Estimation of the pathological invasive size of pulmonary adenocarcinoma using high-resolution computed tomography of the chest: A consideration based on lung and mediastinal window settings

Inaba, Yoshitaka; Yatabe, Yasushi; Mizuno, Tetsuya; Kuroda, Hiroaki; Yoshimura, Kenichi; Sakao, Yukinori

doi:10.1016/j.lungcan.2016.02.017

Cited by 32 publications

(40 citation statements)

References 18 publications

(29 reference statements)

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“…Fifth, pathologic invasive size was not measured in this study because our cohort included old cases and the pathologists at the time did not measure it. However, previous studies reported that the pathologic invasive size was correlated with solid size (2, 26,27).…”

Section: Figurementioning

confidence: 96%

“…For non-small cell lung cancer resected surgically, many pathologic and genetic factors have been reported to define prognosis (23)(24)(25). The pathologic invasive size of the surgical specimen that is correlated with the solid size at thin-section CT is a representative prognostic factor (2, 26,27). Recently, stereotactic radiation therapy has been gaining attention as an alternative therapy; however, the pathologic prognostic factors are limited for this therapy.…”

Section: Figurementioning

confidence: 99%

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Computer-aided Volumetry of Part-Solid Lung Cancers by Using CT: Solid Component Size Predicts Prognosis

et al. 2018

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Purpose To investigate the relationship between the postoperative prognosis of patients with part-solid non-small cell lung cancer and the solid component size acquired by using three-dimensional (3D) volumetry software on multidetector computed tomographic (CT) images. Materials and Methods A retrospective study by using preoperative multidetector CT data with 0.5-mm section thickness, clinical records, and pathologic reports of 96 patients with primary subsolid non-small cell lung cancer (47 men and 49 women; mean age ± standard deviation, 66 years ± 8) were reviewed. Two radiologists measured the two-dimensional (2D) maximal solid size of each nodule on an axial image (hereafter, 2D MSSA), the 3D maximal solid size on multiplanar reconstructed images (hereafter, 3D MSSMPR), and the 3D solid volume of greater than 0 HU (hereafter, 3D SV) within each nodule. The correlations between the postoperative recurrence and the effects of clinical and pathologic characteristics, 2D MSSA, 3D MSSMPR, and 3D SV as prognostic imaging biomarkers were assessed by using a Cox proportional hazards model. Results For the prediction of postoperative recurrence, the area under the receiver operating characteristics curve was 0.796 (95% confidence interval: 0.692, 0.900) for 2D MSSA, 0.776 (95% confidence interval: 0.667, 0.886) for 3D MSSMPR, and 0.835 (95% confidence interval: 0.749, 0.922) for 3D SV. The optimal cutoff value for 3D SV for predicting tumor recurrence was 0.54 cm, with a sensitivity of 0.933 (95% confidence interval: 0.679, 0.998) and a specificity of 0.716 (95% confidence interval: 0.605, 0.811) for the recurrence. Significant predictive factors for disease-free survival were 3D SV greater than or equal to 0.54 cm (hazard ratio, 6.61; P = .001) and lymphatic and/or vascular invasion derived from histopathologic analysis (hazard ratio, 2.96; P = .040). Conclusion The measurement of 3D SV predicted the postoperative prognosis of patients with part-solid lung cancer more accurately than did 2D MSSA and 3D MSSMPR. RSNA, 2018.

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Section: Figurementioning

confidence: 96%

Section: Figurementioning

confidence: 99%

Computer-aided Volumetry of Part-Solid Lung Cancers by Using CT: Solid Component Size Predicts Prognosis

et al. 2018

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“…MD was an important predictive factor for prognosis as well as for lymph node involvement and tumor invasiveness in small (1–3 cm) lung adenocarcinoma [ 10 ]. Additionally, the high correlation between IS and MD findings were previously postulated [ 14 ]. Furthermore, for the evaluation of the tumor malignant behavior, the mediastinal window setting reflected it among various imaging settings, and we considered that even volume (3D) was similar to the area (2D).…”

Section: Discussionmentioning

confidence: 81%

“…One main reason exists why we used MWV as a substitute for MTV. Our previously reports suggested that tumor dimension determined by mediastinal window settings provided additional useful prognostic data that could not be evaluated by lung window settings in previous studies [ 9 , 10 , 14 ]. Furthermore, tumor size was a significantly better prognostic factor when evaluated by MD, instead of consolidation maximum diameter on lung window setteing.…”

