Tumor Disappearance Rate Research Articles

Thermal Ablation for Papillary Thyroid Carcinoma

Image-guided thermal ablation has been administered for patients with T1N0M0 papillary thyroid carcinoma (PTC) who elect to not undergo surgery or receive active surveillance. Considering the indolent nature of PTC, long-term outcomes of ablation are needed. To investigate l0-year outcomes of thermal ablation in treating T1N0M0 PTC. This multicenter study was conducted at 4 university-affiliated hospitals in China and included 179 consecutive patients with T1N0M0 PTC (median [IQR] volume, 88.0 [163.2] mm3) who underwent thermal ablation between June 2010 and March 2014. Patients who were ineligible to undergo surgery or elected not to were included, and patients had PTC tumors that were smaller than 20 mm as confirmed by biopsy; no clinical or imaging evidence of extrathyroidal extension, lymph node metastasis (LNM), or distant metastasis; and no history of neck irradiation. The primary outcomes were disease progression (LNM, newly developed tumors, persistent tumors, and distant metastasis) and disease-free survival (DFS). Secondary outcomes were technical success, volume reduction rate, tumor disappearance, complications, and delayed surgery. DFS was calculated using a Kaplan-Meier analysis. Among the 179 patients, the mean (SD) age was 45.8 (12.7) years, and 118 (65.9%) were female. During a mean (SD) follow-up period of 120.8 (10.8) months, disease progression was found in 11 of 179 patients (6.1%), including LNM in 4 patients (2.2%), newly developed tumors in 6 patients (3.3%), and persistent tumor in 1 patient (0.6%). The 10-year DFS was 93.9%. The technical success, median volume reduction rate, and tumor disappearance rate was 100%, 100%, and 97.2%, respectively. The magnitude of the disease progression (6.1% vs 7.1%; difference, 1.0%; 95% CI, -6.5% to 25.6%) and DFS (93.9% vs 92.9%; difference, 1.0%, 95% CI, -6.5% to 25.6%) between patients with T1a and T1b tumors was small. The difference in the rate of tumor disappearance between T1a and T1b tumors was large (99.4% vs 71.4%; difference, 28.0%; 95% CI, 10.9%-54.0%). One patient experienced transient voice hoarseness (0.6%). Because of anxiety, 1 patient underwent delayed surgery (0.6%). The results of this 10-year multicenter cohort study suggest that thermal ablation is an effective and safe alternative for patients with T1N0M0 PTC who do not undergo surgery or receive active surveillance. For safe and effective treatment, accurate radiologic evaluation, an understanding of ablation techniques, and experienced physicians are recommended.

Retrospective Analysis of the Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation in the Treatment of Papillary Thyroid Microcarcinoma: A Follow-Up Study of Continuous Postoperative Surveillance and Large-Sample Data.

To retrospectively evaluate the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) in the treatment of papillary thyroid microcarcinoma (PTMC) through a follow-up study of continuous postoperative surveillance and large-sample data. The efficacy of ultrasound-guided RFA was evaluated by measuring the tumor volume reduction rate (VRR), tumor disappearance rate, and disease progression in 358 patients with low-risk unifocal PTMC who underwent ultrasound-guided RFA at Hangzhou Weja Hospital, while the safety was evaluated by measuring their complications. The VRR was -745.69 ± 1012.69 (%), -150.35 ± 395.5 (%), 46.47 ± 138.74 (%), 92.95 ± 27.88 (%), 97.78 ± 10.99 (%), and 99.27 ± 3.82 (%), respectively, at 1, 3, 6, 12, 18, and 24 months after RFA. The corresponding tumor disappearance rate was 1.68%, 9.78%, 43.85%, 82.68%, 92.59%, and 95.63%, respectively. No local recurrence, new tumors, lymph node metastasis, distant metastasis, and deaths caused by recurrent/metastatic PTMC were found at the last follow-up. Except for 3 cases (0.84%) with thickening or hoarseness of voice and 3 cases (0.84%) with coughing during drinking water, no other complications were found. Ultrasound-guided RFA has good efficacy and safety for the treatment of low-risk unifocal PTMC and can be promoted for use in patients who meet the required indications.

