Tumor Shadow Disappearance Rate Research Articles

Precise characterization of a solitary pulmonary nodule using tumor shadow disappearance rate-corrected F-18 FDG PET and enhanced CT.

We aimed to characterize solitary pulmonary nodule (SPN) using imaging parameters for F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) or enhanced CT corrected by tumor shadow disappearance rate (TDR) to reflect the tissue density.We enrolled 51 patients with an SPN who underwent PET/CT and chest CT with enhancement. The FDG uptake of SPN was evaluated using maximum standardized uptake value (SUVmax) on PET/CT. The mean Hounsfield unit (HU) for each SPN was evaluated over the region of interest on nonenhanced and enhanced CT images. The change in mean HU (HUpeak-pre) was quantified by subtracting the mean HU of the preenhanced CT from that of the post-enhanced CT. TDR was defined as the ratio of the tumor area, which disappears at a mediastinal window, to the tumor area of the lung window. We investigated which parameters (SUVmax or HUpeak-pre) could contribute to the characterization of SPN classified by TDR value and whether diagnostic performance could be improved using TDR-corrected imaging parameters.For SPN with higher tissue density (TDR <42%, n = 22), high value of SUVmax (≥3.1) was a significant factor to predict malignancy (P = .006). High value of HUpeak-pre (≥38) was a significant factor to characterize SPN (P = .002) with lower tissue density (TDR ≥42%, n = 29). The combined approach using TDR-corrected parameters had better predictive performance to characterize SPN than SUVmax only (P = .031).Applying imaging parameters such as SUVmax or HUpeak-pre in consideration of tissue density calculated with TDR could contribute to accurate characterization of SPN.

Assessment of relationships among clinicopathological characteristics, morphological computer tomography features, and tumor cell proliferation in stage I lung adenocarcinoma.

BackgroundSurgically resected stage I lung adenocarcinoma (ADC) has wide variation in prognosis. It is significant to identify high-risk patients and optimize therapeutic strategy. This study aimed to investigate the relationships among histological grade, serum tumor marker index (TMI), morphological computer tomography (CT) features, and a well-established prognosticator cell proliferation (Ki-67) in stage I ADC.MethodsPreoperative CT was performed in 182 patients with stage I ADC confirmed by pathology. The Ki-67 expression was acquired by immunohistochemistry. TMI was the square root of standardized serum carcinoembryonic antigen (CEA) and cytokeratin 19 fragments (CYFRA 21-1) values. Tumor shadow disappearance rate (TDR) and other morphological CT features were interpreted by two radiologists. Histological grade, TMI, CT features were statistically evaluated to explore the associations with Ki-67 expression.ResultsIn univariate analysis, gender, smoking history, pack-year, histological grade, TNM stage (IA and IB), serum CEA and CYFRA 21-1 status, TMI status, as well as TDR, long-axis diameter, short-axis diameter, lobulation, spiculation, attenuation types, vacuolation, vascular invasion, vascular convergence, thickened bronchovascular bundles, pleural attachment and peripheral fibrosis were significantly associated with Ki-67 expression (all P<0.05). Solid-predominant ADC had the highest Ki-67 expression, followed by micropapillary, papillary and acinar-predominant ADC, while lepidic-predominant ADC had the lowest Ki-67 expression (P<0.001). TDR was negatively correlated with Ki-67 (r =−0.478, P<0.001). Multivariate logistic regression analysis revealed that gender, histological grade, TDR and attenuation types were independent factors associated with Ki-67 expression.ConclusionsKi-67 expression differed distinctly according to ADC histological subtypes. High Ki-67 expression is independently associated with male patients of stage I ADC with worse differentiation, lower TDR and solid tumors, which might be of prognostic value for poor prognosis in stage I ADC.

Solitary Nodular Invasive Mucinous Adenocarcinoma of the Lung: Imaging Diagnosis Using the Morphologic-Metabolic Dissociation Sign.

