
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Affiliation(s)
- Jane P Ko
- Department of Radiology, New York University Medical Center, 560 1st Avenue, New York, NY 10016, USA.
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Nakajima R, Yokose T, Kakinuma R, Nagai K, Nishiwaki Y, Ochiai A. Localized pure ground-glass opacity on high-resolution CT: histologic characteristics. J Comput Assist Tomogr 2002; 26:323-9. [PMID: 12016356 DOI: 10.1097/00004728-200205000-00001] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The aim of this study is to assess the histologic characteristics in cases of localized pure ground-glass opacity (LPGGO) that do not exhibit consolidation on high-resolution CT (HRCT) images. METHOD Twenty surgically resected lesions from 20 consecutive cases were retrospectively investigated. Each of the 20 lesions had exhibited LPGGO on HRCT images. The HRCT images and histopathologic findings were examined for correlations. RESULTS The areas of LPGGO had a maximum diameter of 2.0-24 mm on the HRCT images. Histopathology of the LPGGO lesions resulted in diagnosis of fibrosis (n = 3; 15%), atypical adenomatous hyperplasia (n = 5; 25%), bronchioloalveolar carcinoma (n = 10; 50%), and adenocarcinoma with stromal invasion (n = 2; 10%). Nonaerogenous components corresponding to solid components without normal alveolar septal destruction were pathologically observed in 15 of the 20 lesions. The diameter of the nonaerogenous components varied between 0.2 and 2.0 mm. CONCLUSION Because 10% of LPGGO lesions include invasive disease, patients with LPGGO should undergo pathologic examination for confirmation.
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Affiliation(s)
- Ryu Nakajima
- Pathology Division, National Cancer Center Research Institute East, Chiba, Japan
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Mirtcheva RM, Vazquez M, Yankelevitz DF, Henschke CI. Bronchioloalveolar carcinoma and adenocarcinoma with bronchioloalveolar features presenting as ground-glass opacities on CT. Clin Imaging 2002; 26:95-100. [PMID: 11852215 DOI: 10.1016/s0899-7071(01)00372-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE As bronchioloalveolar carcinoma (BAC) is noninvasive but, in its later stages, has a worse prognosis than adenocarcinoma with bronchioloalveolar features (ACB), early identification and differentiation is important for therapeutic and prognostic purposes. We wanted to identify features of BAC, which differentiated it from ACB when both presented as ground-glass opacities (GGOs) on CT. MATERIALS AND METHODS We reviewed all pathologic specimens of patients who were diagnosed with BAC and ACB in the lung from 1991 to 1999 in our institution and whose malignancy presented as a GGO on CT. This yielded 29 patients, 15 with BAC and 14 with ACB with GGOs on CT. Both univariate frequency table and multivariate logistic regression approaches were used to analyze the CT characteristics of these GGOs (location, GGO pattern, size, shape, margin, presence and type of air bronchogram and pseudocavitation). RESULTS BAC most frequently had a "GGO halo" around a solid opacity, often was a GGO "mixed with consolidation" with the smallest BACs being "pure GGO." Air bronchograms were frequently present in the largest GGOs. Pseudocavitations were rare. ACB, on the other hand, most frequently presented as a GGO "mixed with consolidation," less frequently with a "GGO halo" and rarely with "superimposed lymphangitis." The air bronchograms, frequently present, were usually tortuous and ectatic. Pseudocavitation was present in about one-third of the cases. The most useful CT features of GGO in separating those due to BAC from those due to ACB were pure (uniform) ground-glass attenuation and absence of lymphangitis. CONCLUSION The CT features of BAC and ACB presenting as GGO reflect the histologic descriptions of these carcinomas.