Radiofrequency ablation for solitary T1N0M0 papillary thyroid carcinoma in the danger triangle area: a preliminary analysis

Objectives To evaluate the feasibility, efficacy, and safety of radiofrequency ablation (RFA) for solitary T1N0M0 papillary thyroid carcinoma (PTC) in the danger triangle area. Methods 94 participants (mean age 44.45 ± 13.08; 73 females) with solitary T1N0M0 PTC in the danger triangle area who underwent percutaneous RFA at the hospital from January 2018 to April 2020 were retrospectively analyzed. Key ablation procedures included sufficient paratracheal fluid isolation, low-power, and short active tip (5 mm working electrode). Tumor size changes at different time points after RFA, technical success rates, tumor disappearance, disease progression, and complications were recorded and compared. Results Contrast-enhanced ultrasonography revealed that complete tumor ablation was performed with a 100% success rate in these patients. Post-ablation, the maximum diameter and volume of the ablation zone increased at the first and third month (p < 0.001), followed by a gradual decrease in size, without significant difference by the 6th month. The tumor disappearance rate was 76.59% (72/94), with higher rates in the T1a group compared to the T1b group (80% [64/80] VS57.1% [8/14], p < 0.001). There were no local recurrences. The incidence of new lesions and LNM was 3.2% (3/94), limited to the T1a subgroup. Further ablation was successfully applied to all new lesions and LMN. Mild voice changes were the only complication, with a rate of 3.2% (3/94), resolved within 4 months after RFA. Conclusions Sufficient paratracheal fluid isolation combined with a low-power, short active tip radiofrequency ablation strategy is a safe and effective method for treating solitary T1N0M0 PTC in the danger triangle area.

Radiofrequency ablation for papillary thyroid microcarcinoma with a trachea-adjacent versus trachea-distant location

Objective To evaluate the outcomes of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) adjacent to the trachea and compare them with those of PTMC distant from the trachea. Methods Patients who received RFA for solitary low-risk PTMC between June 2014 and July 2020 were reviewed and classified into adjacent and distant groups. To balance between-group confounders, the propensity score matching approach was employed. Volume, volume reduction ratio (VRR), tumor disappearance, complications, and disease progression were assessed and compared between the groups. Furthermore, factors affecting disease progression were evaluated. Results A total of 122 and 470 patients were included in the adjacent and distant groups, respectively. Overall VRR was 99.5% ± 3.1 and cumulative tumor disappearance rate was 99.4% after a mean follow-up time of 40.1 months ± 16.2. Overall disease progression and complications incidence were 3.7% and 1.0%, respectively. No substantial differences were observed between the two groups in the latest volume (0.8 mm3 ± 4.1 vs. 0.9 mm3 ± 4.2, p = .77), VRR (99.7% ± 1.6 vs. 99.5% ± 2.7, p = .75), cumulative tumor disappearance rate (92.6% vs. 94.2%, p = .58), and incidence of disease progression (4.1% vs. 4.5%, p = .70) and complication (1.7% vs. 0.8%, p = .86) after 1:2 matching. Additionally, tracheal adjacency exhibited no association with disease progression in multivariate Cox regression analysis (p = .73). Conclusion For eligible patients with PTMC located adjacent to or distant from the trachea, RFA may offer a safe and effective alternative treatment method.

Ten-Year Outcomes of Radiofrequency Ablation for Locally Recurrent Papillary Thyroid Cancer.

This study investigates the long-term efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for treating locally recurrent papillary thyroid cancer (PTC). We retrospectively analyzed 39 consecutive patients with 61 locally recurrent PTCs (14 males, 25 females; mean ± standard deviation age, 52.8 ± 16.7 years; range 21-92 years) who underwent US-guided RFA with curative intent between September 2008 and April 2012. A subgroup of 24 patients with 37 recurrent PTCs who had a follow-up of at least 10 years were analyzed separately. All patients were followed for changes in lesion size on US and thyroglobulin (Tg) levels at 1, 3, 6, and 12 months after RFA, with follow-up every 6-12 months thereafter. Any complications were documented during the follow-up period. Recurrence-free survival (RFS) rates were assessed using Kaplan-Meier estimates. Long-term outcomes were evaluated in patients with follow-up of at least 10 years. The follow-up period ranged from 7 to 180 months (median 133 months). The RFS rates for the 39 patients at 3, 5, and 10 years were 86.8%, 75.5%, and 60.6%, respectively. Among the 24 patients with 37 recurrent PTCs followed for more than 10 years, the volume reduction rate was 99.9% (range 96%-100%), and the complete tumor disappearance rate was 91.9%. The mean serum Tg level also decreased significantly, from 2.66 ± 86.5 mIU/L before ablation to 0.43 ± 0.73 mIU/L (P < 0.001) at the final follow-up. In 14 (58.3%) of the 24 patients, Tg levels were undetectable (below 0.08 mIU/L) at the last follow-up. No life-threatening or delayed complications were observed during the 10-year follow-up period. The high RFS throughout the follow-up period, with efficacy and safety lasting beyond 10 years, supports US-guided RFA as a valuable option for local control of recurrent PTCs.

