ABSTRACT

Objectives:

To analyse the correlation between computed tomography (CT) features and histopathological findings of small lung adenocancers using the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung Adenocancer.

Materials and Methods:

A retrospective review of 34 nodules (size ≤2 cm) representing lung adenocancer was performed. Besides their attenuation type (solid, mixed, pure ground glass), tumours were defined as air-containing type if their vanishing ratio was ≥%50 and as solid-density type if the vanishing ratio was <%50. The correlation between CT findings (size, air bronchogram, intranodular lucencies, spiculation, lobulation, notches, pleural retraction and thickening, thickening of bronchovascular bundle) and pathological results was investigated. Tumours representing adenocancer in situ (AIS) and minimally invasive adenocancer (MIA) were investigated in one group as non-/minimally invasive adenocancer (NMIA).

Results:

Of the 34 nodules 23 (67.7%) were invasive adenocancer, nine (26.4%) were AIS, and two (5.9%) were MIA. Lesions diagnosed as invasive adenocancer were more often of solid-density type (19, 82.6%), and solid (13, 56.5%) or mixed nodules (10, 43.5%) whereas NMIA group lesions were more often of air-containing type (9, %81.8), and pure ground-glass (3, 27.3%) or mixed nodules (7, 63.6%) with a statistically significant difference between invasive adenocancer and NMIA group (p≤0.05). Furthermore, invasive adenocancer nodules had a larger maximum diameter (15.09±3.32 mm) than NMIA nodules (12.28±3.23 mm) (p=0.031). Thickening of bronchovascular bundle was another CT finding that was significantly more common in invasive adenocancer (p=0.024). The other CT findings showed also a higher frequency in invasive adenocancer compared to NMIA group except for intranodular lucency which was observed in both pathological groups equally. But this difference in frequency was not statistically significant (p>0.05).

Conclusion:

Invasive adenocancer and NMIA lesions can be differentiated by their CT features. But greater study populations are needed for further confirmation.

Keywords: Lung Adenocancer, IASLC/ATS/ERS Classification, Computed Tomography

References

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J CLIN. 2015;65:5-29.

Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer /American Thoracic Society/European Respiratory Society of Lung Adenocarcinoma. J Thoracic Oncol. 2011;6:244-285.

Travis WD, Brambilla E, Müller-Hermelink HK, et al. World Health Organization Classification of Tumours. Pathology and Genetics ofTumours of the Lung, Pleura, Thymus and Heart. Lyon: IARC Press. 2004:11-127.

Yoshino I, Nakanishi R, Kodate M, et al. Pleural retraction and intra-tumoral air-bronchogram as prognostic factors for stage I pulmonary adenocarcinoma following complete resection. Int Surg. 2000;85:105-112.

Colby TV, Koss M, Travis WD. Tumors of the Lower Respiratory Tract. Washington, DC. Armed Forces Institute of Pathology 3rd ed., 1995.

Suzuki K, Asamura H, Kusumoto M et al. “Early” peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan. Ann Thorac Surg. 2002;74:1635-1639.

Aoki T, Tomoda Y, Watanabe H, et al. Peripheral lung adenocarcinoma: Correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology. 2001;220:803-809.

Akira M, Atagi S, Kawahara M, et al. High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients. Am J Roentgenol. 1999;173:1623-1629.

Saito H, Yamada K, Hamanaka N, et al. Initial findings and progression of lung adenocarcinoma on serial computed tomography scans. J Comput Assist Tomogr. 2009;33:42-48.

Ishikawa H, Koizumi N, Morita T, et al. Ultrasmall pulmonary opacities on multidetector-row high-resolution computed tomography: a prospective radiologic-pathologic examination. J Comput Assist Tomogr. 2005;29:621-625.

Ikeda K, Awai K, Mori T, et al. Differential diagnosis of ground-glass opacity nodules: CT number analysis by three-dimensional computerized quantification. Chest. 2007;132:984-990.

Choi JA, Kim JH, Hong KT, et al. CT bronchus sign in malignant solitary pulmonary lesions: value in the prediction of cell type. Eur Radiol. 2000;10:1304-1309.

Takashima S, Maruyama Y, Hasegawa M, et al. CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern. AJR Am J Roentgenol. 2003;180:817-826.

Gould MK, Fletcher J, Iannettoni MD, et al. American College of Chest Physicians. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:108S–130S.

Dong B, Sato M, Sagawa M, et al. Computed tomographic image comparison between mediastinal and lung windows provides possible prognostic information in patients with small peripheral lung adenocarcinoma. J Thorac Cardiovasc Surg. 2002;124:1014-1020.

Nakazono T, Sakao Y, Yamaguchi K, et al. Subtypes of peripheral adenocarcinoma of the lung: differentiation by thin-section CT. Eur Radiol. 2005;15:1563-1568.

Yabuuchi H, Murayama S, Murakami J, et al. High-resolution CT characteristics of poorly differentiated adenocarcinoma of the peripheral lung: comparison with well differentiated adenocarcinoma. Radiat Med. 2000;18:343-347.

Ikehara M, Saito H, Kondo T, et al.Comparison of thin-section CT and pathological findings in small solid-density type pulmonary adenocarcinoma: prognostic factors from CT findings. Eur J Radiol. 2012;81:189-194.

Correlation of Computed Tomography Findings with Histopathology in Small Lung Adenocancer

ABSTRACT

References