To evaluate the efficacy of the morphologic-metabolic (M-M) dissociation sign based on computed tomography (CT) and fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/CT in discriminating invasive mucinous adenocarcinoma (IMA) from invasive non-mucinous adenocarcinomas (ADCs) of the lung. The Institutional Review Board approved this retrospective study. Among surgically resected solitary pulmonary nodule (SPN)-type ADCs (< 3 cm in diameter), 35 patients with IMAs and 329 with invasive non-mucinous ADCs were included. Morphologic malignancy was established if the tumor with lobulated or spiculated margin on CT presented a tumor shadow disappearance rate of < 0.5. The M-M dissociation sign was determined when a malignant-morphologic nodule on CT showed maximum standardized uptake value (SUVmax) < 3.5 on PET/CT. Among 35 IMAs (size: 21 ± 7 mm, SUVmax: 1.8 ± 2.0) and 329 invasive non-mucinous ADCs (size: 21 ± 6 mm, SUVmax: 4.6 ± 4.2), the M-M dissociation sign was observed in 54% of IMAs (19/35) and 10% of invasive non-mucinous ADCs (34/329) (p < 0.001). The diagnostic performance of the sign in discriminating IMA from invasive non-mucinous ADCs showed a sensitivity of 54.3% (95% confidence interval [CI], 36.7-71.2), specificity 89.7% (95% CI, 85.9-92.7), positive predictive value 35.8% (95% CI, 26.5-46.5), and negative predictive value 94.9% (95% CI, 92.8-96.4). Multivariate analyses revealed metabolic benignity (odds ratio [OR] 2.99; 95% CI, 1.01-8.93; p = 0.047) and M-M dissociation sign (OR 6.35; 95% CI, 2.76-14.62; p < 0.001) to be significant predictors of SPN-type IMAs. Identification of the absence of M-M dissociation sign is an accurate indicator for excluding IMA from SPN-type lung ADCs.

P1.05-07 Clinical Significance of Pleural Indentation of Lung Adenocarcinoma Presented as Ground Glass Opacities

After the emphasis on lung cancer screening, incidental detection of ground glass opacities (GGOs) has increased. Such GGOs commonly have peripheral location and pleural indentation, which may increase the risk of visceral pleural invasion (VPI). Although the impact of pleural indentation among solid lung cancers is well established, such impact among GGO lung cancers is not well known. Patients who underwent lung resection with curative intention of GGO lung cancer from April 2007 to January 2016 were retrospectively evaluated. Demographics, radiographic findings, pathological findings, and clinical outcomes including recurrence were analyzed. A total 404 of patients were analyzed, and pleural indentation was observed in 258 patients (63.9%). All cancers turned out to be adenocarcinoma. Older age, worse lung function, longer diameter, and tumor shadow disappearance rate were associated with indentation. VPI was observed in 36 (8.9%) patients, and indentation was independently associated with VPI (odds ratio 9.34, p=0.032) after adjustment of pleural attachment, diameter, and tumor shadow disappearance rate. During a median follow-up duration of 48.3 months, 34 (8.4%) patients recurred. Although indentation was not associated with earlier recurrence (adjusted hazard ratio 2.16, p=0.168), concurrent pleural attachment with indentation was associated with recurrence among those with solid portion≥8mm (adjusted hazard ratio 3.05, p=0.019). Pleural indentation was associated with increased risk of VPI in GGO lung adenocarcinoma. Although indentation itself did not increase the risk of recurrence, concurrent pleural attachment with indentation may increase the risk of recurrence among selected patients.

P1.05-018 Prognostic Impact of Tumor Shadow Disappearance Rate in Patients with Clinical IA Lung Adenocarcinoma

P1.05-018 Prognostic Impact of Tumor Shadow Disappearance Rate in Patients with Clinical IA Lung Adenocarcinoma

Associations between clinical data and computed tomography features in patients with epidermal growth factor receptor mutations in lung adenocarcinoma

BackgroundTo analyse the differences in computed tomography (CT) features between patients with lung adenocarcinoma who have epidermal growth factor receptor (EGFR) mutations and those who have wild-type EGFR.MethodsPatients with lung adenocarcinoma (n = 156) were enrolled from October 2013 to March 2016, including 56 patients with wild-type EGFR and 100 patients with EGFR mutations. Two independent radiologists evaluated patient characteristics and imaging features. Chi-squared test, Fisher’s exact test or ANOVA was applied to discriminate clinical and CT characteristics between the genotypes. A prediction tool for EGFR mutation was devised from principal component analysis.ResultsThe proportion of females and non-smokers in the exon 19 deletion and exon 21 missense groups was higher than in the wild-type group (P < 0.01). Severe emphysema was higher in the wild-type group than in the exon 19 deletion group (P < 0.01). The maximum diameter in the mediastinal window (MaxDmediastinal) in the wild-type group was longer than in the exon 19 deletion and exon 21 missense groups. The minimum diameter in the mediastinal window (MinDmediastinal) in the wild-type group was also longer than in the exon 21 missense group, with a significant difference (P < 0.05). The tumor shadow disappearance rate (TDR) in the exon 19 deletion group was higher than in the wild-type group. Ground glass opacity (GGO) appeared to be more common in the exon 19 deletion group (P = 0.010). The prediction score for exon 19 deletion mutation was: 0.305 × gender + 0.254 × smoking history + 0.198 × MaxDmediastinal + TDR × 0.254 + 0.280 × GGO + 0.095 × emphysema. The sensitivity and specificity for predicting exon 19 deletion were 59.09 and 76.79%, respectively. The prediction score for the exon 21 missense mutation was: 0.354 × gender + 0.291 × smoking history + 0.410 × MaxDmediastinal + 0.408 × MinDmediastinal. The sensitivity and specificity for predicting exon 21 missense mutation were 72.34 and 78.57%, respectively.ConclusionAs well as gender, smoking history and GGO, adenocarcinomas with EGFR mutation were significantly associated with emphysema, TDR, and the diameter in the mediastinal window. As exon 19 deletion and 21 missense mutations might be predicted by those features, the scoring system might be valuable for clinical diagnosis.

