1
|
Liao HF, Huang XT, Li X, Lv FJ, Luo TY, Li Q. Solitary lung adenocarcinoma: follow-up CT, pathological-molecular characteristics, and surgical prognosis for different morphological classifications. Insights Imaging 2023; 14:209. [PMID: 38010599 PMCID: PMC10682316 DOI: 10.1186/s13244-023-01563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To investigate the dynamic changes during follow-up computed tomography (CT), histological subtypes, gene mutation status, and surgical prognosis for different morphological presentations of solitary lung adenocarcinomas (SLADC). MATERIALS AND METHODS This retrospective study compared dynamic tumor changes and volume doubling time (VDT) in 228 patients with SLADC (morphological types I-IV) who had intermittent growth during follow-ups. The correlation between the morphological classification and histological subtypes, gene mutation status, and surgical prognosis was evaluated. RESULTS Among the 228 patients, 66 (28.9%) were classified as type I, 123 (53.9%) as type II, 16 (7%) as type III, and 23 (10.1%) as type IV. Type I had the shortest VDT (254 days), followed by types IV (381 days) and III (501 days), and then type II (993 days) (p < 0.05 each). Type I had a greater proportion of solid/micropapillary-predominant pattern than type II, and the lepidic-predominant pattern was more common in type II and III than in type I (p < 0.05 each). Furthermore, type II and IV SLADCs were correlated with positive epidermal growth factor receptor mutation (p < 0.05 each). Lastly, the Kaplan-Meier curves showed that the disease-free survival was longest for patients with type II tumors, followed by those with type III and IV tumors, and then those with type I tumors (p < 0.001 each). CONCLUSION A good understanding of the natural progression and pathological-molecular characteristics of different morphological SLADC types can help make accurate diagnoses, develop individual treatment strategies, and predict patient outcomes. CRITICAL RELEVANCE STATEMENT A good understanding of the natural progression and pathological-molecular characteristics of different morphological solitary lung adenocarcinoma types can help make accurate diagnoses, develop individual treatment strategies, and predict patient outcomes. KEY POINTS • Type I-IV solitary lung adenocarcinomas exhibit varying natural progression on serial CT scans. • Morphological classification of solitary lung adenocarcinomas predicts histological subtype, gene status, and surgical prognosis. • This classification of solitary lung adenocarcinomas may help improve diagnostic, therapeutic, and prognosticating abilities.
Collapse
Affiliation(s)
- Hong-Fan Liao
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China
| | - Xing-Tao Huang
- Department of Radiology, the Fifth People's Hospital of Chongqing, Chongqing, 400062, China
| | - Xian Li
- Department of Pathology, Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Tian-You Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qi Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| |
Collapse
|
2
|
State of the Art: Lung Cancer Staging Using Updated Imaging Modalities. Bioengineering (Basel) 2022; 9:bioengineering9100493. [PMID: 36290461 PMCID: PMC9598500 DOI: 10.3390/bioengineering9100493] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Lung cancer is among the most common mortality causes worldwide. This scientific article is a comprehensive review of current knowledge regarding screening, subtyping, imaging, staging, and management of treatment response for lung cancer. The traditional imaging modality for screening and initial lung cancer diagnosis is computed tomography (CT). Recently, a dual-energy CT was proven to enhance the categorization of variable pulmonary lesions. The National Comprehensive Cancer Network (NCCN) recommends usage of fluorodeoxyglucose positron emission tomography (FDG PET) in concert with CT to properly stage lung cancer and to prevent fruitless thoracotomies. Diffusion MR is an alternative to FDG PET/CT that is radiation-free and has a comparable diagnostic performance. For response evaluation after treatment, FDG PET/CT is a potent modality which predicts survival better than CT. Updated knowledge of lung cancer genomic abnormalities and treatment regimens helps to improve the radiologists’ skills. Incorporating the radiologic experience is crucial for precise diagnosis, therapy planning, and surveillance of lung cancer.
Collapse
|
3
|
Liu J, Yang X, Li Y, Xu H, He C, Qing H, Ren J, Zhou P. Development and validation of qualitative and quantitative models to predict invasiveness of lung adenocarcinomas manifesting as pure ground-glass nodules based on low-dose computed tomography during lung cancer screening. Quant Imaging Med Surg 2022; 12:2917-2931. [PMID: 35502397 PMCID: PMC9014141 DOI: 10.21037/qims-21-912] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/03/2022] [Indexed: 08/04/2023]
Abstract
BACKGROUND Due to different management strategy and prognosis of different subtypes of lung adenocarcinomas appearing as pure ground-glass nodules (pGGNs), it is important to differentiate invasive adenocarcinoma (IA) from adenocarcinoma in situ/minimally invasive adenocarcinoma (AIS/MIA) during lung cancer screening. The aim of this study was to develop and validate the qualitative and quantitative models to predict the invasiveness of lung adenocarcinoma appearing as pGGNs based on low-dose computed tomography (LDCT) and compare their diagnostic performance with that of intraoperative frozen section (FS). METHODS A total of 223 consecutive pathologically confirmed pGGNs from March 2018 to December 2020 were divided into a primary cohort (96 IAs and 64 AIS/MIAs) and validation cohort (39 IAs and 24 AIS/MIAs) according to scans (Brilliance iCT and Somatom Definition Flash) performed at Sichuan Cancer Hospital and Institute. The following LDCT features of pGGNs were analyzed: the qualitative features included nodule location, shape, margin, nodule-lung interface, lobulation, spiculation, pleural indentation, air bronchogram, vacuole, and vessel type, and the quantitative features included the diameter, volume, and mean attenuation. Multivariate logistic regression analysis was used to build a qualitative model, quantitative model, and combined qualitative and quantitative model. The diagnostic performance was assessed according to the following factors: the area under curve (AUC) of the receiver operating characteristic (ROC) curve, sensitivity, specificity, and accuracy. RESULTS The AUCs of the qualitative model, quantitative model, combined qualitative and quantitative model, and the FS diagnosis were 0.854, 0.803, 0.873, and 0.870, respectively, in the primary cohort and 0.884, 0.855, 0.875, and 0.946, respectively, in the validation cohort. No significant difference of the AUCs was found among the radiological models and the FS diagnosis in the primary or validation cohort (all corrected P>0.05). Among the radiological models, the combined qualitative and quantitative model consisting of vessel type and volume showed the highest accuracy in both the primary and validation cohorts (0.831 and 0.889, respectively). CONCLUSIONS The diagnostic performances of the qualitative and quantitative models based on LDCT to differentiate IA from AIS/MIA in pGGNs are equivalent to that of intraoperative FS diagnosis. The vessel type and volume can be preoperative and non-invasive biomarkers to assess the invasive risk of pGGNs in lung cancer screening.
