Honeycomb lung is a major risk factor for preoperative radiological tumor size underestimation in patients with primary lung cancer

Abstract

Background: Lung cancer frequently occurs in lungs with background idiopathic interstitial pneumonias (IIPs). Limited resection is often selected to treat lung cancer in patients with IIPs in whom respiratory function is already compromised. However, accurate surgical margins are essential for curative resection; underestimating these margins is a risk for residual lung cancer after surgery. We aimed to investigate the findings of lung fields adjacent to cancer segments affect the estimation of tumor size on computed tomography compared with the pathological specimen.Methods: This analytical observational study retrospectively investigated 896 patients with lung cancer operated on at Fujita Health University from January 2015 to June 2020. The definition of underestimation was a ≥10 mm difference between the radiological and pathological maximum sizes of the tumor. Results:The lung tumors were in 15 honeycomb, 30 reticulated, 207 emphysematous, and 628 normal lungs. The ratio of underestimation in honeycomb lungs was 33.3% compared to 7.4% without honeycombing (P=0.004). Multivariate analysis showed that honeycombing was a significant risk factor for tumor size underestimation. A Bland-Altman plot represented wide 95% limits of agreement, −40.8 to 70.2 mm, between the pathological and radiological maximum tumor sizes in honeycomb lungs.Conclusions: Honeycomb lung adjacent to the tumor is a major risk factor for preoperative radiological tumor size underestimation in patients with lung cancer.

Impact of pulmonary fibrosis on tumor measurements

“…The current study by Ishizawa et al is therefore the first study exploring the impact of different lung abnormalities on tumor measurements ( 7 ). They included 896 patients with lung cancer, operated in one center.…”

A conundrum of honeycombing: challenges in tumor size estimation in patients with honeycombing in the lung

“…The study conducted by Ishizawa and his colleagues’ sheds light on the challenges faced in accurately determining the size of tumors in lung cancer patients with underlying ILD. They recruited patients diagnosed with lung cancer between January 2015 and June 2020, at Fujita Health University, a tertiary care center ( 15 ). The cohort was divided into those with normal lungs (n=628, 71.1%), emphysema (n=207, 23.4%), reticulations (n=30, 3.4%) and honeycombing (n=15, 1.7%) as seen on computed tomography (CT) chest, and radiological tumor size estimates were compared with pathologic/histologic measurements ( 15 ).…”

“…They recruited patients diagnosed with lung cancer between January 2015 and June 2020, at Fujita Health University, a tertiary care center ( 15 ). The cohort was divided into those with normal lungs (n=628, 71.1%), emphysema (n=207, 23.4%), reticulations (n=30, 3.4%) and honeycombing (n=15, 1.7%) as seen on computed tomography (CT) chest, and radiological tumor size estimates were compared with pathologic/histologic measurements ( 15 ). The authors used the 7 th edition of tumor, node, metastasis (TNM) lung cancer staging of tumor size estimation and staging the cancers ( 15 ).…”

“…The cohort was divided into those with normal lungs (n=628, 71.1%), emphysema (n=207, 23.4%), reticulations (n=30, 3.4%) and honeycombing (n=15, 1.7%) as seen on computed tomography (CT) chest, and radiological tumor size estimates were compared with pathologic/histologic measurements ( 15 ). The authors used the 7 th edition of tumor, node, metastasis (TNM) lung cancer staging of tumor size estimation and staging the cancers ( 15 ). Their study revealed critical findings concerning the preoperative radiological assessment of tumor size in lung cancer patients compared to the size of the tumor evaluated by pathologic examination.…”

“…It identified a significant risk of underestimating tumor size by 10 mm or more when honeycombing was adjacent to the tumor, as opposed to cases with reticulation, emphysema, or normal lung (P=0.003). Furthermore, the research highlighted a higher likelihood of tumor size underestimation in larger lesions (P=0.001) ( 15 ). Interestingly, there was no significant difference in tumor size underestimation between lung adenocarcinoma and squamous cell carcinoma ( 15 ).…”