Comparison of thin-section CT and pathological findings in small solid-density type pulmonary adenocarcinoma: Prognostic factors from CT findings

• Published in: European journal of radiology Vol. 81; no. 1; pp. 189 - 194
• Main Authors: Ikehara, Mizuki, Saito, Haruhiro, Kondo, Tetsuro, Murakami, Shuji, Ito, Hiroyuki, Tsuboi, Masahiro, Oshita, Fumihiro, Noda, Kazumasa, Nakayama, Haruhiko, Yokose, Tomoyuki, Kameda, Yoichi, Yamada, Kouzo
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.01.2012
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - mortality; Adult; Aged; Aged, 80 and over; Female; Humans; Japan - epidemiology; Male; Middle Aged; Notch; Prevalence; Prognosis; Radiology; Risk Assessment; Risk Factors; Small adenocarcinoma; Solid-density type; Solitary Pulmonary Nodule - diagnosis; Solitary Pulmonary Nodule - mortality; Survival Analysis; Survival Rate; Thin-section CT; Tomography, X-Ray Computed - statistics & numerical data; Japan; Solid-density type; Prognosis; Small adenocarcinoma; Notch; Thin-section CT
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2010.09.026

Abstract Objective We divided pulmonary adenocarcinoma of ≤20 mm into air-containing and solid-density types based on a percentage reduction of the maximum tumor diameter in the mediastinal window image compared to the area in the lung window image on thin-section (TS) CT of ≥50% (air-containing type) and <50% (solid-density type). No relapse occurred in patients with air-containing type. The prognosis of solid-density type may be poor even when the tumor size is 20 mm or smaller. We investigated whether CT findings for these tumors could serve as prognostic factors. Methods The subjects were 105 patients with solid-density type pulmonary adenocarcinoma that was identified on TSCT and found to have a diameter of 20 mm or smaller after surgical resection during the period from April 1997 to November 2004. Notches, air bronchogram, pleural retraction, spiculation, venous involvement, and ground glass opacity were examined on TSCT, and their associations with pathological findings (i.e., pleural invasion, lymphatic permeation, vascular invasion, lymph node metastasis, and Noguchi's classification) and relapse were investigated using chi-square test and Cox proportional hazards model. Results The incidence of relapse was significantly higher in cases with notches. The incidence of notches increased with tumor growth and notches were frequent in Noguchi type D tumors, reflecting poorly differentiated adenocarcinoma. Lymphatic permeation and type D cases were independent factors associated with a poor prognosis using Cox proportional hazards model. Conclusions TSCT findings may be useful for prediction of the prognosis of solid-density type pulmonary adenocarcinoma.