Clinical and CT characteristics of surgically resected lung adenocarcinomas harboring ALK rearrangements or EGFR mutations

PurposeTo determine if clinical and CT characteristics of surgically resected lung adenocarcinomas can distinguish those harboring ALK rearrangements from EGFR mutations. Materials and methodsPatients who had surgical resection and histologically confirmed lung adenocarcinoma were enrolled, including 41 patients with ALK rearrangements and 66 patients with EGFR mutations. Eighteen categorical and six quantitative CT characteristics were used to evaluate the tumors. Differences in clinical and CT characteristics between the two groups were investigated. ResultsAge (P=0.003), histological subtypes (P<0.001), pathological stage (P=0.007), and five CT characteristics, including size (P<0.001), GGO (P=0.001), bubble-like lucency (P=0.048), lymphadenopathy (P=0.001), and tumor shadow disappearance rate (P=0.005) were significantly different between patients harboring ALK rearrangements compared to patients with EGFR mutations. When we compared histologic components, a solid pattern was more common (P=0.009) in tumors with ALK rearrangements, and lepidic and acinar patterns were more common (P<0.001 and P=0.040, respectively) in those with EGFR mutations. Backward elimination analyses revealed that age (OR=0.93; 95% CI 0.89–0.98), GGO (OR=0.14; 95% CI 0.03–0.67), and lymphadenopathy (OR=4.15; 95% CI 1.49–11.60) were significantly associated with ALK rearrangement status. ConclusionOur analyses revealed that clinical and CT characteristics of lung adenocarcinomas harboring ALK rearrangements were significantly different, compared with those with EGFR mutations. These differences may be related to the molecular pathology of these diseases.

Assessment of Relationship Between CT Features and Serum Tumor Marker Index in Early-stage Lung Adenocarcinoma

The study aimed to assess the relationship between tumor marker index (TMI) and high-resolution computed tomography features in early-stage lung adenocarcinoma. Seventy-four stage IA lung adenocarcinomas confirmed pathologically were retrospectively evaluated. Lung nodules were divided into two types: solid nodule (SN) and subsolid nodule (SSN). The maximum diameters on mediastinal window in axial imaging (Dm) and tumor shadow disappearance rate (TDR) were measured. Meanwhile, other computed tomography features of lung nodules were also recorded. TMI represents the geometric mean of normalized CEA and CYFRA 21-1 values, and the discriminatory value of TMI in this study was set at 1.0. The evaluation of discriminatory values for Dm and the TMI between SNs and SSNs was done with Mann-Whitney U-test. The relationship between TDR and TMI in SSNs was evaluated by Pearson correlation analysis. Of 74 cases, 40 cases (54.05%) showed SNs and 34 cases (45.95%) showed SSNs. Dm and TMI were higher in SNs than in SSNs (z = -4.782, P < 0.001; z = -2.647, P = 0.008). TDR demonstrated negative relationship with TMI in SSNs (r = -0.448, P = 0.008). Spiculation (odds ratio [OR] = 14.685; 95% confidence interval [CI]: 2.739-78.729; P = 0.002), nodule type (OR = 6.215; 95% CI: 1.531-25.228; P = 0.011), and gender (OR = 0.227; 95% CI: 0.062-0.833; P = 0.025) were independent factors associated with TMI. Early-stage lung adenocarcinoma with lower TDR coexisting with spiculation was associated with higher TMI, especially in patients with solid nodule, which tended to have poor prognosis.

The prognostic value of tumor shadow disappearance rate on integrated PET/CT evaluation of solitary pulmonary nodules with low glucose metabolism.