Collapse
Affiliation(s)
- Jieke Liu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xi Yang
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yong Li
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Xu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Changjiu He
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Haomiao Qing
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Ren
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Peng Zhou
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
4
|
Li Y, Liu J, Yang X, Xu H, Qing H, Ren J, Zhou P. Prediction of invasive adenocarcinomas manifesting as pure ground-glass nodules based on radiomic signature of low-dose CT in lung cancer screening. Br J Radiol 2022; 95:20211048. [PMID: 34995082 PMCID: PMC10993960 DOI: 10.1259/bjr.20211048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To develop a radiomic model based on low-dose CT (LDCT) to distinguish invasive adenocarcinomas (IAs) from adenocarcinoma in situ/minimally invasive adenocarcinomas (AIS/MIAs) manifesting as pure ground-glass nodules (pGGNs) and compare its performance with conventional quantitative and semantic features of LDCT, radiomic model of standard-dose CT, and intraoperative frozen section (FS). METHODS A total of 147 consecutive pathologically confirmed pGGNs were divided into primary cohort (43 IAs and 60 AIS/MIAs) and validation cohort (19 IAs and 25 AIS/MIAs). Logistic regression models were built using conventional quantitative and semantic features, selected radiomic features of LDCT and standard-dose CT, and intraoperative FS diagnosis, respectively. The diagnostic performance was assessed by area under curve (AUC) of receiver operating characteristic curve, sensitivity, and specificity. RESULTS The AUCs of quantitative-semantic model, radiomic model of LDCT, radiomic model of standard-dose CT, and FS model were 0.879 (95% CI, 0.801-0.935), 0.929 (95% CI, 0.862-0.971), 0.941 (95% CI, 0.876-0.978), and 0.884 (95% CI, 0.805-0.938) in the primary cohort and 0.897 (95% CI, 0.768-0.968), 0.933 (95% CI, 0.815-0.986), 0.901 (95% CI, 0.773-0.970), and 0.828 (95% CI, 0.685-0.925) in the validation cohort. No significant difference of the AUCs was found among these models in both the primary and validation cohorts (all p > 0.05). CONCLUSION The LDCT-based quantitative-semantic score and radiomic signature, with good predictive performance, can be pre-operative and non-invasive biomarkers for assessing the invasive risk of pGGNs in lung cancer screening. ADVANCES IN KNOWLEDGE The LDCT-based quantitative-semantic score and radiomic signature, with the equivalent performance to the radiomic model of standard-dose CT, can be pre-operative predictors for assessing the invasiveness of pGGNs in lung cancer screening and reducing excess examination and treatment.
Collapse
Affiliation(s)
- Yong Li
- Department of Radiology, Sichuan Cancer Hospital &
Institute, Sichuan Cancer Center, School of Medicine, University of
Electronic Science and Technology of China,
Chengdu, China
| | - Jieke Liu
- Department of Radiology, Sichuan Cancer Hospital &
Institute, Sichuan Cancer Center, School of Medicine, University of
Electronic Science and Technology of China,
Chengdu, China
| | - Xi Yang
- Department of Radiology, Sichuan Cancer Hospital &
Institute, Sichuan Cancer Center, School of Medicine, University of
Electronic Science and Technology of China,
Chengdu, China
| | - Hao Xu
- Department of Radiology, Sichuan Cancer Hospital &
Institute, Sichuan Cancer Center, School of Medicine, University of
Electronic Science and Technology of China,
Chengdu, China
| | - Haomiao Qing
- Department of Radiology, Sichuan Cancer Hospital &
Institute, Sichuan Cancer Center, School of Medicine, University of
Electronic Science and Technology of China,
Chengdu, China
| | - Jing Ren
- Department of Radiology, Sichuan Cancer Hospital &
Institute, Sichuan Cancer Center, School of Medicine, University of
Electronic Science and Technology of China,
Chengdu, China
| | - Peng Zhou
- Department of Radiology, Sichuan Cancer Hospital &
Institute, Sichuan Cancer Center, School of Medicine, University of
Electronic Science and Technology of China,
Chengdu, China
| |
Collapse
|
5
|
Jiang Y, Xiong Z, Zhao W, Zhang J, Guo Y, Li G, Li Z. Computed tomography radiomics-based distinction of invasive adenocarcinoma from minimally invasive adenocarcinoma manifesting as pure ground-glass nodules with bubble-like signs. Gan To Kagaku Ryoho 2022; 70:880-890. [PMID: 35301662 DOI: 10.1007/s11748-022-01801-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/03/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To explore an effective model based on radiomics features extracted from nonenhanced computed tomography (CT) images to distinguish invasive adenocarcinoma (IAC) from minimally invasive adenocarcinoma (MIA) presenting as pure ground-glass nodules (pGGNs) with bubble-like (B-pGGNs) signs. PATIENTS AND METHODS We retrospectively reviewed 511 nodules (MIA, n = 288; IAC, n = 223) between November 2012 and June 2018 from almost all pGGNs pathologically confirmed MIA or IAC. Eventually, a total of 109 B-pGGNs (MIA, n = 55; IAC, n = 54) from 109 patients fulfilling the criteria were randomly assigned to the training and test cluster at a ratio of 7:3. The gradient boosting decision tree (GBDT) method and logistic regression (LR) analysis were applied to feature selection (radiomics, semantic, and conventional CT features). LR was performed to construct three models (the conventional, radiomics and combined model). The performance of the predictive models was evaluated using the area under the curve (AUC). RESULTS The radiomics model had good AUCs of 0.947 in the training cluster and of 0.945 in the test cluster. The combined model produced an AUC of 0.953 in the training cluster and of 0.945 in the test cluster. The combined model yielded no performance improvement (vs. the radiomics model). The rad_score was the only independent predictor of invasiveness. CONCLUSION The radiomics model showed excellent predictive performance in discriminating IAC from MIA presenting as B-pGGNs and may provide a necessary reference for extending clinical practice.
Collapse
Affiliation(s)
- Yining Jiang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ziqi Xiong
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wenjing Zhao
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jingyu Zhang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yan Guo
- GE Healthcare, Beijing, China
| | - Guosheng Li
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhiyong Li
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China. .,Dalian Engineering Research Centre for Artificial Intelligence in Medical Imaging, Dalian, China.
| |
Collapse
|
6
|
Hu B, Ren W, Feng Z, Li M, Li X, Han R, Peng Z. Correlation between CT imaging characteristics and pathological diagnosis for subcentimeter pulmonary nodules. Thorac Cancer 2022; 13:1067-1075. [PMID: 35212152 PMCID: PMC8977167 DOI: 10.1111/1759-7714.14363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 01/15/2023] Open
Abstract
Background Advances in chest computed tomography (CT) have resulted in more frequent detection of subcentimeter pulmonary nodules (SCPNs), some of which are non‐benign and may represent invasive lung cancer. The present study aimed to explore the correlation between pathological diagnosis and the CT imaging manifestations of SCPNs. Methods This retrospective study included patients who underwent pulmonary resection for SCPNs at Shandong Provincial Hospital in China. Lesions were divided into five categories according to their morphological characteristics on CT: cotton ball, solid‐filled with spiculation, solid‐filled with smooth edges, mixed‐density ground‐glass, and vacuolar. We further analyzed lesion size, enhancement patterns, vascular aggregation, and SCPN traversing. Chi‐square tests, Fisher's exact tests, and Welch's one‐way analysis of variance were used to examine the correlation between CT imaging characteristics and pathological type. Results There were statistically significant differences in the morphological distributions of SCPNs with different pathological types, including benign lesions and malignant lesions at different stages (p < 0.01). The morphological distributions of the four subtypes of invasive lung adenocarcinoma also exhibited significant differences (p < 0.01). In addition, size and enhancement patterns differed significantly among different pathological types of SCPNs. Conclusion Different pathological types of SCPNs exhibit significant differences based on their morphological category, size, and enhancement pattern on CT imaging. These CT characteristics may assist in the qualitative diagnosis of SCPNs.
Collapse
Affiliation(s)
- Benchuang Hu
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Wangang Ren
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Zhen Feng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Meng Li
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Xiao Li
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Rui Han
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Zhongmin Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| |
Collapse
|
7
|
Succony L, Rassl DM, Barker AP, McCaughan FM, Rintoul RC. Adenocarcinoma spectrum lesions of the lung: Detection, pathology and treatment strategies. Cancer Treat Rev 2021; 99:102237. [PMID: 34182217 DOI: 10.1016/j.ctrv.2021.102237] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 02/07/2023]
Abstract
Adenocarcinoma has become the most prevalent lung cancer sub-type and its frequency is increasing. The earliest stages in the development of lung adenocarcinomas are visible using modern computed tomography (CT) as ground glass nodules. These pre-invasive nodules can progress over time to become invasive lung adenocarcinomas. Lesions in this developmental pathway are termed 'adenocarcinoma spectrum' lesions. With the introduction of lung cancer screening programs there has been an increase in the detection of these lesions raising questions about natural history, surveillance and treatment. Here we review how the radiological appearance of an adenocarcinoma spectrum lesion relates to its underlying pathology and explore the natural history and factors driving lesion progression. We examine the molecular changes that occur at each stage of adenocarcinoma spectrum lesion development, including the effects of the driver mutations, EGFR and KRAS, that are key to invasive adenocarcinoma pathology. A better understanding of the development of pre-invasive disease will create treatment targets. Our understanding of how tumours interact with the immune system has led to the development of new therapeutic strategies. We review the role of the immune system in the development of adenocarcinoma spectrum lesions. With a clear preinvasive phase there is an opportunity to treat early adenocarcinoma spectrum lesions before an invasive lung cancer develops. We review current management including surveillance, surgical resection and oncological therapy as well as exploring potential future treatment avenues.