Radiofrequency ablation for papillary thyroid cancer located in isthmus: comparison with that originated in thyroid lobe

Purpose To analyze the outcomes of radiofrequency ablation (RFA) for isthmus papillary thyroid cancer (PTC) versus PTC originating from the lobes. Methods Patients with solitary low-risk PTC treated with RFA between July 2014 and December 2019 were retrospectively reviewed. This study was approved by our institutional review board. Of the 562 patients, 104 and 458 had PTCs located in the thyroid isthmus and thyroid lobes, respectively. Local tumor progression (LTP), LTP-free survival (LTPFS), changes in tumor volume, and complications were compared between the two groups using propensity-score matching (PSM). Results The isthmic and lobar groups showed no significant differences in LTP (2.9% vs. 3.8%), new PTC (2.9% vs. 2.9%), persistent lesions (0.0% vs. 0.2%), or LTPFS after PSM. Before PSM, the two groups showed significant differences in the volume reduction ratio (VRR) of the ablated tumors at 1, 3, 24, 30, and 48 months after RFA, but no differences between the two groups were observed in tumor volume, VRR, or disappearance rate after PSM (p > .05). One patient in the isthmic group presented with coughing, while another complained of hoarseness. Complications did not differ significantly between the two groups (p > .05). Conclusions The outcomes of RFA for patients with low-risk PTC in the thyroid isthmus and thyroid lobes were similar. Therefore, RFA may serve as an alternative treatment option for patients with low-risk isthmic PTC.

Sirolimus can promote the disappearance of renal angiomyolipoma associated with tuberous sclerosis complex: a prospective cohort study.

Renal angiomyolipoma (RAML) is the most common kidney lesion in patients with tuberous sclerosis complex (TSC), affecting about 80% of patients. It is a benign tumor that grows over time, usually bilaterally, and can easily lead to kidney complications such as acute hemorrhage. Herein, we investigated the efficacy and safety of sirolimus in children with TSC-associated RAML and explored the factors affecting tumor disappearance under sirolimus treatment through subgroup analysis. A prospective cohort study was conducted. Sirolimus was initiated at 1mg/(m2 × day), and dose adjustments were made by a 2-week titration period to attain a trough blood concentration of 5-10ng/mL. The disappearance of RAML in children after sirolimus treatment was observed, and Cox regression was used to screen the factors affecting tumor disappearance. One hundred and twenty-six patients who met the criteria were analyzed. After 3months, 6months, 12months, and 24months of follow-up, tumors disappeared in 18 (14.3%), 30 (23.8%), 39 (31.0%), and 42 (33.3%) children, respectively. Tumors disappeared in 50 (39.7%) children by the last visit of each individual, and 30 (60%) of them occurred within 6months. The multivariate Cox regression analysis showed that patients with a smaller maximum tumor diameter at baseline had a higher tumor disappearance rate. Thirty-six (29%) patients had stomatitis during the entire treatment period, and no serious adverse reactions were observed. Sirolimus could promote the disappearance of TSC-related RAML. The disappearance rate was correlated with the maximum diameter at baseline, and the smaller the tumor was, the higher the disappearance rate. It is well tolerated in the treatment of RAML associated with TSC.

Wedge resection vs. segmentectomy for lung cancer measuring ≤ 2 cm with consolidation tumor ratio > 0.25.

We aimed to clarify the differences in prognosis between wedge resection and segmentectomy performed for cN0 non-small cell lung cancer (NSCLC) measuring ≤ 2 cm, with consolidation tumor ratio (CTR) > 0.25. This multicenter study included 570 patients with cN0 NSCLC (tumor size ≤ 2 cm, CTR > 0.25) who underwent wedge resection (n = 244) and segmentectomy (n = 326) between January 2010 and December 2018. After propensity score matching (PSM, 1:1 method), 182 patients were matched for clinical characteristics (age, sex, laterality, smoking index, tumor size, CTR, carcinoembryonic antigen value, positron-emission tomography-documented maximum standardized uptake value, clinical stage, and tumor disappearance rate) and intergroup comparison of disease-free survival (DFS) and overall survival (OS). Using Gray's test, an intergroup comparison of the cumulative incidence of lung cancer-specific mortality was performed. After PSM, similar DFS (5-year DFS, 79.9% vs. 87.1%, p = 0.103) and OS (5-year OS, 88.7% vs. 88.9%, p = 0.719) rates were observed in the wedge resection and segmentectomy groups. We observed no significant intergroup differences in lung cancer-specific mortality (5-year cumulative incidence: 4.6% vs. 3.5%; p = 0.235). Subgroup analysis revealed no specific subgroup demonstrating improved DFS or OS after undergoing wedge resection or segmentectomy. DFS, OS, and lung cancer-specific mortality were comparable between wedge resection and segmentectomy of cN0 NSCLC-tumor size ≤ 2 cm and CTR > 0.25. Large-scale prospective clinical trials are warranted to compare the prognoses of wedge resection and segmentectomy for these tumors.

