Convex border of peripheral non-small cell lung cancer on CT images as a potential indicator of pleural invasion

Abstract

The aim of the study is to evaluate the use of the tumor border in peripheral non-small cell lung cancer (NSCLC) as an indicator of pleural invasion.This retrospective study was performed at a single tertiary center. The analysis of 136 patients with peripheral NSCLC included 101 (74.3%) patients with pathologically proven pleural invasion and 35 (25.7%) patients without pleural invasion. The tumor borders on conventional computed tomography (CT) were classified into 5 types on lung window setting: type 1, S or reverse S border with a blunt angle; type 2, sharp angle; type 3, concave border with a blunt angle; type 4, straight border with a perpendicular angle; and type 5, convex border with a perpendicular or blunt angle. In patients with more than 1 tumor border type, the priority was type 5, 4, 3, 2, and 1. Blunt angle, pleural contact >3 cm, and adjacent pleural thickening were also recorded for comparison with pleural invasion of peripheral tumors.Tumor border types 2 and 5 significantly differed between patients with and without pleural invasion (P = .001 and P < .001, respectively). Patients with and without pleural invasion did not significantly differ in tumor border type 1, tumor border type 3, tumor border type 4, blunt angle, pleural contact >3 cm, or pleural thickening. Tumor border type 5 was a moderate indicator of pleural invasion with positive LR, 5.20; accuracy, 57%; sensitivity, 45%; specificity, 91%; PPV, 94%; and NPV, 36%. Tumor border type 2 was a weak indicator of pleural invasion with positive LR, 0.51; accuracy, 34%; sensitivity, 34%; specificity, 34%; PPV, 60%; and NPV, 15%.Tumor border type 5 has a high PPV and high specificity for predicting pleural invasion by peripheral NSCLC.

Prediction of pleural invasion using different imaging tools in non-small cell lung cancer

“…A tumor abutting the pleural surface does not indicate invasion. Many methods for predicting pleural invasion using CT have been published (18)(19)(20)(21), one of which is analysis of the tumor border. Some radiologists diagnosed pleural invasion of NSCLC by using conventional CT criteria combined with at least two of the following three criteria: tumor size more than 3 cm, with contact with the neighboring pleura; obtuse angle with the contact surface; and related pleural thickening.…”

“…Hsu et al (21) evaluated the tumor border for predicting plural invasion in peripheral NSCLC in 136 patients. A retrospective study was performed and the tumor border was classified into 5 types.…”

“…However, CXR is not suitable for assessing pleural invasion in early stage NSCLC. Ultrasound (US) (9,10), computed tomography (CT) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), magnetic resonance imaging (MRI) (22,23) and fluorine-18-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) (24)(25)(26) have been used for preoperative prediction of pleural invasion. However, no single imaging method has been proposed for the definitive diagnosis of pleural invasion, and each imaging modality has its advantages as well as limitations ( Figure 3).…”

Imaging Assessment of Visceral Pleural Surface Invasion by Lung Cancer: Comparison of CT and Contrast-Enhanced Radial T1-Weighted Gradient Echo 3-Tesla MRI

“…However, it has limitations in the detection of more subtle cases of pleural invasion, as contiguity of the tumor with the pleural surface is not necessarily equivalent to its invasion [ 5 ]. A skirt-like 3-dimensional (3D) CT pattern of pleural morphology adjacent to the tumor [ 6 ], pleural tag with a soft tissue component [ 7 ], and type-5 border (convex border with a perpendicular or blunt angle) [ 8 ] have been shown to have predictive value for pleural invasion; however, these methods cannot be used to differentiate PL1 from PL2.…”

Efficacy of erlotinib and celecoxib for patients with advanced non-small cell lung cancer

“…Targeted therapies have been reported to prolong survival for NSCLC, [ 9 – 13 ] especially for epidermal growth factor receptor (EGFR)-mutations by tyrosine kinase inhibitors (TKIs). [ 14 , 15 ] However, these kinds of therapies are not eligible for about 80% patients with NSCLC.…”