Collapse
Affiliation(s)
- L Succony
- Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge CB2 0AY, United Kingdom
| | - D M Rassl
- Department of Pathology, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, United Kingdom
| | - A P Barker
- Department of Radiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, United Kingdom
| | - F M McCaughan
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - R C Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge CB2 0AY, United Kingdom; Department of Oncology, University of Cambridge, Cambridge CB2 0QQ United Kingdom.
| |
Collapse
|
8
|
Lambe G, Durand M, Buckley A, Nicholson S, McDermott R. Adenocarcinoma of the lung: from BAC to the future. Insights Imaging 2020; 11:69. [PMID: 32430670 PMCID: PMC7237554 DOI: 10.1186/s13244-020-00875-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/17/2020] [Indexed: 02/04/2023] Open
Abstract
Adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic predominant adenocarcinoma and invasive mucinous adenocarcinoma are relatively new classification entities which replace the now retired term, bronchoalveolar carcinoma (BAC). The radiographic appearance of these lesions ranges from pure, ground glass nodules to large, solid masses. A thorough understanding of the new classification is essential to radiologists who work with MDT colleagues to provide accurate staging and treatment. A 2-year review was performed of all surgically resected cases of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma in our institution. Cases are broken down by age, gender, tumour type and tumour location. A pictorial review is presented to illustrate the radiologic and pathologic features of each entity.
Collapse
|
9
|
Panunzio A, Sartori P. Lung Cancer and Radiological Imaging. Curr Radiopharm 2020; 13:238-242. [PMID: 32445458 PMCID: PMC8206195 DOI: 10.2174/1874471013666200523161849] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/16/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lung cancer is the neoplasm with the highest prevalence and mortality rates in the world. Most patients with lung cancer that are symptomatic have hemoptysis, coughing, shortness of breath, chest pain and persistent infections. Less than 10% of patients are asymptomatic when the tumor is detected as an incidental finding. OBJECTIVE The present expert review aims to describe the use of radiological imaging modalities for the diagnosis of lung cancer. METHODS Some papers were selected from the international literature, by using mainly Pubmed as a source. RESULTS Chest x-ray (CXR) is the first investigation performed during the workup of suspected lung cancer. In the absence of a rib erosion, CXR cannot distinguish between benign and malignant masses, therefore computed tomography (CT) with contrast enhancement should be performed in order to obtain a correct staging. Magnetic resonance imaging of the chest is considered a secondary approach as the respiratory movement affects the overall results. CONCLUSION Radiological imaging is essential for the management of patients affected by lung cancer.
Collapse
Affiliation(s)
- Annalori Panunzio
- Address correspondence to this author at the Unità operativa di Radiodiagnostica, Presidio Ospedaliero di Ostuni, ASL Brindisi, Via Villafranca 72017 Ostuni, Brindisi, Italy; Tel: +39 0831309111; Fax: +39 0831309420; E-mail:
| | | |
Collapse
|
10
|
Zhu Y, Hou D, Lan M, Sun X, Ma X. A comparison of ultra-high-resolution CT target scan versus conventional CT target reconstruction in the evaluation of ground-glass-nodule-like lung adenocarcinoma. Quant Imaging Med Surg 2019; 9:1087-1094. [PMID: 31367562 DOI: 10.21037/qims.2019.06.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of this study was to determine whether the clinical value of scanned computed tomography (CT) images is higher when using ultra-high-resolution CT (U-HRCT) target scanning than conventional CT target reconstruction scanning in the evaluation of ground-glass-nodule (GGN)-like lung adenocarcinoma. Methods A total of 91 consecutive patients with isolated GGN-like lung adenocarcinoma were included in this study from April 2017 to June 2018. U-HRCT and conventional CT scans were conducted in all enrolled patients. Two experienced thoracic radiologists independently assessed image quality and made diagnoses. Based on the pathological results, the accuracies of U-HRCT target scanning and conventional CT target reconstruction for detecting morphological features on CT, including spiculation of GGNs, bronchial vascular bundles, solid components in the nodules, burr, vacuole, air bronchial signs, and fissure distortion, were calculated. All statistical analyses were performed using SPSS 17.0 software. Enumeration data were tested using the Chi-square test. A P value of <0.05 was considered statistically significant. Results When both techniques were compared with the pathological findings, the detection rate for CT images obtained using U-HRCT target scanning and conventional CT target reconstruction with regard to the spiculation of GGNs, bronchial vascular bundles, and solid components in the nodules were 78% vs. 61.5%, 72.5% vs. 54.9%, 65.9% vs. 49.5%, respectively. The presence of the spiculation of GGNs, bronchial vascular bundles, and solid components in the nodules in U-HRCT target scanning was significantly higher than that in conventional CT target reconstruction (all P<0.05). However, no significant difference was observed between the two techniques with regard to the burr, vacuole, air bronchial signs, and fissure distortion (all P>0.05). Conclusions When viewing GGNs, the detection rate was higher for U-HRCT target scanning than for conventional CT target reconstruction, and this improvement significantly enhanced the diagnostic accuracy of early lung adenocarcinoma.
Collapse
Affiliation(s)
- Yanyan Zhu
- Division of Computed Tomography, Department of Radiology, Shandong University School of Medicine, Shandong Provincial Third Hospital, Jinan 250031, China
| | - Dailun Hou
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Meihong Lan
- Department of Radiology, Shandong Chest Hospital, Jinan 250101, China
| | - Xiaoli Sun
- Department of Computed Tomography, Beijing Shijitan Hospital, Ninth Clinical Medical College of Peking University, Capital Medical University, Beijing 100038, China
| | - Xiangxing Ma
- Department of Radiology, Qilu Hospital, Shandong University, Jinan 250012, China
| |
Collapse
|
11
|
Gao F, Li M, Zhang Z, Xiao L, Zhang G, Zheng X, Hua Y, Li J. Morphological classification of pre-invasive lesions and early-stage lung adenocarcinoma based on CT images. Eur Radiol 2019; 29:5423-5430. [PMID: 30903336 DOI: 10.1007/s00330-019-06149-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/18/2019] [Accepted: 03/08/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To retrospectively analyze the computed tomography (CT) features in patients with pre-invasive lesions and early-stage lung adenocarcinoma and to explore the correlation between tumor morphological changes and pathological diagnoses. MATERIALS AND METHODS CT morphological characteristics in 2106 patients with pre-invasive (stage 0) and early-stage (stage I) lung adenocarcinoma were analyzed; lesions were confirmed by surgical pathology. Based on the morphological characteristics, the lesions were divided into eight types: I (cotton ball, ground-glass nodules), II (solid fill), III (granular), IV (dendriform), V (bubble-like lucencies), VI (alveolate or honeycomb), VII (scar-like), and VIII (notched or umbilication). The different distributions of eight morphological types in pathological types of the lesions and subtypes of invasive adenocarcinoma were analyzed by chi-squared or Fisher's exact test. Correlation between the percentage of ground-glass opacity in the lesions and pathology types were analyzed by two-tailed Pearson's test. RESULTS A negative correlation was observed between the pathological types and proportion of ground-glass component in the lesions (p < 0.001 and r = - 0.583). Significant differences in morphological characteristics among various pathological types of pre-invasive lesions and early lung adenocarcinomas were observed (p < 0.05). Furthermore, among the different pathological subtypes of stage I invasive adenocarcinoma, the differences in their manifestation as morphological types I, II, III, and VI were statistically significant (p < 0.05). CONCLUSION The eight types of morphological classification of pre-invasive lesions and early-stage (stage 0 or stage I) lung adenocarcinoma has different pathological bases, and morphological classification may be useful for the diagnosis and differential diagnosis of lung adenocarcinoma. KEY POINTS • CT morphological classification of pre-invasive lesions and lung adenocarcinoma is intuitive. • CT morphological classification characterizes morphological changes of the entire lesion. • Different pathological types of lung adenocarcinoma have different morphological features.
