Abstract
ObjectivesThis study aimed to explore the predictive CT features of spread through air spaces (STAS) in patients with small-sized lung adenocarcinoma.MethodsFrom January 2017 to May 2019, patients with confirmed pathology of small-sized lung adenocarcinoma (less than or equal to 2 cm) and who underwent surgery were retrospectively analyzed. The clinical, pathological, and surgical information and CT features were analyzed.ResultsA total of 47 patients with STAS (males, 61.7%; mean age, 56 ± 8years) and 143 patients without STAS (males, 58%; mean age, 53 ± 11 years) were included. Pathologically, papillary, micropapillary, solid predominant subtypes, and vascular and pleural invasion were most commonly observed features in the STAS group. Radiologically, higher consolidation tumor ratio (CTR), presence of spiculation, satellites, ground glass ribbon sign, pleural attachment, and unclear tumor–lung interface were more commonly observed features in the STAS group. CTR, presence of ground glass ribbons and pleural connection, and absence of cystic airspaces were considered as stable predictors of STAS in multivariate logistic models. The receiver operating characteristic curve (ROC) analysis for predicting STAS demonstrated higher area under the curve (AUC) in the model that used CTR (0.760, 95% confidence interval, 0.69–0.83) for predicting STAS than in the model that used long diameter of entire lesion (0.640).ConclusionsCTR is the best CT sign for predicting STAS in small-sized lung adenocarcinoma. The ground glass ribbon is a newly found indicator and has the potential for predicting STAS.
Highlights
The concept of spread through air spaces (STAS) is regarded as an additional pattern of invasion of lung cancer proposed by the World Health Organization classification of lung tumors in 2015
One hundred and ninety patients with small-sized lung adenocarcinoma were enrolled in our study, which included 47 patients with STAS and 143 patients without STAS
Significant differences between the two groups were observed in predominant histologic subtypes, where acinar and lepidic are the most common predominant subtypes in the non-STAS group, while papillary, micropapillary, and solid subtypes were more commonly observed in the STAS group
Summary
The concept of spread through air spaces (STAS) is regarded as an additional pattern of invasion of lung cancer proposed by the World Health Organization classification of lung tumors in 2015. For small-sized lung adenocarcinoma (less than or equal to 2 cm), limited resection can be usually performed, and its precise preoperative prediction of STAS on computed tomography (CT) before surgery remains crucial and challenging. This enables chest surgeons to change the treatment strategy from wedge resection to lobectomy, thereby reducing the recurrence rate. We performed comprehensive imaging and pathological statistical analysis to determine the imaging predictors predicting STAS in small-sized lung adenocarcinoma
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