Upgraded hydrodissection and its safety enhancement in microwave ablation of papillary thyroid cancer: a comparative study

Objectives To study the efficacy and safety of an improved hydrodissection protocol based on the perithyroidal fascial space during microwave ablation for papillary thyroid carcinoma (PTC). Methods The data of 341 patients (94 men and 247 women, median age 41 years old, 25%–75% interquartile range 34–53 years old, nodule maximum diameter 0.2–1.9 cm) who underwent microwave ablation for PTC were retrospectively reviewed. Among them, 185 patients underwent traditional hydrodissection and served as a control group, and 156 patients underwent improved hydrodissection based on perithyroidal fascial spaces, constituting the improved group. Improvements in safety were analyzed by comparing complications between the two groups. The characteristics of hydrodissected spaces, complications, and follow-up results were recorded. Results Hydrodissection was successfully performed in all enrolled patients according to the protocol. The incidence of hoarseness caused by recurrent laryngeal nerve injury, the most common complication in thermal ablation of thyroid nodules, was significantly lower in the improved group than in the control group (1.9% vs. 8.1%, p = 0.021). The median hoarseness recovery time in the improved group was shorter than that in the control group (2 months vs. 3 months, p = 0.032). During follow-up, no local recurrence was encountered in either group. The tumor disappearance rate was not significantly different between the two groups (69.9% vs. 75.7%, p = 0.228). Conclusions Improved hydrodissection based on perithyroidal fascial spaces had better protective effects than traditional hydrodissection.

Preliminary Study of Microwave Ablation for Multifocal Papillary Thyroid Microcarcinoma in Nonoperative Candidates

PurposeTo study the feasibility, safety, and effectiveness of microwave ablation (MWA) in patients with multifocal papillary thyroid microcarcinoma (PTMC). Materials and MethodsThis retrospective study included patients who underwent MWA for multifocal PTMC (number of nodules ≤3). A total of 44 patients were included, and the mean age was 43 years (SD ± 11). After ablation, progression-free survival (PFS) at 6, 12, 24, 36, and 48 months; disease progression; change in tumor size and volume; tumor disappearance rate; and adverse events (AEs) were assessed, and the feasibility, safety, and effectiveness of MWA for PTMC were evaluated on the basis of statistical analysis. ResultsThe median follow-up period was 18 months (interquartile range, 12–33 months). The PFS rates at 6, 12, 24, 36, and 48 months were 100.0%, 96.4%, 96.4%, 70.3%, and 52.7%, respectively. The disease progression rate was 11.4% (5 of 44 patients). The maximum diameter (MD) and volume of the ablation zone were larger at the 3-month follow-up than before ablation (median MD, 13.0 vs 7.0 mm; P < .001; median volume, 503.8 vs 113.0 mm3; P < .001). Subsequently, the tumors exhibited a reduction in both size and volume after 18 months (median MD, 4.0 vs 7.0 mm; P = .04; median volume, 12.6 vs 113.0 mm3; P = .055). At the end of the follow-up period, the complete response rate was 59% (26 of 44 patients). The overall AE rate was 6.8%. ConclusionsMWA is a feasible treatment for PTMC (number of nodules ≤3), and this study preliminarily demonstrated the safety and effectiveness of this technique.

A clinical study on microwave ablation of multifocal (≤ 3) T1N0M0 papillary thyroid carcinoma.

To evaluate the feasibility, efficiency, and safety of microwave ablation (MWA) for T1N0M0 multifocal (≤ 3) papillary thyroid carcinoma (PTC). This was a retrospective study, and patients who underwent MWA for multifocal (≤ 3) PTC were reviewed between October 2016 and December 2020. After ablation, the changes in tumor size and volume, as well as the rate of technical success, tumor disappearance, disease progression, and complications were assessed. There were a total of 57 cases enrolled in the present study, which included 18 males and 39 females. The mean age was 44 ± 11 years (22-66 years); the mean follow-up time was 18 ± 11 months (6-48 months). Complete ablation was achieved in all enrolled cases. Therefore, the technical success rate was 100%. Due to expanding ablation, the MD and volume of the ablation zone, as well as the VRR, increased at the 1st and 3rd months after ablation and decreased at 12 and 18 months after ablation (p < 0.05 for all). The total complete tumor disappearance rate was 43.9% (25/57), including 54% (24/44) in the T1a subgroup vs. 7.7% (1/13) in the T1b subgroup (p = 0.003). The total disease progression rate was 7% (4/57), including 9.1% (4/44) in the T1a subgroup vs. 0% (0/13) in the T1b subgroup (p = 0.142). The overall complication rate was 5.3% (3/57), including 6.8% (4/44) in the T1a subgroup vs. 0% (0/13) in the T1b subgroup (p = 0.206). This preliminary study indicates that MWA is a safe and effective treatment for T1N0M0 multifocal (≤ 3) PTC. • MWA is a promising alternative method for T1N0M0 multifocal (≤ 3) PTC.