Collapse
Affiliation(s)
- Feng Gao
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, 200040, China
| | - Ming Li
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, 200040, China. .,Diagnostic and Treatment Center of Small Lung Nodules, Huadong Hospital Fudan University, 221#, West Yanan Road, Shanghai, 200040, China. .,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, 200040, China.
| | - Ziwei Zhang
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Li Xiao
- Department of Pathology, Huadong Hospital Fudan University, Shanghai, 200040, China
| | - Guozhen Zhang
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, 200040, China
| | - Xiangpeng Zheng
- Diagnostic and Treatment Center of Small Lung Nodules, Huadong Hospital Fudan University, 221#, West Yanan Road, Shanghai, 200040, China
| | - Yanqing Hua
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, 200040, China
| | - Jianying Li
- CT Research Center, GE Healthcare China, Shanghai, 200040, China
| |
Collapse
|
12
|
Pascoe HM, Knipe HC, Pascoe D, Heinze SB. The many faces of lung adenocarcinoma: A pictorial essay. J Med Imaging Radiat Oncol 2018; 62:654-661. [DOI: 10.1111/1754-9485.12779] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/28/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Heather M Pascoe
- Department of Radiology; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Henry C Knipe
- Department of Radiology; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Diane Pascoe
- Department of Radiology; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Stefan B Heinze
- Department of Radiology; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| |
Collapse
|
13
|
|
14
|
Nelson DB, Godoy MCB, Benveniste MF, Shewale JB, Spicer JD, Mitchell KG, Hofstetter WL, Mehran RJ, Rice DC, Sepesi B, Walsh GL, Vaporciyan AA, Swisher SG, Roth JA, Antonoff MB. Clinicoradiographic Predictors of Aggressive Biology in Lung Cancer With Ground Glass Components. Ann Thorac Surg 2018. [PMID: 29534957 DOI: 10.1016/j.athoracsur.2018.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ground glass opacities pose diagnostic challenges, and even after malignancy is confirmed, prognosis is often unclear. We sought to identify clinicoradiographic features that could predict aggressive tumor biology in lung adenocarcinoma with associated ground glass components. METHODS A retrospective review of patients with resected lung adenocarcinoma from 2008 to 2013 was performed. Detailed radiographic features were reviewed by two radiologists. Logistic regression was used to identify risks of poor differentiation or a composite outcome of nodal metastases and lymphovascular invasion. RESULTS In all, 79 patients met criteria for analysis. Larger tumor size (p = 0.04), increasing solid component (p = 0.01), pleural tags (p = 0.03), spiculation (p = 0.01), lobulation (p < 0.05), history of coronary artery disease (p = 0.04), and increasing number of pack-years smoking (p < 0.05) were associated with poorly differentiated tumors. However, after adjustment for size of the solid component, the associations between pleural tags, spiculation, and lobulation with poorly differentiated tumors were negated, whereas number of pack-years and history of coronary artery disease remained statistically significant (p = 0.01 and p = 0.03, respectively). There were no identified clinical or radiographic features associated with lymphovascular invasion/nodal metastasis. CONCLUSIONS Several radiographic features were associated with aggressive tumor biology, a well-known finding. However, we found that none of these radiographic features remained relevant after we adjusted for the size of the solid component, indicating that radiographic features are not as important as previously believed. Further research will be required to identify reliable markers associated with favorable tumor biology. These studies will ultimately be critical in informing prognosis or guiding extent of resection.
Collapse
Affiliation(s)
- David B Nelson
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Myrna C B Godoy
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marcelo F Benveniste
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jitesh B Shewale
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan D Spicer
- Division of Thoracic Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
15
|
Ichikawa T, Saruwatari K, Mimaki S, Sugano M, Aokage K, Kojima M, Hishida T, Fujii S, Yoshida J, Kuwata T, Ochiai A, Suzuki K, Tsuboi M, Goto K, Tsuchihara K, Ishii G. Immunohistochemical and genetic characteristics of lung cancer mimicking organizing pneumonia. Lung Cancer 2017; 113:134-139. [PMID: 29110840 DOI: 10.1016/j.lungcan.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/02/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Lung cancer mimicking organizing pneumonia (LCOP) is a novel radiological entity of lung adenocarcinoma that could be misdiagnosed as inflammatory lesions. However, the characteristic biological and genetic features of LCOP are not fully clarified. MATERIALS AND METHODS We used thin-section CT images to select cases of (LCOP) among surgically resected lung adenocarcinoma patients. We compared the clinicopathological characteristics and the immunophenotypes of LCOP (n=44) and other lepidic-predominant adenocarcinomas (non-LCOP, n=56). We also analyzed the genomic mutation features of LCOP (n=4) by whole-exome sequencing (WES). RESULTS All LCOP lesions were lepidic-predominant invasive adenocarcinoma. Patients with LCOP had significantly superior recurrence-free survival, compared to non-LCOP patients (95.5% and 74.4%; P=0.006, respectively). Vascular invasion and lymph node metastasis were less frequent in LCOP than in non-LCOP patients (P=0.001 and P=0.03, respectively). The cancer cell expression levels of aggressiveness-related molecules, including ezrin, ALDH-1, laminin-5 were similar between LCOP and non-LCOP. On the contrary, the number of tumor promoting stromal cells, i.e., podoplanin-positive cancer-associated fibroblasts and CD204-positive tumor associated macrophages, was significantly lower in LOCP (P=0.021 and P=0.037, respectively). WES revealed that ABCB1, DNAH3, MSI2, and SLITRK2 were specifically mutated in LCOP. CONCLUSIONS Our results indicate that LCOP is characterized by fewer tumor-promoting stromal cells, which may contribute to the better prognosis of LCOP patients. Moreover, recognition of specific somatic mutations of LCOP patients may provide information regarding the development and progression of this type of lung cancer.
