Abstract
BackgroundTo investigate the difference in the measured diameter of subsolid lung adenocarcinomas of thin‐section computed tomography (TSCT) and pathology according to presence of emphysema.MethodsA total of 268 surgically resected pathologic T1 or T2 adenocarcinomas visualized as subsolid nodules (SSNs) on TSCT were analyzed in 252 patients. Two observers measured the greatest diameters of the whole tumor (WTsize) and solid tumor (STsize) on TSCT in lung windows, classified nodules as part‐solid or nonsolid, and recorded the presence of regional emphysema. Interobserver variability was determined with intraclass correlation coefficients (ICC). CT measurements were compared to pathologic size (Psize) and invasive size (PIsize) using the Wilcoxon signed‐rank test.ResultsThe interobserver agreement between the diameters measured by the two observers was strong for WTsize (ICC = 0.968 [95% confidence interval, 0.960–0.975]) and STsize (ICC = 0.966 [95% CI, 0.950–0.969]). Radiologic WTsize was significantly greater than Psize (P < 0.001), while STsize was less than PIsize. The WTsize of the emphysema group was better correlated with Psize than WTsize of the normal lung group (P = 0.001), while the STsize of the normal lung group was better correlated with PIsize than STsize of the emphysema group. The concordance rate in T staging between CT and pathologic analysis was better correlated in patients with normal lungs than in those with emphysema (P = 0.023).ConclusionSTsize on TSCT was underestimated in patients with emphysema, resulting in higher discordance in T staging between TSCT and pathologic analysis for subsolid lung adenocarcinomas.
Highlights
Lung cancer is the leading cause of cancer death worldwide
We investigated the size discrepancy in the measurement of surgically resected subsolid lung adenocarcinomas (LACs) in thin-section computed tomography (TSCT) and pathologic analysis and the impact of local emphysema on this discrepancy
Measurement of subsolid nodules (SSNs) tended to overestimate the pathologic size of the whole tumor, and these differences were less prominent in the emphysema group than in the normal lung group
Summary
Lung cancer is the leading cause of cancer death worldwide. Staging of lung cancer is crucial in correctly allocating patients to proper treatment and determining prognosis. Tumor size is a key parameter in TNM staging of lung cancer, which has been shown to be an independent predictor of survival in large databases, such as those assembled by the National Cancer Institute’s Surveillance, Epidemiology, End Results registry, and the International Association for the Study of Lung Cancer (IASLC).[1] the new eighth edition of the TNM classification of lung cancer revised by the American Joint Committee on Cancer (AJCC) subdivided the T descriptor for smaller lung cancers,[2,3] reflecting the importance of precise size measurement, as small differences in maximum tumor dimension play important roles in the prognosis of lung cancer. Conclusion: STsize on TSCT was underestimated in patients with emphysema, resulting in higher discordance in T staging between TSCT and pathologic analysis for subsolid lung adenocarcinomas
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