This study aimed to determine the prognostic value of the tumor shadow disappearance rate (TDR) on integrated PET/computed tomography (PET/CT) evaluation of solitary pulmonary nodules (SPNs) with low glucose uptake. From January 2008 to September 2010, 99 patients who underwent fluorine-18 fluorodeoxyglucose PET (F-FDG-PET)/CT scanning for the evaluation of SPNs with a maximum standardized uptake value (SUVmax) below 2.75 (2.5+10%) were retrospectively reviewed. Among the 99 SPNs from these patients, 67 were malignant and 32 were benign, based on surgical pathology. Differences in baseline characteristics between the two groups were examined by means of the independent t-test, the Mann-Whitney U-test, and the χ-test. To test the efficacy of TDR for determining malignancy, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and positive and negative likelihood ratios (LR+ and LR-, respectively) with 95% confidence intervals were calculated using the pathological test as the gold standard. Patients with malignant nodules were older than those with benign nodules (64.5 vs. 55.1 years, respectively, P<0.001) and had higher TDRs (0.8 vs. 0.3, respectively, P<0.001). The optimal cutoff point for the TDR was 0.4886 where the sensitivity, specificity, positive predictive value, and negative predictive value were 0.851, 0.844, 0.919, and 0.730, respectively, and the LR+ and LR- were 5.443 and 0177, respectively. A significant negative correlation between TDR and SUVmax was found only in the malignant group. The diagnostic value of TDR complements the PET/CT evaluation of SPNs with a low F-FDG uptake.

A decrease in the size of ground glass nodules may indicate the optimal timing for curative surgery

ObjectivesAlthough ground glass nodules (GGNs) are generally considered to grow slowly to a large size, their natural progression remains unclear, and a decrease in tumor size has been reported in a few previous studies. The study aimed to retrospectively review the radiologic and pathological characteristics of resected ground glass nodules (GGNs) followed with chest computed tomography (CT) for at least a year before surgery to clarify the natural progression of GGNs. Patients and methodsThe chest CT cans and clinical charts of 32 GGNs in 31 patients who underwent pulmonary resection between January 2006 and March 2013 were retrospectively reviewed. The definitions of pure GGNs and part-solid nodules were based on the tumor shadow disappearance rate. The tumor size was measured twice, and the mean size was used for evaluation. ResultsThe mean GGN size before surgery was 15.2mm, and the median follow-up period before surgery was 21 months. In the follow-up period, 15 (58%) of 26 pure GGNs at the initial CT remained pure GGNs at the last CT. However, a solid component appeared in the remaining 11 tumors (42%) of the 26 initial pure GGNs. Furthermore, 1 GGN of the 15 GGNs that remained pure and 10 of the 11 GGNs with solid component also showed a size decrease. In addition, 6 part-solid nodules were observed at the initial CT. Of these, 3 showed a decrease in size during follow-up. Overall, 47% of the GGNs showed a size reduction on follow-up chest CT. ConclusionsA size reduction was observed in nearly half of the GGNs and suggested the progression to an invasive adenocarcinoma. When a mild collapse of the GGNs is observed, a careful follow-up is necessary to identify a solid component. Tumor size decreases may represent the optimal timing of pulmonary resection for curative treatment.

Lung adenocarcinoma as a solitary pulmonary nodule: Prognostic determinants of CT, PET, and histopathologic findings

We aimed to retrospectively compare CT, PET, and histopathologic (the extent of bronchioloalveolar carcinoma [BAC] components) findings of solitary pulmonary nodular (SPN) adenocarcinomas of the lung to determine their value as prognostic determinants. We reviewed CT and PET characteristics of tumors and pathologic specimens from 65 consecutive patients who underwent surgical resection for SPN adenocarcinomas. Nodule size and TDR (tumor shadow disappearance rate) were assessed from CT scans, and maximum standardized uptake value (SUVmax) of tumors was measured at PET. On pathologic examination, BAC, non-BAC, and central fibrous scar ratios were quantified. Prognosis was evaluated by noting disease recurrence during a minimum 12-month follow-up period after curative resection. The interrelationships between TDR, SUVmax, BAC, and non-BAC ratio were studied, and relationships between recurrence and various variables were analyzed. The median follow-up time was 33 months, and seven patients (11%) developed disease recurrence after surgical resection. TDR at CT and SUVmax at PET correlated well with pathologic BAC and non-BAC ratios. Between subgroups with and without recurrence, there were significant differences in SUVmax and BAC and non-BAC ratios. Based on univariate survival analyses, pathologic BAC and non-BAC ratios were risk factors significantly related to recurrence, but only high non-BAC ratio remained as an independent factor associated with recurrence in the multivariate analysis (hazard ratio [HR] = 0.956, P = 0.013). Among the factors examined, pathologic non-BAC ratio is the only independent risk factor for poor prognosis in patients with SPN adenocarcinomas.