Sirolimus Can Increase the Disappearance Rate of Cardiac Rhabdomyomas Associated with Tuberous Sclerosis: A Prospective Cohort and Self-Controlled Case Series Study

To investigate the efficacy and safety of sirolimus in the treatment of cardiac rhabdomyomas associated with tuberous sclerosis complex and the specific benefits in different subgroups. The study was a prospective cohort and self-controlled case series study. Based on the prevalence of cardiac rhabdomyoma at different ages, we estimated the natural tumor disappearance rate. The subgroup analysis was done by Cox regression. Self-controlled case series method was used to assess the magnitude and duration of the drug effect. Adverse events were described. A total of 217 patients were included in the cohort study. Tumor disappearance rate was higher in younger age groups (hazard ratio = 0.99, P=.027) and female patients (hazard ratio=2.08, P=.015). The age-adjusted incidence ratio showed that the disappearance of rhabdomyomas between 3 and 6months was more related to sirolimus. Adverse events were observed 60 times in 42 of 217 children, mainly stomatitis. Sirolimus can increase the disappearance rate of cardiac rhabdomyoma in the tuberous sclerosis complex population. Efficacy varies by sex and age: female and younger patients have higher tumor disappearance rate. Sirolimus is well-tolerated.

Relationship and prognostic significance between preoperative serum albumin to globulin ratio and CT features of non-small cell lung cancer

PurposeThis study was conducted to assess the relationship and prognostic significance between preoperative serum albumin to globulin ratio (AGR) and high-resolution computed tomography (HRCT) features of non-small cell lung cancer (NSCLC). Materials and methodsDemographic parameters, laboratory values including AGR and other clinical variables were evaluated in 180 patients with NSCLC, and 72 of these patients had results of radiology parameters detected with HRCT [including emphysema, tumor disappearance rate (TDR), CT values and CT enhanced values of the tumor mass] were assessed for survival analyses. The 72 patients were divided into two groups: normal lung group and emphysema group. The discriminatory values for AGR between these two groups were assessed by Mann–Whitney U test The relationship between TDR and AGR in NSCLC patients was evaluated by Pearson correlation analysis. ResultsIn multivariate analysis, TDR (p = 0.033), AGR (p = 0.038), emphysema (p = 0.009), and N stage (P = 0.026) were independent predictors of overall survival (OS). AGR was higher in NSCLC patients without emphysema than NSCLC patients with emphysema (z = −2.979, P = 0.003). TDR demonstrated that there was a positive relationship with AGR (r = 0.307, p = 0.009). A nomogram with AGR, TDR, emphysema, and N stage was established to predict 5-year survival. ConclusionsThere is a relationship between CT features and AGR in NSCLC. The integrative nomogram combined with CT images, clinical and hematologic features improved survival prediction in NSCLC patients, which offers a non-invasive, comprehensive, and convenient evaluation for individualized management of NSCLC patients.

Prognostic factors for stage I lung adenocarcinoma and surgical management of subsolid nodules.

This study aims to identify the prognostic factors for stage I lung adenocarcinoma and to evaluate the surgical management of subsolid nodules. The study included 133 patients (90 males, 43 females; mean age 64.9 years; range, 29 to 82 years) who had undergone operation in our clinic for stage I lung adenocarcinoma between January 2007 and December 2015. Clinical, radiological and pathological data were retrospectively evaluated and their effects on recurrence and survival were examined by Kaplan-Meier and Cox regression analyses. Comparing the histopathological tumor types according to the pathological tumors size, we determined that the prevalence of invasive adenocarcinoma significantly increased with increasing tumor size (p<0.001). For all nodules, a tumor disappearance rate lower than 25% negatively influenced disease-free survival and a maximum standardized uptake value higher than 5.6 negatively influenced overall survival (p=0.027 for both). The grouping, which was performed considering the maximum standardized uptake value 5.6 as the cut-off value, was an independent prognostic factor for overall survival (hazard ratio: 5.973, 95% confidence interval: 1.186-30.073, p=0.03). Five-year overall survival rate was statistically significantly higher in patients who underwent wedge resection or segmentectomy for subsolid nodules compared to those who underwent lobectomy (100% vs. 79.3%, p=0.044). Sublobar resections can be safely performed in subsolid nodules smaller than 2 cm in diameter with tumor disappearance rate ≥25% and maximum standardized uptake value ≤5.6.