Collapse
Affiliation(s)
- Tomohiro Ichikawa
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Japan; Division of Thoracic Surgery, National Cancer Center Hospital East, Japan; Department of General Thoracic Surgery, Juntendo University School of Medicine, Japan
| | - Koichi Saruwatari
- Division of Thoracic Oncology, National Cancer Center Hospital East, Japan
| | - Sachiyo Mimaki
- Division of Translational Research, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Japan
| | - Masato Sugano
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Japan
| | - Motohiro Kojima
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, National Cancer Center Hospital East, Japan
| | - Satoshi Fujii
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Japan
| | - Junji Yoshida
- Division of Thoracic Surgery, National Cancer Center Hospital East, Japan
| | - Takeshi Kuwata
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Japan
| | - Atsushi Ochiai
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Japan
| | - Masahiro Tsuboi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Japan
| | - Koichi Goto
- Division of Thoracic Oncology, National Cancer Center Hospital East, Japan
| | - Katsuya Tsuchihara
- Division of Translational Research, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Japan
| | - Genichiro Ishii
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Japan.
| |
Collapse
|
16
|
Borghesi A, Farina D, Michelini S, Ferrari M, Benetti D, Fisogni S, Tironi A, Maroldi R. Pulmonary adenocarcinomas presenting as ground-glass opacities on multidetector CT: three-dimensional computer-assisted analysis of growth pattern and doubling time. Diagn Interv Radiol 2017; 22:525-533. [PMID: 27682741 DOI: 10.5152/dir.2016.16110] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We aimed to evaluate the growth pattern and doubling time (DT) of pulmonary adenocarcinomas exhibiting ground-glass opacities (GGOs) on multidetector computed tomography (CT). METHODS The growth pattern and DT of 22 pulmonary adenocarcinomas exhibiting GGOs were retrospectively analyzed using three-dimensional semiautomatic software. Analysis of each lesion was based on calculations of volume and mass changes and their respective DTs throughout CT follow-up. Three-dimensional segmentation was performed by a single radiologist on each CT scan. The same observer and another radiologist independently repeated the segmentation at the baseline and the last CT scan to determine the variability of the measurements. The relationships among DTs, histopathology, and initial CT features of the lesions were also analyzed. RESULTS Pulmonary adenocarcinomas presenting as GGOs exhibited different growth patterns: some lesions grew rapidly and some grew slowly, whereas others alternated between periods of growth, stability, or shrinkage. A significant increase in volume and mass that exceeded the coefficient of repeatability of interobserver variability was observed in 72.7% and 84.2% of GGOs, respectively. The volume-DTs and mass-DTs were heterogeneous throughout the follow-up CT scan (range, -4293 to 21928 and -3113 to 17020 days, respectively), and their intra- and interobserver variabilities were moderately high. The volume-DTs and mass-DTs were not correlated with the initial CT features of GGOs; however, they were significantly shorter in invasive adenocarcinomas (P = 0.002 and P = 0.001, respectively). CONCLUSION Pulmonary adenocarcinomas exhibiting GGOs show heterogeneous growth patterns with a trend toward a progressive increase in size. DTs may be useful for predicting tumor aggressiveness.
Collapse
Affiliation(s)
- Andrea Borghesi
- Department of Radiology, University and Spedali Civili of Brescia, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Xu X, Wu K, Zhao Y, Mei L. Stage I lung adenocarcinoma: the value of quantitative CT in differentiating pathological subtypes and predicting growth of subsolid nodules. Medicine (Baltimore) 2017; 96:e6595. [PMID: 28422852 PMCID: PMC5406068 DOI: 10.1097/md.0000000000006595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to investigate feasibility of quantitative computed tomography (CT) measurements in predicting invasiveness and growth of nodular ground glass opacities (nGGOs).A set of 203 patients (group A) with nGGOs that were confirmed stage-I adenocarcinomas and 79 patients (group B) with nGGOs that were completely followed up were included. Lesions diameters, volume (VOL), maximum (MAX), mean (MEN), and standard deviation (STD) of CT attenuation were measured. P53 labeling index (LI) was evaluated through immunohistochemistry in group-A patients. Multivariate linear stepwise regressions were performed based on group-A lesions to calculate P53-LI prediction from CT measurements. The receiver operating characteristic (ROC) curve analyses were performed to assess the performance of P53-LI prediction in predicting invasiveness and growth of nGGOs. The Cox regression analysis was conducted to identify correlation between P53-LI Prediction and volume doubling time (VDT) of lesions in group B.Diameter, VOL, MEN, STD, and the P53 LI showed significant differences between lesions of different pathological invasiveness (P < .01). By multivariate linear regressions, MEN and STD were identified as independent variables indicating P53 LI (P < .001); thus, an equation was established to calculate P53-LI Prediction as: P53LI Prediction = 0.013 × MEN + 0.024 × STD + 9.741 (R square = 0.411, P < .001). The P53-LI Prediction showed good performance, similar as the actual one, in differentiating pathological invasiveness of nGGOs. In addition, the P53-LI Prediction demonstrated excellent performance in predicting growth of nGGOs (AUC = 0.833, P < .001) and independently forecasted VDT of nGGOs (β = 1.773, P < .001).The P53-LI Prediction that was calculated from preoperative quantitative CT measurements of nGGOs indicates lesions' invasiveness and allows for predicting growth of nGGOs.
Collapse
Affiliation(s)
| | | | | | - Liejun Mei
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
18
|
MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD, Schaefer-Prokop CM, Travis WD, Van Schil PE, Bankier AA. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology 2017; 284:228-243. [PMID: 28240562 DOI: 10.1148/radiol.2017161659] [Citation(s) in RCA: 1340] [Impact Index Per Article: 191.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 13, 2017.
Collapse
Affiliation(s)
- Heber MacMahon
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - David P Naidich
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Jin Mo Goo
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Kyung Soo Lee
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Ann N C Leung
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - John R Mayo
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Atul C Mehta
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Yoshiharu Ohno
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Charles A Powell
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Mathias Prokop
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Geoffrey D Rubin
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Cornelia M Schaefer-Prokop
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - William D Travis
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Paul E Van Schil
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Alexander A Bankier
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| |
Collapse
|
19
|
Ko JP, Suh J, Ibidapo O, Escalon JG, Li J, Pass H, Naidich DP, Crawford B, Tsai EB, Koo CW, Mikheev A, Rusinek H. Lung Adenocarcinoma: Correlation of Quantitative CT Findings with Pathologic Findings. Radiology 2016; 280:931-9. [DOI: 10.1148/radiol.2016142975] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
20
|
Ichikawa T, Hattori A, Suzuki K, Matsunaga T, Takamochi K, Oh S, Suzuki K. Clinicopathological characteristics of lung cancer mimicking organizing pneumonia on computed tomography-a novel radiological entity of pulmonary malignancy. Jpn J Clin Oncol 2016; 46:681-6. [PMID: 27174957 DOI: 10.1093/jjco/hyw053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/29/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Lung cancer could be misdiagnosed as benign due to its atypical radiological findings or difficulty in the histological diagnosis. We intended to elucidate the clinicopathological features of such lung cancers. METHODS Between 2008 and 2011, we performed surgical resection for 564 consecutive patients with lung adenocarcinoma. Findings on thin-section computed tomography were reviewed for all patients, 13 of whom were found to have lung cancer mimicking organizing pneumonia. The radiological and clinicopathological features of lung cancer mimicking organizing pneumonia and other adenocarcinomas were evaluated. RESULTS Among 13 patients with lung cancer mimicking organizing pneumonia, 4 were men. The median age was 70 years (range 62-81 years). Six patients were followed up for more than 1 year (range 1-108 months) as their lesions were misdiagnosed as organizing pneumonia. Preoperative carcinoembryonic antigen was significantly high (P = 0.025), and maximum tumor dimension was significantly large for lung cancer mimicking organizing pneumonia (30 vs. 23.6 mm, P = 0.001). Pathologically, there was no vascular invasion (P = 0.012) and only one lymphatic invasion (P = 0.064). One case of lymph node metastasis to the N2 node was found due to misdiagnosis as organizing pneumonia for 9 years. CONCLUSIONS Basically, lung cancer mimicking organizing pneumonia was less invasive and showed slow growth. However, nodal metastasis could be found. Thus, radiological diagnosis based on the findings of thin-section computed tomography is valuable to avoid delay in diagnosis.