Sublobar Resection for Patients With Peripheral Small Adenocarcinomas of the Lung: Surgical Outcome is Associated With Features on Computed Tomographic Imaging

Sublobar resection for peripheral small adenocarcinomas of the lung remains controversial. We studied the feasibility of deciding whether to perform limited pulmonary resection on the basis of preoperative images obtained by high-resolution computed tomography. A total of 123 patients with adenocarcinoma of the lung underwent sublobar resection of clinical T1N0M0 tumors measuring 2 cm or less in diameter on high-resolution computed tomography. Patients with multiple lung cancers or a history of lung cancer or other malignancies were excluded. The remaining 63 patients were studied. All tumors were classified as "air-containing type" or "solid-density type" according to the tumor shadow disappearance rate on high-resolution computed tomography. We evaluated the surgical outcomes of sublobar resection with respect to findings on high-resolution computed tomography images. Forty-six patients had air-containing type tumors (tumor shadow disappearance rate > or = 50%), and 17 had solid-density type tumors (tumor shadow disappearance rate < 50%). Forty-nine wedge resections and 14 segmentectomies were performed. Wedge resection was the most common procedure in patients with air-containing type tumors. Pathologically, air-containing type tumors comprised 38 bronchioloalveolar carcinomas and 8 nonbronchioloalveolar carcinomas. No patient with air-containing type tumors had recurrence after a median follow-up of 70 months (range, 21 to 133 months). Overall and relapse-free survival rates at 5 years were 95% and 100%, respectively, in patients with air-containing type tumors, as compared with 69% and 57%, respectively, in those with solid-density type tumors. Sublobar resection might be an acceptable procedure for the treatment of small air-containing type adenocarcinomas of the lung on preoperative high-resolution computed tomography. However, our findings must be confirmed in larger, multicenter studies.

Detection of lung cancer using single-exposure dual-energy subtraction chest radiography

The aim of this study was to evaluate the detectability of lung cancer by chest radiography with a single-exposure dual-energy subtraction (ES) method. Five radiologists read two sets of chest radiographs from 77 patients (66.5 +/- 9.6 years old) with histologically proven lung cancer measuring <or=3.0 cm and those from 77 normal subjects (65.7 +/- 9.0 years old). The observer tests were performed in two sessions: standard computed radiography (CR) images only and a combination of CR and ES images. Receiver-operating characteristic analysis was used for statistical analysis. All tumors were classified into three groups according to the appearance on thin-section CT: (1) nonsolid: tumor shadow disappearance rate (TDR) was 100%; (2) partly solid: TDR was >or=50 but <100%; (3) solid: TDR was <50%. Overall, detectability with the ES method was significantly better than that without ES (mean Az value increased from 0.7673 to 0.8265, P < 0.05). In the subgroup analysis of the nonsolid group and the solid group detectability did not change using the ES method, whereas in the partly solid group detectability with the ES method was significantly better than that without ES (mean Az value increased from 0.7162 to 0.8209, P < 0.005). The ES method improves the detectability of lung cancer by chest radiography, especially of the partly solid group.

Associations among bronchioloalveolar carcinoma components, positron emission tomographic and computed tomographic findings, and malignant behavior in small lung adenocarcinomas

The aggressiveness of small adenocarcinomas has not been fully evaluated using integrated positron emission tomography/computed tomography. We investigated malignant aggressiveness according to positron emission tomography/computed tomography, high-resolution computed tomographic findings, and the proportions of pathologically defined bronchioloalveolar carcinomas in cT1N0M0 lung adenocarcinoma. Sixty consecutive patients with cT1N0M0 lung adenocarcinomas of 3 cm or less in diameter underwent fluorodeoxyglucose-positron emission tomograph/computed tomography, and high-resolution computed tomography, followed by complete tumor resection. Correlations between the proportion of bronchioloalveolar carcinoma and maximum standardized uptake value on positron emission tomographic scan/computed tomographic scan, ground-glass opacity, and tumor shadow disappearance rate were investigated and the findings were compared with clinicopathologic features. Lymphatic and vascular invasion occurred in 18 (30%) and 13 (22%) patients, respectively, whereas hilar or mediastinal lymph nodes occurred in 8 patients (13%). Maximum standardized uptake value generally seemed the most valuable predictor of lymphatic invasion, vascular invasion, and nodal metastasis compared with ground-glass opacity, tumor shadow disappearance rate, and bronchioloalveolar carcinoma ratios. Although the association was significant between the bronchioloalveolar carcinoma ratio versus maximum standardized uptake value, ground-glass opacity ratio, and tumor shadow disappearance rate (all P < .0001), maximum standardized uptake value (R2 = 0.245) was less correlated with the bronchioloalveolar carcinoma ratio than was the ground-glass opacity ratio (R2 = 0.554) and tumor shadow disappearance rate (R2 = 0.671). The malignant behavior of small adenocarcinomas with a lower maximum standardized uptake value and a greater proportion of ground-glass opacity, tumor shadow disappearance rate, and bronchioloalveolar carcinoma was less aggressive. Maximum standardized uptake value was a more powerful clinical predictor of biologic tumor performance, independent of pathologic bronchioloalveolar carcinoma proportion. Preoperative assessment of maximum standardized uptake value on positron emission tomographic/computed tomographic findings, in addition to the ground-glass opacity ratio and tumor shadow disappearance rate on high-resolution computed tomographic scans, might be useful to guide treatment strategies for small adenocarcinomas.