Prognostic significance of histologic classification and tumor disappearance rate by computed tomography in lung cancer.

We investigated the prognostic value of the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification and assessed the relationship between pathologic invasiveness and tumor disappearance rate (TDR) in lung adenocarcinoma with ground-glass opacity (GGO). We reviewed data from 202 consecutive patients operated on between 2000 and 2009 for clinical T1-2N0 lung adenocarcinoma with GGO and reclassified their histologic subtypes according to the IASLC/ATS/ERS classification. Thirty-nine patients had adenocarcinoma in situ (AIS), 29 minimally invasive adenocarcinoma (MIA), 75 lepidic predominant invasive adenocarcinoma (LPA), and 59 non-lepidic predominant invasive adenocarcinoma (NLPA). Survival outcomes were compared according to histologic subtype and TDR. The mean age was 58 years and 101 patients (50%) were male. Lobectomy was performed in 161 patients (79.7%), wedge resection in 34 (16.8%), and segmentectomy in 7 (3.5%). Patients with AIS, MIA, and LPA had significantly smaller tumor sizes, earlier pathologic T stages, and lower incidences of lymphatic/pleural invasion than those with NLPA. The 5-year recurrence-free survival (RFS) rates were 95.1%, 94.5%, and 87.6% in the AIS + MIA, LPA, and NLPA groups, respectively (P=0.029). Tumors with a TDR>75% were associated with lepidic predominant histologic subtype and less pathologic invasiveness. The 5-year RFS rates were 97.4% in tumors with a TDR >75% and 87.8% in tumors with a TDR ≤75% (P=0.0009). Histologic subtype according to the IASLC/ATS/ERS classification and TDR both correlated with pathologic invasiveness and predicted survival in patients with lung adenocarcinoma with GGO.

SC24.01 Risk Assessment in the Management of Pulmonary Nodules

Solitary pulmonary nodules are seen on approximately 0.1% of all chest X-ray films.1 High-resolution computed tomography (HRCT), which is used in lung cancer screening programs, can detect pulmonary nodules that are smaller than those detected by conventional radiography. The radiological diagnosis and treatment of these small pulmonary nodules are now the focus of lung cancer research. The timely detection of lung cancers is essential for successful treatment. The guidelines and recommendations for the management of pulmonary nodules include follow up, nonsurgical biopsy, or surgery; and are based on the size of the nodule, and ground glass opacity (GGO) ratio or size of the solid component.2-4 The diagnosis of a pulmonary nodule is frequently problematic. The management of pulmonary nodules is based on their characteristics. When a pulmonary nodule is monitored by CT, the important features include not only its size but also its density. According to the guidelines of the American College of Chest Physicians, solid nodules measuring > 8 mm in diameter need further examination.3 The Fleischner Society for Thoracic Imaging and Diagnosis uses a cutoff diameter of 5 mm for decision making for subsolid nodules.2 It should be kept in mind that solid nodules that are suspicious for lung cancer are frequently invasive. A subsolid nodule can be classified as a pure ground glass nodule (GGN) or part-solid nodule. Subsolid nodules grow slowly and may develop a solid component. The HRCT findings of early lung adenocarcinomas were significantly correlated with the histopathologic findings of the resected specimens.5 In the evaluation of subsolid nodules, the features indicating noninvasive lung adenocarcinoma include tumor disappearance rate, diameter of consolidation, and GGO ratio.6 However, even HRCT cannot accurately assess the areas of solid opacities or GGO, and results might vary between investigators. In the upcoming 8th TNM classification, the Lung Cancer Staging Project of the International Association for the Study of Lung Cancer showed that the solid part of a nodule on HRCT represents the clinical T factor, and that measurement of the solid part is essential for lung cancer staging.5 Positron emission tomography (PET)-CT has a clearly established role in lung cancer clinical practice. Based on the pretest probability, PET-CT should be used for patients with a solid, indeterminate nodule > 8 mm in size.3,4 For adenocarcinomas in situ (AIS) and minimally invasive adenocarcinomas (MIA) of the lung that show solid opacities on HRCT, the preoperative PET-CT and thin-section CT findings together can provide information on the aggressiveness of the tumor. Our study group found that these modalities used together could detect aggressive lung cancers in clinical stage IA (Fig. 1).7 However, since PET-CT can show false-negative results for slow-growing and low-grade lung malignancies, we think that HRCT is the best modality for identifying indolent lung cancers. Transthoracic biopsy, bronchoscopy, or surgery is used for obtaining specimens for histopathological diagnosis. The definitive diagnosis of small pulmonary nodules, especially GGO-dominant nodules, is challenging. The diagnostic yields of percutaneous CT-guided fine needle aspiration biopsy for GGO-dominant and solid-dominant lesions were 51.2% and 75.6%, respectively (p = 0.018).9 The diagnostic yield of GGO-dominant lesions < 10 mm was 35.2%. Since invasive biopsy is not without risk, a histopathological diagnosis should be limited to nonsurgical candidates. For cases with high likelihood of lung cancer, a surgical biopsy followed by lung resection might be warranted. Although surgery might be performed on patients with benign nodules, it does provide the definitive diagnosis. If surgery is performed after careful preoperative assessment, the surgical mortality is very low, and the surgical risk may be acceptable. While lobectomy is the standard procedure for lung cancers, sublobar resection, meaning segmentectomy or wedge resection, might be justified for patients with noninvasive small lung cancers. However, to date, which procedure, sublobar resection or lobectomy, provides a better outcome remains unclear in these cases, since prospective randomized control trials are ongoing (JCOG0802/WJOG4607L8 and CALGB140503). One of the concerns in sublobar resection is recurrence at the surgical margin (Fig. 2). Recurrence at the surgical margin might be accounted for by tumor cells spreading via air spaces.10 Accurate intraoperative cytology and adequate surgical margins have been reported to be important for preventing recurrence at the surgical margin. Another concern is lymph node metastasis. In a prospective radiological study for clinical stage IA lung cancer, 47 of 545 (8.6%) patients had lymph node metastasis.6 Sublobar resection, especially wedge resection, does not allow evaluation of lymph nodes for metastatic disease. HRCT findings play an important role in discriminating the biological behaviors of pulmonary nodules. The definitive diagnosis by HRCT can be difficult, and the combination of HRCT and PET-CT might be beneficial. Randomized control trials should clarify the role of sublobar resection in treating patients with noninvasive lung cancer.Figure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Imaging Phenotyping Using Radiomics to Predict Micropapillary Pattern within Lung Adenocarcinoma

