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Conclusions: The addition of FDG PET/CT scanning to chest CT imaging provides better performance for predicting conversion to thoracotomy during VATS lobectomy in lung cancer patients. Therefore, in lung cancer patients undergoing surgical resection, FDG PET/CT can provide additional reliable information in selecting the appropriate surgical approach for a lobectomy.

Objectives To compare the differences in radiologic and pathologic features of surgically resected chronic obstructive pulmonary disease (COPD)‐related adenocarcinomas according to the presence of emphysema. Methods A total of 216 smokers with surgically resected lung adenocarcinoma were included in this retrospective study, and 102 patients were diagnosed with COPD. We classified COPD patients as emphysematous or non‐emphysematous group based on the emphysema severity on computed tomography (CT) and evaluated the differences in the CT and pathologic features between the two groups. The relationship between emphysema and disease‐free survival was assessed using a Kaplan–Meier curve. Results Lung adenocarcinomas in emphysema group presented a more aggressive pathologic grade and higher prevalence of solid lesions (vs subsolid lesions) on CT than those in non‐emphysematous group (P = 0.006 and <0.001, respectively). After adjustment for age, sex, smoking pack‐years and tumor size, emphysema group had a greater risk for higher histologic grade and higher prevalence of solid lesions than non‐emphysema group (odds ratio, 3.445; 95% confidence interval, 1.124‐10.564; P = 0.030, odds ratio, 6.192; 95% confidence interval, 1.804‐21.254; P = 0.004, respectively). Kaplan‐Meier survival curves showed that patients with emphysema had significantly impaired disease‐free survival compared with those without emphysema (median disease‐free survival = 37.0 vs 57.5 months, P = 0.038). Conclusion Adenocarcinomas in emphysema‐present COPD had more aggressive features of pathology and CT findings, and worse disease‐free survival than those without emphysema. These findings might provide an insight into the different pathobiology and prognostic implications of lung adenocarcinomas according to the presence of emphysema in patients with COPD.

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