Surgically Curable Peripheral Lung Carcinoma: Correlation of Thin-Section CT Findings With Histologic Prognostic Factors and Survival

Study objectives To define characteristics of surgically curable, early cancers of the lung, we retrospectively studied relationships between thin-section CT (TS-CT) scans, pathologic features, and outcome data in 287 patients with resected small-diameter (< 20 mm) peripheral lung carcinoma. Cases included 260 adenocarcinomas, 16 squamous cell carcinomas, 6 small cell carcinomas, 3 large cell carcinomas, and 2 others Measurements and results All tumors were classified by tumor shadow disappearance rate (TDR) on TS-CT as having either an “air-containing” or “solid-density” pattern. Adenocarcinomas are typically classified into these patterns. Air-containing patterns (n = 136) showed 1% pleural involvement and 2% vascular invasion, with no lymphatic permeation by pathology. Solid-density patterns (n = 124) showed 34% pleural involvement, 42% vascular invasion, and 29% lymphatic permeation. No cases of relapse or death were observed in cases with the air-containing pattern, in contrast to the high relapse and death rate in solid-density cases (p < 0.0001). All non-adenocarcinoma cases (n = 25) had a solid-density pattern, with 4% pleural involvement, 52% vascular invasion, and 44% lymphatic permeation. The overall 5-year survival rate for non-adenocarcinoma was 60%, similar to that for solid-density adenocarcinoma Conclusions When peripheral lung cancers < 20 mm in diameter show air-containing patterns on TS-CT images, surgical outcomes may be favorable with curable disease To define characteristics of surgically curable, early cancers of the lung, we retrospectively studied relationships between thin-section CT (TS-CT) scans, pathologic features, and outcome data in 287 patients with resected small-diameter (< 20 mm) peripheral lung carcinoma. Cases included 260 adenocarcinomas, 16 squamous cell carcinomas, 6 small cell carcinomas, 3 large cell carcinomas, and 2 others All tumors were classified by tumor shadow disappearance rate (TDR) on TS-CT as having either an “air-containing” or “solid-density” pattern. Adenocarcinomas are typically classified into these patterns. Air-containing patterns (n = 136) showed 1% pleural involvement and 2% vascular invasion, with no lymphatic permeation by pathology. Solid-density patterns (n = 124) showed 34% pleural involvement, 42% vascular invasion, and 29% lymphatic permeation. No cases of relapse or death were observed in cases with the air-containing pattern, in contrast to the high relapse and death rate in solid-density cases (p < 0.0001). All non-adenocarcinoma cases (n = 25) had a solid-density pattern, with 4% pleural involvement, 52% vascular invasion, and 44% lymphatic permeation. The overall 5-year survival rate for non-adenocarcinoma was 60%, similar to that for solid-density adenocarcinoma When peripheral lung cancers < 20 mm in diameter show air-containing patterns on TS-CT images, surgical outcomes may be favorable with curable disease

Prognosis and histologic features of small pulmonary adenocarcinoma based on serum carcinoembryonic antigen level and computed tomographic findings.