Collapse
Affiliation(s)
- Tomohiro Ichikawa
- Departments of General Thoracic Surgery, Diagnostic Radiology, and Surgical Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Departments of General Thoracic Surgery, Diagnostic Radiology, and Surgical Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Suzuki
- Departments of General Thoracic Surgery, Diagnostic Radiology, and Surgical Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Departments of General Thoracic Surgery, Diagnostic Radiology, and Surgical Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Departments of General Thoracic Surgery, Diagnostic Radiology, and Surgical Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Departments of General Thoracic Surgery, Diagnostic Radiology, and Surgical Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Departments of General Thoracic Surgery, Diagnostic Radiology, and Surgical Pathology, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
21
|
Kim H, Park CM, Koh JM, Lee SM, Goo JM. Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy. Diagn Interv Radiol 2015; 20:47-57. [PMID: 24100062 DOI: 10.5152/dir.2013.13223] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pulmonary subsolid nodules (SSNs) refer to pulmonary nodules with pure ground-glass nodules and part-solid ground-glass nodules. SSNs are frequently encountered in the clinical setting, such as screening chest computed tomography (CT). The main concern regarding pulmonary SSNs, particularly when they are persistent, has been lung adenocarcinoma and its precursors. The CT manifestations of SSNs help radiologists and clinicians manage these lesions. However, the management plan for SSNs has not previously been standardized. Recently, the Fleischner Society published recommendations for the management of incidentally detected SSNs. The guidelines reflect the new lung adenocarcinoma classification system proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) and include six specific recommendations according to the nodule size, solid portion and multiplicity. This review aims to increase the understanding of SSNs and the imaging features of SSNs according to their histology, natural course, possible radiologic interventions, such as biopsy, localization prior to surgery, and current management.
Collapse
Affiliation(s)
- Hyungjin Kim
- From the Department of Radiology (H.K., C.M.P. e-mail: , S.M.L., J.M.G.), Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea; Cancer Research Institute (C.M.P., J.M.G.), Seoul National University, Seoul, Korea; Department of Pathology (J.M.K.), Seoul National University Hospital, Seoul, Korea
| | | | | | | | | |
Collapse
|
22
|
Mascalchi M, Picozzi G, Falchini M, Vella A, Diciotti S, Carrozzi L, Pegna AL, Falaschi F. Initial LDCT appearance of incident lung cancers in the ITALUNG trial. Eur J Radiol 2014; 83:2080-6. [PMID: 25174775 DOI: 10.1016/j.ejrad.2014.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To characterize early features of lung cancers detected with low-dose computed tomography (LDCT) screening. MATERIALS AND METHODS Two radiologists reviewed prior LDCTs in 20 incident cancers diagnosed at annual repeat screening rounds and 83 benign nodules observed in the ITALUNG trial. RESULTS No abnormality was observed in 3 cancers. Focal abnormalities in prior LDCT were identified in 17(85%) cancers (14 adenocarcinomas; 14 stage I). Initial abnormalities were intra-pulmonary in 10, subpleural in 4 and perifissural in 3. Average mean diameter was 9mm (range 4.5-18mm). Nine exhibited solid, 4 part-solid and 4 non-solid density. The margins were smooth and regular in 5 cases, lobulated in 6, irregular with spiculations in 3 and blurred in 3. Ten (59%) initial focal abnormalities had a round or oval nodular shape, but 7(41%) had a non-nodular complex (n=5) or "stripe-like" (n=2) shape. Bronchus sign was observed in 3 cases and association with cystic airspace in 2 cases. Non-solid density, complex or "stripe-like" shape, bronchus sign and association with cystic airspace had a specificity higher than 90%, but positive predictive value of every feature of incident lung cancers was low (range 10.4-50%). CONCLUSIONS The vast majority of cancers diagnosed at annual repeat show corresponding focal lung abnormalities in prior LDCTs. Perifissural location and non-nodular shape do not exclude the possibility of early lung cancer. Since specificity of the early features of incident lung cancer is incomplete and their positive predictive value is low, all focal pulmonary abnormalities detected in screened subjects should be re-evaluated in subsequent LDCTs.
Collapse
Affiliation(s)
- Mario Mascalchi
- Quantitative and Functional Radiology Research Programs at Meyer Children Hospital and Careggi Hospital of Florence, Florence, Italy; "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
| | - Giulia Picozzi
- Institute for Oncological Study and Prevention, Florence, Italy
| | - Massimo Falchini
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Alessandra Vella
- Nuclear Medicine Unit, Le Scotte University Hospital, Siena, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Laura Carrozzi
- Cardiopulmonary Department University Hospital, Pisa, Italy
| | | | - Fabio Falaschi
- 2nd RadiologyUnit Cisanello University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
23
|
Patel VK, Naik SK, Naidich DP, Travis WD, Weingarten JA, Lazzaro R, Gutterman DD, Wentowski C, Grosu HB, Raoof S. A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 1: radiologic characteristics and imaging modalities. Chest 2013; 143:825-839. [PMID: 23460160 DOI: 10.1378/chest.12-0960] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The solitary pulmonary nodule (SPN) is frequently encountered on chest imaging and poses an important diagnostic challenge to clinicians. The differential diagnosis is broad, ranging from benign granulomata and infectious processes to malignancy. Important concepts in the evaluation of SPNs include the definition, morphologic characteristics via appropriate imaging modalities, and the calculation of pretest probability of malignancy. Morphologic differentiation of SPN into solid or subsolid types is important in the choice of follow-up and further management. In this first part of a two-part series, we describe the morphologic characteristics and various imaging modalities available to further characterize SPN. In Part 2, we will describe the determination of pretest probability of malignancy and an algorithmic approach to the diagnosis of SPN.
Collapse
|
24
|
Lee SW, Leem CS, Kim TJ, Lee KW, Chung JH, Jheon S, Lee JH, Lee CT. The long-term course of ground-glass opacities detected on thin-section computed tomography. Respir Med 2013; 107:904-10. [PMID: 23514949 DOI: 10.1016/j.rmed.2013.02.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/19/2013] [Accepted: 02/21/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Focal ground-glass opacity (GGO) is becoming a major concern because of its possible association with lung cancer. In this study, we analyzed the long-term progression of GGOs that persisted for more than 2 years. METHODS We reviewed focal GGOs identified by thin-section computed tomography that persisted for more than 2 years. RESULTS We enrolled a total of 114 patients with 175 GGO lesions. The median patient age was 61 years (range, 37-92 years) and 42 (36.8%) patients were male. Mean initial GGO size was 7.8 ± 4.4 mm. Median follow-up duration was 45 months. Forty-six (26.3%) GGOs had significant size increases (≥2 mm in the longest diameter) with a mean volume doubling time of 1041 days. In a multivariate analysis, large size (≥10 mm), the presence of a solid portion (mixed GGO) and old age (≥65 years) were risk factors for significant size increase, with odds ratios (95% CI) of 6.46 (2.69-15.6), 2.69 (1.11-6.95) and 2.55 (1.13-5.77), respectively. GGOs with character changes from pure to mixed or mixed to solid showed more rapid volume expansion. CONCLUSIONS GGOs which persisted for several years showed an indolent course. Large lesions with a solid portion and GGOs in male or elderly individuals may be cause for more concern, as these factors were associated with size increase. Resection should be considered if GGOs show character changes, as these may be associated with rapid size progression.
Collapse
Affiliation(s)
- Sei Won Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Chang B, Hwang JH, Choi YH, Chung MP, Kim H, Kwon OJ, Lee HY, Lee KS, Shim YM, Han J, Um SW. Natural History of Pure Ground-Glass Opacity Lung Nodules Detected by Low-Dose CT Scan. Chest 2013; 143:172-178. [DOI: 10.1378/chest.11-2501] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|
26
|
Honda T, Kondo T, Murakami S, Saito H, Oshita F, Ito H, Tsuboi M, Nakayama H, Yokose T, Kameda Y, Isobe T, Yamada K. Radiographic and pathological analysis of small lung adenocarcinoma using the new IASLC classification. Clin Radiol 2012; 68:e21-6. [PMID: 23146553 DOI: 10.1016/j.crad.2012.09.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 09/11/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
Abstract
AIM To analyse the correlation between computed tomography (CT) findings of small lung adenocarcinomas and the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocarcinoma. MATERIALS AND METHODS A retrospective review of 300 lung adenocarcinoma lesions (size ≤20 mm) after surgical resection in 295 consecutive patients was performed. Tumours were defined as air-containing type if the ratio of the maximum dimension of the tumour on mediastinal windows to the maximum dimension of the tumour on lung windows was ≤50%, and as solid-density type if the ratio was >50%. The incidence between CT findings (air bronchogram, vascular involvement, pleural tags, notches, and spiculation) and pathological findings were investigated. RESULTS Of the 142 air-containing lesions, 114 were adenocarcinoma in situ (AIS), 28 were minimally invasive adenocarcinoma (MIA), and none of the lesions were invasive adenocarcinoma. Of the 158 solid-density lesions, 30 were AIS, 24 were MIA, and 104 were invasive adenocarcinoma. Notches and pleural tags were commonly observed in cases of invasive adenocarcinoma (p < 0.05). CONCLUSIONS In the air-containing type of small lung adenocarcinomas, AIS and MIA were observed but no cases of invasive adenocarcinoma were found. The presence of notches and pleural tags were a significant factor in invasive adenocarcinoma.
