Correlation Between Pulmonary Sclerosing Pneumocytoma Features and MSCT Imaging Manifestations in 34 Patients: Implications for Precision Medicine

Abstract

Objective: To identify and analyze the multi-slice computed tomography (MSCT) imaging manifestations and clinicopathological features of PSP to improve the preoperative and intraoperative diagnosis of the disease.Method: This was a retrospective study conducted on the imaging and clinicopathological data of the PSP patients treated in two major hospitals in China from October 2001 to December 2019. The locations of lung lesions, clinical symptoms, surgical complications, MSCT imaging features, and the corresponding relationship with clinicopathological features were assessed. Then, a new diagnostic approach was defined and used to train imaging and pathological doctors (experimental group). Then, the diagnostic accuracy of the experimental group was evaluated in preoperative and intraoperative diagnosis of PSP.Results: Thirty-four PSP cases were analyzed (mean: 51.42; range: 39–69 years old). The peripheral type was more common, while 92% of the lesions located in the middle lobe of the right lung and the lower lobe of bilateral lungs. The shortest lesion edge-pleura distance ranged 0 to 30 mm and 46% of the lesions (16/34) were attached to the pleura, 62% (21/34) located at 0–5 mm, 92% (31/34) within 20 mm from the pleura. Diameters of the lesions ranged 8.58 to 68.41 mm, while most of them were 20-40 mm. All lesions showed enhancement, and 97% (33/34) were unevenly enhanced. PSP volume was negatively correlated with the total degree of enhancement (r = −0.587, p < 0.01), and the volume difference between the obvious enhancement zone and the slight enhancement zone (r = −0.795, p < 0.01). Welt vessel sign was observed in 61.7% (21/34) of cases, and none of welt vessels entered into the lesions. Vascular-like enhancement area inside the lesion showed no significant correlation with the welt vessels outside the lesion, and no case showed entrance of bronchus into the lesion. The trained experimental group showed significantly greater diagnostic accuracy than the control group. In particular, the accuracy rate of intraoperative frozen section diagnosis was 60% higher in the experimental group than the control group.Conclusion: PSP has characteristic imaging manifestations, which can be utilized to improve the preoperative and intraoperative diagnostic coincidence rate of PSP.

Central and peripheral pulmonary sclerosing pneumocytomas: multi-phase CT study and comparison with Ki-67

“…The histological evolution of PSP might not always follow the hemangiomatous-papillary-solid-sclerotic sequence. 26 , 27 With the growth of PSP, its enhancement characteristics changed according to the tumor size and its pathological components. 27 , 28 The smaller peripheral PSPs mainly contained papillary and hemangiomatous components and were enhanced significantly in arterial and venous phases, with a peak enhancement in the venous phase.…”

Giant pulmonary sclerosing pneumocytoma with potentially malignant biological behavior: a case report and literature review

“…Moreover, 73.7% of isolated PSPs are smaller than 3 cm in average diameter ( 4 ), and rare cases of giant PSP have also been reported, including cases with tumors measuring 14 and 19 cm in size ( 12 , 13 ). PSP is more commonly found in a peripheral pattern and mainly distributed in the RML or lower left lobe (LLL) or right lobe (RLL) of the lungs ( 14 ). Multiple or diffuse PSP is rare, even in the mediastinum and bronchial lumen ( 11 , 15 ).…”

“…In one report, enhanced CT combined with texture analysis was used to locate calcification, and arterial phase CT values could assist in differentiating PSP from peripheral lung cancer ( 17 ). Depending on the different tissue structures of the lesion, different degrees of enhancement may occur in the early stage after enhanced scanning ( 14 ). Other less common CT signs of PSP, such as the halo sign, air crescent sign, caudal sign, and hemagglutination sign ( 11 , 18 ), are required to differentiate PSP from pulmonary aspergillosis, tuberculosis (TB), hamartoma, and other diseases.…”

Cross-sectional imaging review of common to uncommon lung cancer mimickers in a tertiary care oncology center

“…Even though solitary is the most common type, multiple lesions (Fig. 18) can also occur; in such cases, it is difficult to differentiate PSP from lung malignancy/metastases on imaging and will require histopathology to confirm the diagnosis (36,37).…”