Reply to the Editor

Abstract

We are grateful for the letter by Baisi and colleagues regarding our study,1Tsutani Y. Miyata Y. Nakayama H. Okumura S. Adachi S. Yoshimura M. et al.Prediction of pathologic node-negative clinical stage IA lung adenocarcinoma for optimal candidates undergoing sublobar resection.J Thorac Cardiovasc Surg. 2012; 144: 1365-1371Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar and we are delighted by their thoughtful insights into our results. We appreciate their viewpoint that 2 parameters (solid tumor size <0.8 cm on high-resolution computed tomography [HRCT] or a maximum standardized uptake volume [SUVmax] <1.5 on 18F-fluorodeoxyglucose positron emission tomography–computed tomography [PET–CT]) for predicting no nodal metastasis are easily achievable by the chest CT and PET–CT scan that are always performed in staging the disease of every patient with lung cancer.2Okada M. Nakayama H. Okumura S. Daisaki H. Adachi S. Yoshimura M. et al.Multicenter analysis of high-resolution computed tomography and positron emission tomography/computed tomography findings to choose therapeutic strategies for clinical stage IA lung adenocarcinoma.J Thorac Cardiovasc Surg. 2011; 141: 1384-1391Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar Generally, clinical physicians measure tumor size according to the TNM Classification of Malignant Tumors (TNM) by including the ground-glass opacity (GGO) components visualized on HRCT. We have found3Tsutani Y. Miyata Y. Nakayama H. Okumura S. Adachi S. Yoshimura M. et al.Prognostic significance of using solid versus whole tumor size on high-resolution computed tomography for predicting pathologic malignant grade of tumors in clinical stage IA lung adenocarcinoma: a multicenter study.J Thorac Cardiovasc Surg. 2012; 143: 607-612Abstract Full Text Full Text PDF PubMed Scopus (180) Google Scholar, 4Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Solid tumors versus mixed tumors with a ground-glass opacity component in patients with clinical stage IA lung adenocarcinoma: prognostic comparison using high-resolution computed tomography findings. J Thorac Cardiovasc Surg. December 14, 2012 [Epub ahead of print].Google Scholar that in addition to the SUVmax found on PET–CT,2Okada M. Nakayama H. Okumura S. Daisaki H. Adachi S. Yoshimura M. et al.Multicenter analysis of high-resolution computed tomography and positron emission tomography/computed tomography findings to choose therapeutic strategies for clinical stage IA lung adenocarcinoma.J Thorac Cardiovasc Surg. 2011; 141: 1384-1391Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar the predictive values of the solid tumor size found on HRCT for pathologic high-grade malignancy and prognosis in patients with clinical stage IA lung adenocarcinoma are greater than those of whole tumor size, including solid and GGO components. We strongly recommend that solid tumor size be used to determine the T descriptor in the TNM classification of lung cancer and should be defined as the true tumor size in cases of lung adenocarcinoma with a GGO component visualized on HRCT. The suggestion regarding a technique in PET–CT scan for lung lesions affected by physiologic motion is justified. The difference between the CT volume and the gated PET volume is significantly less than the difference between the CT volume and the ungated PET volume.5Werner M.K. Parker J.A. Kolodny G.M. English J.R. Palmer M.R. Respiratory gating enhances imaging of pulmonary nodules and measurement of tracer uptake in FDG-PET/CT.Am J Roentgenol. 2009; 193: 1640-1645Crossref PubMed Scopus (78) Google Scholar Respiratory gating has the potential to enhance imaging of organs in motion, such as lungs, and although some additional time is needed for setup and acquisition, it can be incorporated practically and efficiently into clinical routine. Alternatively, breath-holding might be used during diagnostic PET–CT if true respiratory gating is not available. Our belief, based on our data, is that the optimal surgical strategy for cT1N0M0 adenocarcinomas can be chosen using the solid tumor size found on HRCT and an SUVmax found on 18F-fluorodeoxyglucose PET–CT. Clinical implications related to preoperative detection of stage IA lung adenocarcinomaThe Journal of Thoracic and Cardiovascular SurgeryVol. 145Issue 4PreviewWe read with interest the article by Tsutani and colleagues.1 They aimed to determine clinical predictors of nodal involvement in stage IA lung adenocarcinoma and successfully identified that tumor size <0.8 cm and maximum standardized uptake value <1.5 are predictive for stage N0 status. We would like to discuss the following interesting items. Full-Text PDF Open Archive