Collapse
Affiliation(s)
- T Honda
- Department of Thoracic Oncology, Kanagawa Cancer Center Hospital, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Gaikwad A, Gupta A, Hare S, Gomes M, Sekhon H, Souza C, Inacio J, Lad S, Seely J. Primary adenocarcinoma of lung: a pictorial review of recent updates. Eur J Radiol 2012; 81:4146-55. [PMID: 23000187 DOI: 10.1016/j.ejrad.2012.08.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 08/23/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
Abstract
Primary adenocarcinoma of lung has replaced squamous cell carcinoma as the commonest histological subtype of lung cancer and the incidence of primary lung adenocarcinoma appears to be rising. Although the main factors behind this 'epidemic-like' situation are largely undiscovered, filter cigarettes appear to significantly contribute to this shift in the histopathological spectrum. The new multidisciplinary classification of adenocarcinoma of lung was introduced to address advances in clinical, pathological, radiological and molecular sciences. The purpose of this essay is to discuss various classes of lung adenocarcinoma in the new classification with their classical imaging features on computed tomography and summarise the recent advances in the field of radiology and review radiology recommendations.
Collapse
Affiliation(s)
- Anand Gaikwad
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Association between tumor epidermal growth factor receptor mutation and pulmonary tuberculosis in patients with adenocarcinoma of the lungs. J Thorac Oncol 2012; 7:299-305. [PMID: 22173705 DOI: 10.1097/jto.0b013e31823c588d] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The possible association between pulmonary tuberculosis (TB) and lung cancer development has been studied for several decades. However, the association between epidermal growth factor receptor (EGFR) mutation status and pulmonary TB in patients with adenocarcinoma of the lungs is unknown. METHODS We reviewed the data of our patients with adenocarcinoma of the lungs who had a clinical history of pulmonary TB or old TB lesions shown on chest computed tomography scan and evaluated the association between tumor EGFR mutation status and pulmonary TB. RESULTS From June 1999 to January 2011, there were 275 patients with pulmonary adenocarcinoma with tumor EGFR mutation data available for analysis. Of them, 191 patients had EGFR mutations, 17 had a clinical history of pulmonary TB infection, 72 had old TB lesions on chest computed tomography scans, and 14 had scar cancer. Patients with old TB lesions had a higher incidence of EGFR mutation than those without (p = 0.018). Exon 19 deletions occurred more frequently in patients with old TB lesions than in patients without (p < 0.001). Those patients with old TB lesions who had EGFR mutations or exon 19 mutations survived longer than those who did not (p = 0.014 and 0.001, respectively). Patients with exon 19 deletions and old TB lesions showed no survival difference compared with those with exon 19 deletions and without old TB lesions (p = 0.271). CONCLUSIONS Patients with pulmonary adenocarcinoma who had scar cancer or had old TB lesions had a higher probability of having EGFR mutations, especially exon 19 deletions.
Collapse
|
29
|
Takahashi S, Tanaka N, Okimoto T, Tanaka T, Ueda K, Matsumoto T, Ashizawa K, Kunihiro Y, Kido S, Matsunaga N. Long term follow-up for small pure ground-glass nodules: implications of determining an optimum follow-up period and high-resolution CT findings to predict the growth of nodules. Jpn J Radiol 2011; 30:206-17. [PMID: 22187390 DOI: 10.1007/s11604-011-0033-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 11/14/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE To identify the optimum follow-up period for pure ground-glass nodules (GGN) measuring less than 15 mm in diameter, and to evaluate whether the initial HRCT findings can be used as predictors for the progression of pure GGN. MATERIALS AND METHODS A total of 150 pure GGNs present in 111 patients were evaluated. The series of HRCT images for each GGN at the time of the initial detection, 2 years after detection, and at the final follow-up were evaluated. The HRCT findings of GGN were compared between the "increasing nodule" and "non-increasing nodule" groups. RESULTS Most (87.3%) pure GGN did not increase whereas some nodules (12.7%) eventually increased after long-term follow-up (mean 66.0 ± 25.0 months). Six (31.6%) out of the 19 increasing nodules were regarded as stable at the 2 year follow-up examination. Some morphological findings on initial HRCT, including a size greater than 10 mm (p = 0.001), lobulated margins (p = 0.015), and a bubble-like appearance (p = 0.002), were significantly associated with the growth of pure GGNs. CONCLUSION More than 2 years of follow-up are necessary to detect the growth of pure GGNs. Some characteristic findings indicated a high likelihood of future growth of the GGN.
Collapse
Affiliation(s)
- Shotaro Takahashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Mikita K, Saito H, Sakuma Y, Kondo T, Honda T, Murakami S, Oshita F, Ito H, Tsuboi M, Nakayama H, Yokose T, Kameda Y, Noda K, Yamada K. Growth rate of lung cancer recognized as small solid nodule on initial CT findings. Eur J Radiol 2011; 81:e548-53. [PMID: 21794996 DOI: 10.1016/j.ejrad.2011.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 06/07/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION To study the characteristics of lung cancer, appearing as small solid nodules on initial computed tomography (CT) findings, and to determine an appropriate follow-up duration so as to differentiate between malignancy and benign tumor. METHODS We analyzed the records of 34 patients who had undergone surgical resection of lung cancer, which appeared as small solid nodules on initial CT findings. We studied the CT findings, volume doubling times (VDT), follow-up durations, pathological and clinical findings. RESULTS VDT is classified as follows: (1) slow growth group (SGG), with a VDT of more than 700 days and (2) rapid growth group (RGG), with a VDT of less than 700 days. The median VDT of the SGG was 1083 days, and the RGG was 256 days (p<0.01). The median duration for follow-up of the SGG was 1218 days, and 179 days for the RGG. A statistical difference was noted in the follow-up durations (p<0.01). There were no statistical differences in the preoperative thin-section CT (TSCT) findings, or in the pathological findings. The RGG included more patients with smoking histories. The CT findings of RGG tended to reveal changed in base lung field such as emphysema, and lung fibrosis. CONCLUSIONS Generally, lung cancer appearing as small solid nodules on initial CT findings grew rapidly, but there were some cases which displayed slow growth patterns. These cases required follow up for over two years, before diagnosis was possible. We concluded the appropriate maximum followup duration is three years.