Section: Discussionmentioning

confidence: 93%

Prognostic significance of combined radiologic imaging modalities for prognosis of clinical IA adenocarcinomas

et al. 2017

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BackgroundWe previously proposed measuring tumor size using mediastinal window setting on high-resolution computed tomography (CT) as a simple and useful modality for preoperative prognostication of small adenocarcinoma. Hence, the importance of tumor volume and positron emission tomography (PET) for preoperative prognostication of clinical stage IA (cIA) adenocarcinoma was studied.Materials and MethodsWe retrospectively evaluated total 324 patients who underwent pulmonary resection of cIA adenocarcinoma between July 2008 and August 2015. Reconstructed three-dimensional (3D) images from 1–1.5 mm-sliced CT were evaluated for whole tumor volume including ground grass opacity, consolidation volume on lung window setting, and mediastinal window volume (MWV). The values examined by PET were total lesion glycolysis (TLG), and maximum standardized uptake (SUV max) and mean. Pathologic status was evaluated according to tumor maximum size, invasive size (IS), lymphatic and vascular vessels, pleural invasion (ly/v/pl), and TNM staging.ResultsAccording to ly/v/pl invasion and lymph node positivity, no variables were superior to IS. We used Mean/MWV (SUV mean x MWV) to evaluate tumor quality and quantity in the role of surrogate TLG. Mean/MWV were superior to IS. Additionally, Mean/MV was associated with lymph node metastases. Among the various histologic subtypes, solid-predominant had the highest expression of Mean/MV. The higher Mean/MV significantly contributed to unfavorable disease-free survival in cIA adenocarcinomas, but not to overall survival.ConclusionsThe mean/MWV value determination on 3D-reconstructed CT images was a simple and useful preoperative modality for predicting invasive facet in cIA adenocarcinoma. However, higher values didn't significantly affect overall survival.

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“…On preoperative on thin sliced CT (1–2 mm), we evaluated the tumor maximum diameter (TMD) and the consolidation diameter on the lung window setting (level = −550 HU; width =1,500 HU) and hilar and mediastinal LNs on the mediastinal window setting (level =40 HU; width =360 HU). 14 , 15 The C/T ratio was calculated by dividing the consolidation diameter by the TMD. A C/T ratio of >0.5 has previously been reported to suggest a high frequency of LN metastases in NSCLC.…”

Section: Methodsmentioning

confidence: 99%

Higher frequency of occult lymph node metastasis in clinical N0 pulmonary adenocarcinoma with <em>ALK</em> rearrangement

Seto

Kuroda

Yoshida

et al. 2018

CMAR

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ObjectivesThere have been few studies that have fully elucidated the relationship between genomic mutations in pulmonary adenocarcinomas and occult lymph node (LN) metastases (pN1-2) despite a preoperative clinical N0 stage (cN0). It is well known that anaplastic lymphoma kinase (ALK) rearrangements are more likely to occur in younger patients with high grade tumors. The aim of this study was to investigate the genomic status, examine the clinicopathologic features, and evaluate whether ALK mutations are associated with occult LN metastases.Materials and methodsWe retrospectively evaluated 459 Japanese patients who underwent pulmonary resection of cN0 adenocarcinomas between January 2012 and December 2015. The clinicopathologic characteristics, including age, sex, smoking index, tumor maximum diameter and consolidation/tumor ratio on computed tomography (CT), maximum standardized uptake value on positron emission tomography (PET) and gene mutations (epidermal growth factor receptor [EGFR], ALK, and kirsten ras genes (KRAS), were evaluated.ResultsALK and EGFR and KRAS mutations were all mutually exclusive. Among 324 patients found to have mutations, ALK was involved in 19 (5.9%), EGFR in 266 (82.1%), and KRAS in 39 (12.0%). The incidence of occult LN metastases did not differ significantly between those with or without mutations (p=0.27). On univariate and multivariate analyses, tumors with ALK were more likely to have occult LN metastases (p=0.03). In cN0 tumors with ALK, pN1 was diagnosed in 26.3% and pN2 in 10.5%, whereas pN1 or pN2 stage was found in <10.0% in those with EGFR or KRAS mutations or with no mutations at all. No significant difference was found in the 2-year disease-free survival among those with gene mutations (p=0.08).ConclusionThis study highlights the frequency of PET- and CT-negative occult LN metastases in resected adenocarcinomas with ALK rearrangement. Our multivariate analysis showed that ALK rearrangements were associated with a significantly higher incidence of occult LN metastasis compared with ALK-negative adenocarcinomas.

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Estimation of the pathological invasive size of pulmonary adenocarcinoma using high-resolution computed tomography of the chest: A consideration based on lung and mediastinal window settings

Cited by 32 publications

References 18 publications

Computer-aided Volumetry of Part-Solid Lung Cancers by Using CT: Solid Component Size Predicts Prognosis

Computer-aided Volumetry of Part-Solid Lung Cancers by Using CT: Solid Component Size Predicts Prognosis

Prognostic significance of combined radiologic imaging modalities for prognosis of clinical IA adenocarcinomas

Higher frequency of occult lymph node metastasis in clinical N0 pulmonary adenocarcinoma with <em>ALK</em> rearrangement

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