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Affiliation(s)
- Rosna M Mirtcheva
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA
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Gaeta M, Minutoli F, Ascenti G, Vinci S, Mazziotti S, Pandolfo I, Blandino A. MR white lung sign: incidence and significance in pulmonary consolidations. J Comput Assist Tomogr 2001; 25:890-6. [PMID: 11711801 DOI: 10.1097/00004728-200111000-00011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE The presence of a pulmonary consolidation with a signal intensity comparable with that of the static fluid on heavily T2-weighted MR images has been named the "MR white lung sign." This sign has been described in mucinous bronchioloalveolar carcinoma (BAC). Our purpose was to establish the frequency and significance of this sign in pulmonary consolidations of varied causes. METHOD In this prospective study, 83 patients with pulmonary consolidation underwent MR examination between January and December 1999. Segmental or lobar consolidations were due to pneumonia without central obstruction (n = 22), pneumonitis with central obstruction (n = 21), cicatricial atelectasis (n = 8), passive atelectasis (n = 10), radiation pneumonitis (n = 8), mucinous BAC (n = 5), infarction (n = 3), bronchiolitis obliterans organizing pneumonia (n = 3), nonmucinous BAC (n = 2), and lymphoma (n = 1). The MR white lung sign was considered present when the signal intensity of a pulmonary consolidation was comparable with that of the static fluid on heavily T2-weighted images obtained with MR hydrography sequences. Interobserver agreement, sensitivity, and specificity of the white lung sign in diagnosing mucinous BAC were calculated. RESULTS The MR white lung sign was present in 7 (8%) of 83 consolidations, including 5 (100%) of 5 cases of mucinous BAC and 2 (10%) of 21 cases of obstructive pneumonitis. The frequency of the white lung sign was 100% in mucinous BAC and 2.6% in consolidations due to other causes. The difference was statistically significant (p < 0.05). CONCLUSION The white lung sign is an uncommon finding in pulmonary consolidations evaluated with heavily T2-weighted sequences. However, the sign is characteristic of mucinous BAC and adds specificity to the radiologic diagnosis.
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Affiliation(s)
- M Gaeta
- Institute of Radiological Sciences, University of Messina, Messina, Italy
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Yang ZG, Sone S, Takashima S, Li F, Honda T, Maruyama Y, Hasegawa M, Kawakami S. High-resolution CT analysis of small peripheral lung adenocarcinomas revealed on screening helical CT. AJR Am J Roentgenol 2001; 176:1399-407. [PMID: 11373200 DOI: 10.2214/ajr.176.6.1761399] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the correlation between high-resolution CT morphologic features of small peripheral lung adenocarcinomas and tumor growth patterns. MATERIALS AND METHODS We examined high-resolution CT morphologic features of 59 small, surgically resected peripheral lung adenocarcinomas (diameter, 6-20 mm) that were detected on screening for lung cancer using low-dose helical CT. Among these adenocarcinomas, 14 (24%) were visible and 45 (76%) were invisible on conventional chest radiography. The correlation between high-resolution CT morphologic features and tumor growth patterns was analyzed. RESULTS Sixteen (94%) of 17 type A (Noguchi's classification) adenocarcinomas appeared as nodules of pure ground-glass attenuation (high-resolution CT type I). Ten (71%) of 14 type B tumors appeared as heterogeneous, low-attenuation nodules (type II). Seven (29%) of 24 type C tumors appeared as nodules with ground-glass attenuation in the periphery and a high-density central zone (type III), and 12 (50%) of 24 type C tumors appeared as homogeneous nodules with soft-tissue density (type IV). Among tumors with a replacement growth pattern, the size and CT values of type C tumors were larger than those of type A or type B tumors (p < 0.05), whereas the percentage of ground-glass attenuation and retained air space in type C tumors was smaller than those in type A or type B tumors (p < 0.01). All (100%) four type D tumors appeared to be homogeneous nodules with soft-tissue density (type IV). CONCLUSION Small peripheral lung adenocarcinomas shown on CT exhibit four high-resolution CT patterns that corresponded to the histopathologic findings of different tumor growth patterns.
