CT Findings and Progression of Small Peripheral Lung Neoplasms Having a Replacement Growth Pattern

• Published in: American journal of roentgenology (1976) Vol. 180; no. 3; pp. 817 - 826
• Main Authors: Takashima, Shodayu, Maruyama, Yuichiro, Hasegawa, Minoru, Yamanda, Takeshi, Honda, Takayuki, Kadoya, Masumi, Sone, Shusuke
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.03.2003; American Roentgen Ray Society
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adult; Aged; Biological and medical sciences; Disease Progression; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Male; Medical sciences; Middle Aged; Pneumology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Respiratory system; Tomography, X-Ray Computed; Tumors of the respiratory system and mediastinum; Human; Lung disease; Image analysis; Radiodiagnosis; Respiratory disease; Bronchus disease; Medical imagery; Evolution; Computerized axial tomography; Malignant tumor; Bronchopulmonary
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.180.3.1800817

We investigated the imaging findings and progression of replacement lung neoplasms that were revealed on thin-section CT and serial CT. We evaluated the age of patients and thin-section CT findings (lesion size; percentage of ground-glass opacity areas; and presence or absence of solid portions, lobulation, coarse spiculation, air bronchogram, cavity, multiplicity, and pleural tags) in 73 lesions (11 atypical adenomatous hyperplasias, 17 type A [Noguchi's classification], 18 type B, and 27 type C small peripheral adenocarcinomas). We compared the serial findings of 48 of 73 lesions on low-dose screening CT (n = 21) or thin-section CT (n = 27) obtained at a mean interval of 450 days (range, 85-951 days). Progression from atypical adenomatous hyperplasia through type A to type B and then to type C tumor was studied using trend tests. A significant linear trend was seen for lesion size (r = 0.55; p < 0.001), percentages of ground-glass opacity areas (r = 0.75; p < 0.001), and the prevalence of lobulation (p < 0.001), spiculation (p = 0.001), air bronchogram (p = 0.023), cavity (p = 0.046), pleural tag (p < 0.001), and solid portions (p < 0.001). In general from serial CT assessment, lesions were recognized first as a ground-glass opacity nodule (56% of 48 lesions) with subsequent increase in size (75%), then solid portions appeared in the nodule (17%), and finally solid portions increased (23%) with occasional augmentation of tissue contraction (6%). CT analysis revealed stepwise progression of replacement-type lung neoplasms.