IntroductionLung adenocarcinomas (ADCs) with a micropapillary pattern have been reported to have a poor prognosis. However, few studies have reported on the imaging-based identification of a micropapillary component, and all of them have been subjective studies dealing with qualitative computed tomography variables. We aimed to explore imaging phenotyping using a radiomics approach for predicting a micropapillary pattern within lung ADC. MethodsWe enrolled 339 patients who underwent complete resection for lung ADC. Histologic subtypes and grades of the ADC were classified. The amount of micropapillary component was determined. Clinical features and conventional imaging variables such as tumor disappearance rate and maximum standardized uptake value on positron emission tomography were assessed. Quantitative computed tomography analysis was performed on the basis of histogram, size and shape, Gray level co-occurrence matrix–based features, and intensity variance and size zone variance–based features. ResultsHigher tumor stage (OR = 3.270, 95% confidence interval [CI]: 1.483–7.212), intermediate grade (OR = 2.977, 95% CI: 1.066–8.316), lower value of the minimum of the whole pixel value (OR = 0.725, 95% CI: 0.527–0.98800), and lower value of the variance of the positive pixel value (OR = 0.961, 95% CI: 0.927–0.997) were identified as being predictive of a micropapillary component within lung ADC. On the other hand, maximum standardized uptake value and tumor disappearance rate were not significantly different in groups with a micropapillary pattern constituting at least 5% or less than 5% of the entire tumor. ConclusionA radiomics approach can be used to interrogate an entire tumor in a noninvasive manner. Combining imaging parameters with clinical features can provide added diagnostic value to identify the presence of a micropapillary component and thus, can influence proper treatment planning.

Significant correlation between urinary N(1), N(12)-diacetylspermine and tumor invasiveness in patients with clinical stage IA non-small cell lung cancer.