Collapse
Affiliation(s)
- Kei Mikita
- Department of Thoracic Oncology, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-ku, Yokohama 241-0815, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Cho JS, Jheon S, Park SJ, Sung SW, Lee CT. Outcome of limited resection for lung cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2011; 44:51-7. [PMID: 22263124 PMCID: PMC3249273 DOI: 10.5090/kjtcs.2011.44.1.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/14/2010] [Accepted: 09/16/2010] [Indexed: 11/27/2022]
Abstract
Background Up to now, lobectomy, bilobectomy and pneumonectomy combined with extensive lymph node dissection have been regarded as the standard procedures for non-small cell lung cancer (NSCLC). In high-risk patients, however, limited resection (LR) has been attempted as a salvage procedure, and, recently, indication for LR has been extended to selected cases with early-stage NSCLC. Material and Methods Among the 773 patients who underwent surgical procedures for NSCLC in Seoul National University Bundang Hospital from May 2003 to December 2008, 43 patients received LR. Medical records of these patients were retrospectively reviewed. Results Mean age at operation was 66.0±12.4 years, and there were 30 males. Twenty-five patients underwent conservative limited resection (CLR) and 18 underwent intentional limited resection (ILR). Indications for CLR were multiple primary lung cancer in 9 (9/25, 36%) and severe concomitant diseases in 5 (5/25, 20%). Of these, 6 patients underwent segmentectomy and 19 received wedge resection. During the follow-up period of 28.0±17.8 months, 15 patient developed recurrent lung cancer. ILR was selectively performed in lesions almost purely composed of ground glass opacity (≥95%), or in small solid lesions (≤2 cm). Of these, 11 patients underwent segmentectomy and 7 underwent wedge resection. During the follow-up period of 31.7±11.6 months, no patient developed recurrence. Conclusion Intermediate-term outcome of LR for early-stage lung cancer is comparable to that of standard operation. For the delineation of the indications and appropriate surgical techniques for LR, prospective randomized multi-institutional study may be expedient.
Collapse
Affiliation(s)
- Jeong Su Cho
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Korea
| | | | | | | | | |
Collapse
|
32
|
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JHM, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6:244-85. [PMID: 21252716 PMCID: PMC4513953 DOI: 10.1097/jto.0b013e318206a221] [Citation(s) in RCA: 3444] [Impact Index Per Article: 264.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. METHODS An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS The classification addresses both resection specimens, and small biopsies and cytology. The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with ≤ 5 mm invasion (MIA) to define patients who, if they undergo complete resection, will have 100% or near 100% disease-specific survival, respectively. AIS and MIA are usually nonmucinous but rarely may be mucinous. Invasive adenocarcinomas are classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous BAC), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous BAC), colloid, fetal, and enteric adenocarcinoma. This classification provides guidance for small biopsies and cytology specimens, as approximately 70% of lung cancers are diagnosed in such samples. Non-small cell lung carcinomas (NSCLCs), in patients with advanced-stage disease, are to be classified into more specific types such as adenocarcinoma or squamous cell carcinoma, whenever possible for several reasons: (1) adenocarcinoma or NSCLC not otherwise specified should be tested for epidermal growth factor receptor (EGFR) mutations as the presence of these mutations is predictive of responsiveness to EGFR tyrosine kinase inhibitors, (2) adenocarcinoma histology is a strong predictor for improved outcome with pemetrexed therapy compared with squamous cell carcinoma, and (3) potential life-threatening hemorrhage may occur in patients with squamous cell carcinoma who receive bevacizumab. If the tumor cannot be classified based on light microscopy alone, special studies such as immunohistochemistry and/or mucin stains should be applied to classify the tumor further. Use of the term NSCLC not otherwise specified should be minimized. CONCLUSIONS This new classification strategy is based on a multidisciplinary approach to diagnosis of lung adenocarcinoma that incorporates clinical, molecular, radiologic, and surgical issues, but it is primarily based on histology. This classification is intended to support clinical practice, and research investigation and clinical trials. As EGFR mutation is a validated predictive marker for response and progression-free survival with EGFR tyrosine kinase inhibitors in advanced lung adenocarcinoma, we recommend that patients with advanced adenocarcinomas be tested for EGFR mutation. This has implications for strategic management of tissue, particularly for small biopsies and cytology samples, to maximize high-quality tissue available for molecular studies. Potential impact for tumor, node, and metastasis staging include adjustment of the size T factor according to only the invasive component (1) pathologically in invasive tumors with lepidic areas or (2) radiologically by measuring the solid component of part-solid nodules.
Collapse
Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ikehara M, Saito H, Kondo T, Murakami S, Ito H, Tsuboi M, Oshita F, Noda K, Nakayama H, Yokose T, Kameda Y, Yamada K. Comparison of thin-section CT and pathological findings in small solid-density type pulmonary adenocarcinoma: prognostic factors from CT findings. Eur J Radiol 2010; 81:189-94. [PMID: 20965677 DOI: 10.1016/j.ejrad.2010.09.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 09/23/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We divided pulmonary adenocarcinoma of ≤ 20 mm into air-containing and solid-density types based on a percentage reduction of the maximum tumor diameter in the mediastinal window image compared to the area in the lung window image on thin-section (TS) CT of ≥ 50% (air-containing type) and <50% (solid-density type). No relapse occurred in patients with air-containing type. The prognosis of solid-density type may be poor even when the tumor size is 20mm or smaller. We investigated whether CT findings for these tumors could serve as prognostic factors. METHODS The subjects were 105 patients with solid-density type pulmonary adenocarcinoma that was identified on TSCT and found to have a diameter of 20mm or smaller after surgical resection during the period from April 1997 to November 2004. Notches, air bronchogram, pleural retraction, spiculation, venous involvement, and ground glass opacity were examined on TSCT, and their associations with pathological findings (i.e., pleural invasion, lymphatic permeation, vascular invasion, lymph node metastasis, and Noguchi's classification) and relapse were investigated using chi-square test and Cox proportional hazards model. RESULTS The incidence of relapse was significantly higher in cases with notches. The incidence of notches increased with tumor growth and notches were frequent in Noguchi type D tumors, reflecting poorly differentiated adenocarcinoma. Lymphatic permeation and type D cases were independent factors associated with a poor prognosis using Cox proportional hazards model. CONCLUSIONS TSCT findings may be useful for prediction of the prognosis of solid-density type pulmonary adenocarcinoma.
Collapse
Affiliation(s)
- Mizuki Ikehara
- Division of Respiratory Diseases, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations, Hirakata Kohsai Hospital, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Correlations of thin-section computed tomographic, histopathological, and clinical findings of adenocarcinoma with a bubblelike appearance. J Comput Assist Tomogr 2010; 34:413-7. [PMID: 20498546 DOI: 10.1097/rct.0b013e3181d275b6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We reported that adenocarcinomas with a bubblelike appearance (BLA) appear similar to old inflammation (J Comput Assist Tomogr 2009;33:42-48). The histopathological, clinical, and biological characteristics of adenocarcinomas with BLA need more investigation. METHODS We retrospectively reviewed the records of 26 patients who had undergone surgical resection between 1993 and 2008. We analyzed correlations between thin-section computed tomographic (TS-CT), histopathological, and clinical findings. We analyzed epidermal growth factor receptor and K-ras gene mutations. RESULTS The TS-CT findings are unique with one pattern that was the same in all the 26 cases: (1) polygonal with straight and concave margins, (2) slight peripheral ground-glass opacity areas, (3) 3 or more dilated air bronchograms, and (4) clear pleural indentations. The histopathological findings were identical with our TS-CT findings. The mean tumor doubling time was 1165 days. Epidermal growth factor receptor mutations were observed in 17 cases. There were no K-ras mutations. After resection, the 5-year survival rate is 100%. CONCLUSION The adenocarcinomas with BLA have unique TS-CT, histopathological, and clinical findings.
Collapse
|
35
|
Godoy MCB, Naidich DP. Subsolid Pulmonary Nodules and the Spectrum of Peripheral Adenocarcinomas of the Lung: Recommended Interim Guidelines for Assessment and Management. Radiology 2009; 253:606-22. [PMID: 19952025 DOI: 10.1148/radiol.2533090179] [Citation(s) in RCA: 256] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Myrna C B Godoy
- Department of Radiology, New York University-Langone Medical Center, 560 First Ave, IRM 236, New York, NY 10016, USA
| | | |
Collapse
|