In 2001, we proposed the criteria for combined evaluation of the serum carcinoembryonic antigen (CEA) level and the tumor shadow disappearance rate (TDR) to predict pathologic N0 (pN0) disease in pulmonary adenocarcinomas. The objective of the present study was to determine the prognosis and histologic features in small-sized pulmonary adenocarcinomas according to serum CEA level and TDR. We reviewed clinical records of 189 consecutive patients with peripheral pulmonary adenocarcinoma 3.0 cm or smaller who underwent major lung resection and systematic lymph node dissection: 50 patients with TDR 0.8 or more and normal CEA level (group I) and 139 patients with TDR <0.8 and/or elevated CEA level (group II). Among them, we investigated histologic features of 177 adenocarcinomas according to serum CEA level and TDR. The 5-year survival rates were 95% for group I and 75% for group II (P = 0.002) and for pN0 patients, 97% in group I and 87% in group II (P = 0.04). In univariate analyses, TDR, preoperative serum CEA level, and the maximum tumor dimension on computed tomographic (CT) scan were significantly associated with prognosis. Multivariate analysis showed that only preoperative serum CEA level and TDR were significant independent prognostic factors, and the maximum tumor dimension was not significant. Group I patients developed no local recurrence, including lymph node metastases. In 25 group I adenocarcinomas 2.0 cm or smaller, no lymph node involvement, two lymphatic permeation, two vascular invasion, and one pleural involvement tumors were observed. These signs of local invasiveness were less frequent than the remaining adenocarcinomas. CT findings correlated well with histologic findings in small-sized adenocarcinomas. Combined evaluation of preoperative serum CEA level and TDR may enable us to identify minimally invasive adenocarcinomas with good prognosis. Candidates for limited lung resection without systematic lymph node dissection could be selected based on these findings.

Correlation between computed tomographic findings, bronchioloalveolar carcinoma component, and biologic behavior of small-sized lung adenocarcinomas

Objective Differentiation of bronchioloalveolar carcinoma from other subtypes of lung adenocarcinomas is important in the preoperative assessment of patients. We examined the biologic aggressiveness of small-sized adenocarcinomas according to the pathologically defined bronchioloalveolar carcinoma degree and its correlation with computed tomography findings. In addition, we attempted to predict which patients were suitable for a lesser resection. Methods Of 424 consecutive patients who underwent operation for primary lung cancer in the last 3 years, 114 with a histopathologically proven adenocarcinoma 3 cm or less in diameter underwent complete removal of the primary tumor. We examined the characteristics of patients classified into 3 groups based on the proportion of the bronchioloalveolar carcinoma component: 0% to 20% (n = 40), 21% to 50% (n = 38), and 51% to 100% (n = 36). We also investigated the correlation of the bronchioloalveolar carcinoma component with computed tomography findings such as ground-glass opacity (defined as a hazy increase on the lung window) and tumor shadow disappearance rate (defined as the ratio of the tumor area of the mediastinal window to that of the lung window). Results Male gender ( P = .0001), advanced pathologic stage ( P = .001), larger size of the tumor ( P = .004), nodal involvement ( P = .04), pleural invasion ( P = .0003), lymphatic invasion ( P = .002), and vascular invasion ( P = .0002) were observed more often among patients with a smaller proportion of bronchioloalveolar carcinoma. A positive and significant correlation was found between the rate of bronchioloalveolar carcinoma component and ground-glass opacity (R 2 = 0.488, P < .0001) and tumor shadow disappearance rate (R 2 = 0.727, P < .0001). As an independent predictor of nodal status, tumor shadow disappearance rate ( P = .015) and bronchioloalveolar carcinoma component ( P = .015), as well as tumor size, were significantly valuable, although ground-glass opacity proportion ( P = .086) was marginally informative. Conclusions Small-sized adenocarcinomas with a greater ratio of bronchioloalveolar carcinoma component showed less aggressive behavior. Both tumor shadow disappearance rate and ground-glass opacity ratios, which are obtained preoperatively, were well associated with bronchioloalveolar carcinoma ratios, which are determined postoperatively. Furthermore, tumor shadow disappearance rate had a stronger impact as a predictor of bronchioloalveolar carcinoma component. Preoperative assessment of tumor shadow disappearance rate may be useful to identify patients requiring a less extensive pulmonary resection.

Discrepancy of computed tomographic image between lung and mediastinal windows as a prognostic implication in small lung adenocarcinoma