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Affiliation(s)
- Z G Yang
- Department of Radiology, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390 8621, Japan
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Yoshida J, Shirota T, Tanimura A, Akao M. Clinical pathway for impalpable or small lung lesions treated with coil marking and thoracoscopy. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2001; 49:108-12. [PMID: 11257765 DOI: 10.1007/bf02912126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Advances in computed tomography are detecting increasingly impalpable or small pulmonary lesions. We propose a clinical pathway for managing such lesions. METHODS We conducted a retrospective study in a community teaching hospital to describe the hospital schedules of 18 patients having 19 lesions 10 mm or less and ground glass attenuation. Under computed tomography, a coil (Complex Helical Fibered Platinum Coil-18) was placed at the proximal side of the lesion. Using thoracoscopy and radiographic fluorography, we conducted partial lung resection targeting the coil the next day, adding lobectomy, if required. RESULTS Final diagnosis included primary and metastatic lung cancer (n = 14), atypical adenomatous hyperplasia (n = 1), and benignancy (n = 4). Patients were admitted 2* days before surgery (*Numbers are medians). On postoperative day 3, chest tubes were removed. Epidural analgesia was continued for 5 days. On postoperative day 7, patients were discharged. Their admission charge was a total of yen 979,610. CONCLUSIONS The hospital course above may be applied to the clinical pathway for managing impalpable or small lung lesions.
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Affiliation(s)
- J Yoshida
- Department of Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki 750-8520, Japan.
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Gaeta M, Blandino A, Scribano E, Vinci S, Minutoli F, Pergolizzi S, Pandolfo I. Magnetic resonance imaging of bronchioloalveolar carcinoma. J Thorac Imaging 2000; 15:41-7. [PMID: 10634662 DOI: 10.1097/00005382-200001000-00009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study is to describe the magnetic resonance (MR) features of bronchioloalveolar carcinoma. MR examinations of 18 patients with proven bronchioloalveolar carcinoma were reviewed. Detection at computed tomography (CT) and pathologic confirmation were the entry criteria. Nine patients had a solitary nodule, three patients a lobar consolidation, and six patients had diffuse disease. For each patient, both breath-hold T2-weighted fast spin-echo, and breath-hold T1-weighted gradient-echo images, before and after injection of gadolinium, were available. Nine patients with pulmonary consolidation or diffuse disease had also heavily T2-weighted MR imaging (Haste or TSE 240; Siemens, Erlangen, Germany). MR imaging showed pulmonary abnormalities in 17 of 18 patients. Unenhanced T1-weighted and T2-weighted images depicted tumor in 16 of 18 patients. Contrast-enhanced T1-weighted images showed tumor in 17 of 18 patients. In no case did MR imaging depict abnormalities corresponding to the ground-glass opacities seen on CT scans. In three patients with mucinous bronchioloalveolar carcinoma, heavily T2-weighted images showed lesions isointense with respect to static fluid of the human body. In conclusion, the ability of MR imaging in detecting small nodules and ground-glass opacities is limited. However, heavily T2-weighted sequences are able to show the presence of mucin. This is useful information because mucinous bronchioloalveolar carcinoma carries a poor prognosis.
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Affiliation(s)
- M Gaeta
- Institute of Radiologic Sciences, University of Messina, Policlinico G. Martino-Gazzi, Italy
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Schwarz LA, Tidwell AS. Alternative imaging of the lung. CLINICAL TECHNIQUES IN SMALL ANIMAL PRACTICE 1999; 14:187-206. [PMID: 10652836 DOI: 10.1016/s1096-2867(99)80011-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article illustrates the roles of ultrasonography, scintigraphy, and computed tomography (CT) as alternative techniques for pulmonary imaging in small animals. The advantages and limitations of each modality, normal anatomic features, and technical considerations will be discussed. Selected applications will be examined and include pulmonary consolidation, neoplasia and other masses, atelectasis, pneumothorax, dystrophic mineralization, diffuse infiltrative disease, and pulmonary embolism. The use of ultrasound and CT-guided interventional procedures will also be briefly discussed.
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Affiliation(s)
- L A Schwarz
- Department of Clinical Sciences, Section of Radiology, Foster Hospital for Small Animals, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA
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