BackgroundTo select optimal candidates for limited lung resection, it is necessary to accurately differentiate the non-invasive tumors from other small-sized lung cancer. Urinary N1, N12-diacetylspermine (DiAcSpm) has been reported to be a useful tumor marker for various cancers. We aimed to examine the correlation between preoperative urinary DiAcSpm levels and specific clinicopathological characteristics such as the histological tumor invasiveness in patients with clinical stage IA non-small cell lung cancer (NSCLC).MethodsWe defined non-invasive tumors as NSCLC showing no vascular invasion, lymphatic permeation, pleural invasion, or lymph node metastasis. Preoperative urine samples were obtained from 516 consecutive patients with NSCLC resected at our institution between April 2008 and January 2013. Urinary DiAcSpm values were determined for all preoperative urine samples using the colloid gold aggregation procedure. Among these patients, 171 patients with clinical stage IA NSCLC met the criteria of our study cohort. Finally, we investigated the correlation between non-invasive tumor and urinary DiAcSpm levels.ResultsThe median urine DiAcSpm for males was 147.2 nmol/g creatinine and 161.8 nmol/g creatinine in females. These median values were set as the cut-off values for each gender. Patients with higher urinary DiAcSpm levels frequently had significantly elevated serum CEA (p = 0.023) and greater lymph node metastasis (p = 0.048), lymphatic permeation (p = 0.046), and vascular invasion (p = 0.010). Compared with patients with non-invasive tumors, patients with invasive tumors had a tumor size >2.0 cm (p = 0.001), serum CEA >5.0 mg/dL (p < 0.001), high urinary DiAcSpm (p = 0.002), and a tumor disappearance rate (TDR) <0.75 (p < 0.001). Multivariate analysis revealed that a tumor size < 2.0 cm (RR = 2.901, 95% CI; 1.372-6.136, p = 0.005), high urinary DiAcSpm (RR = 3.374, 95% CI; 1.547-7.361, p = 0.002), and TDR < 0.75 (RR = 4.673, 95% CI; 2.178-10.027, p < 0.001) were independent predictors for invasive tumors.ConclusionsWe successfully showed that there was a significant correlation between urinary DiAcSpm levels and pathological tumor invasiveness in patients with clinical stage IA NSCLC. Further research would elucidate the clinical usefulness of DiAcSpm levels as a predictor of tumor invasiveness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1068-5) contains supplementary material, which is available to authorized users.

Imaging Characteristics in ALK Fusion-Positive Lung Adenocarcinomas by Using HRCT.

We aimed to identify high-resolution computed tomography (HRCT) features useful to distinguish the anaplastic lymphoma kinase gene (ALK) fusion-positive and negative lung adenocarcinomas. We included 236 surgically resected adenocarcinoma lesions, which included 27 consecutive ALK fusion-positive (AP) lesions, 115 epidermal growth factor receptor mutation-positive lesions, and 94 double-negative lesions. HRCT parameters including size, air bronchograms, pleural indentation, spiculation, and tumor disappearance rate (TDR) were compared. In addition, prevalence of small lesions (≤20 mm) and solid lesions (TDR ≤20%) were compared. AP lesions were significantly smaller and had lower TDR (%) than ALK fusion-negative (AN) lesions (tumor diameter: 20.7 mm ± 14.1 mm vs. 27.4 mm ± 13.8 mm, respectively, p <0.01; TDR: 22.8% ± 24.8% vs. 44.8% ± 33.2%, respectively, p <0.01). All AP lesions >20 mm (n = 7, 25.9%) showed a solid pattern. Among all small lesions, AP lesions had lower TDR and more frequent spiculation than AN lesions (p <0.01). Among solid lesions, AP lesions were smaller than AN lesions (p = 0.01). AP lung lesions were significantly smaller and had a lower TDR than AN lesions. Spiculation was more frequent in small lesions. Non-solid >20 mm lesions may be ALK fusion-negative.

Epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements in lung cancer with nodular ground-glass opacity.

BackgroundNodular ground-glass opacities (nGGO) are a specific type of lung adenocarcinoma. ALK rearrangements and driver mutations such as EGFR and K-ras are frequently found in all types of lung adenocarcinoma. EGFR mutations play a role in the early carcinogenesis of nGGOs, but the role of ALK rearrangement remains unknown.MethodsWe studied 217 nGGOs resected from 215 lung cancer patients. Pathology, tumor size, tumor disappearance rate, and the EGFR and ALK markers were analyzed.ResultsAll but one of the resected nGGOs were adenocarcinomas. ALK rearrangements and EGFR mutations were found in 6 (2.8%) and 119 (54.8%) cases. The frequency of ALK rearrangement in nGGO was significantly lower than previously reported in adenocarcinoma. Advanced disease stage (p = 0.018) and larger tumor size (p = 0.037) were more frequent in the ALK rearrangement-positive group than in ALK rearrangement-negative patients. nGGOs with ALK rearrangements were associated with significantly higher pathologic stage and larger maximal and solid diameter in comparison to EGFR-mutated lesions.ConclusionALK rearrangement is rare in lung cancer with nGGOs, but is associated with advanced stage and larger tumor size, suggesting its association with aggressive progression of lung adenocarcinoma. ALK rearrangement may not be important in early pathogenesis of nGGO.