Background There have been no proven preoperative indicators for postoperative survival of patients with an adenocarcinoma, the incidence of which has been increasing lately. Methods Of 952 consecutive patients operated on for primary lung cancer between 1995 and 2002, 167 patients with a proven adenocarcinoma 3 cm or less in diameter underwent complete removal of the primary tumor. We examined their computed tomographic scans to estimate tumor shadow disappearance rate (TDR), which was defined as the ratio of the tumor area of the mediastinal window to that of the lung window, reviewed the clinical records, and evaluated their relation to prognosis. Results On univariate analyses, size of the tumor ( p = 0.0380), TDR ( p = 0.0018), carcinoembryonic antigen ( p = 0.0001) pathologic stage ( p < 0.0001), nodal involvement ( p < 0.0001), lymphatic invasion ( p = 0.0001), and vascular invasion ( p = 0.0017) were significantly associated with prognosis. Also, the outcomes of multivariate analyses for preoperative factors indicated that TDR ( p = 0.0340) and carcinoembryonic antigen ( p = 0.0047) are significant independent prognostic determinants. The 5-year survival was 48% in cases with a TDR of 0% to 25%, 87% in those with a TDR of 26% to 50%, 97% in those with a TDR of 51% to 75%, and 100% in those with a TDR of 76% to 100%. The incidence of lymphatic, vascular invasion, and nodal metastases was lower in patients with a higher TDR. Conclusions Small-sized adenocarcinomas with a higher TDR showed less lymphatic, vascular vessel invasion, or nodal involvement, and demonstrated longer survival, suggesting that TDR was associated with clinical-pathologic characteristics and tumor aggressiveness. Preoperative assessment of TDR may be useful to identify an appropriate candidate for a lesser pulmonary resection.

771 Paclitaxel and carboplatin as adjuvant treatment in high-risk patients with operable non-small cell lung cancer (NSCLC): A feasibility study conducted by the hellenic cooperative oncology group (HeCOG)

The study aimed to assess the relationship between tumor marker index (TMI) and high-resolution computed tomography features in early-stage lung adenocarcinoma.Seventy-four stage IA lung adenocarcinomas confirmed pathologically were retrospectively evaluated. Lung nodules were divided into two types: solid nodule (SN) and subsolid nodule (SSN). The maximum diameters on mediastinal window in axial imaging (Dm) and tumor shadow disappearance rate (TDR) were measured. Meanwhile, other computed tomography features of lung nodules were also recorded. TMI represents the geometric mean of normalized CEA and CYFRA 21-1 values, and the discriminatory value of TMI in this study was set at 1.0. The evaluation of discriminatory values for Dm and the TMI between SNs and SSNs was done with Mann-Whitney U-test. The relationship between TDR and TMI in SSNs was evaluated by Pearson correlation analysis.Of 74 cases, 40 cases (54.05%) showed SNs and 34 cases (45.95%) showed SSNs. Dm and TMI were higher in SNs than in SSNs (z = −4.782, P < 0.001; z = −2.647, P = 0.008). TDR demonstrated negative relationship with TMI in SSNs (r = −0.448, P = 0.008). Spiculation (odds ratio [OR] = 14.685; 95% confidence interval [CI]: 2.739–78.729; P = 0.002), nodule type (OR = 6.215; 95% CI: 1.531–25.228; P = 0.011), and gender (OR = 0.227; 95% CI: 0.062–0.833; P = 0.025) were independent factors associated with TMI.Early-stage lung adenocarcinoma with lower TDR coexisting with spiculation was associated with higher TMI, especially in patients with solid nodule, which tended to have poor prognosis.

Pathologic N0 status in pulmonary adenocarcinoma is predictable by combining serum carcinoembryonic antigen level and computed tomographic findings

Objectives: It is not clear whether lymphadenectomy has therapeutic benefit in non–small cell lung cancer management. To avoid unnecessary lymphadenectomy, we attempted to identify clinical or radiologic predictors of pathologic N0 disease in patients with peripheral adenocarcinoma. Methods: From August 1992 through April 1997, 269 consecutive patients with peripheral adenocarcinoma who underwent major lung resection and systematic lymph node dissection were enrolled in this study. We reviewed their contrast-enhancement computed tomographic scans and recorded the maximum dimension of tumors both on pulmonary (pDmax) and on mediastinal (mDmax) window setting images, the largest dimension perpendicular to the maximum axis on both pulmonary (pDperp) and mediastinal (mDperp) window setting images, and the size of all detectable hilar-mediastinal lymph nodes. We defined a new radiologic parameter, tumor shadow disappearance rate (TDR), which is calculated with the following formula: TDR = 1 − (mDmax × mDperp)/(pDmax × pDperp). Results: In multivariable analysis a lower serum carcinoembryonic antigen level and a higher tumor shadow disappearance rate were significant predictors of pathologic N0 disease. Lymph node size on computed tomographic scanning was not a significant predictor. Among 59 patients with a normal preoperative carcinoembryonic antigen level and a tumor shadow disappearance rate of 0.8 or more, 58 (98%) patients had pathologic N0 disease, and the other patient had pathologic N1 disease. Conclusions: Mediastinal lymph node involvement was not found in patients with a normal preoperative serum carcinoembryonic antigen level and a tumor shadow disappearance rate 0.8 or more. The patients who meet these criteria may be successfully managed with major lung resection without systematic mediastinal lymphadenectomy.J Thorac Cardiovasc Surg 2001;122:325-30