Prognosis of pulmonary lymphangitic carcinomatosis in patients with non-small cell lung cancer

Im, Yunjoo; Lee, Hyewon; Lee, Ho Yun; Baek, Sun‐Young; Jeong, Byeong‐Ho; Lee, Kyungjong; Kim, Hojoong; Kwon, Oh‐Jung; Han, Joungho; Lee, Kyung Soo; Ahn, Myung‐Ju; Kim, Young Tae; Um, Sang‐Won

doi:10.21037/tlcr-21-677

Cited by 6 publications

(3 citation statements)

References 27 publications

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“… 37 As per previous studies, approximately 5.5% of PLCs are associated with lymphangitis carcinomatosa, a feature not described in PLS. 38 In our study, carcinoma frequently showed a higher mean age, male predilection, smaller size at presentation, higher mean postcontrast attenuation, irregular shape, spiculated margins, and frequent distant metastasis with statistically significant difference. Background emphysematous changes, although not statistically significant, were seen 32.1% of carcinomas and only in one patient with sarcomatoid carcinoma, likely due to the higher association with smoking in carcinomas.…”

Section: Discussionsupporting

confidence: 47%

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Mohan,

Dhamija,

Bakhshi

et al. 2024

Indian J Radiol Imaging

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Background Primary lung sarcoma (PLS) differs in management protocols and prognosis from the more common primary lung carcinoma (PLC). It becomes imperative to raise a high index of suspicion on radiological and pathological features. Purpose The aim of this study is to highlight the variable imaging appearances of PLS compared with PLC, which impacts radiologic - pathologic correlation. Materials and Methods A retrospective observational study of 68 patients with biopsy-proven lung tumors who underwent baseline imaging at our tertiary care cancer hospital was conducted between January 2018 and March 2022. The patient details and imaging parameters of the mass on contrast-enhanced computed tomography (CECT) were recorded and analyzed for patients with PLS and compared with PLC. Follow-up imaging was available in 9/12 PLS and 52/56 PLC patients. Results Among 12 patients with PLS, 5 patients had synovial sarcoma on histopathology. PLS was seen in patients with a mean age of 40.8 years; the mass showed a mean size of 13.2 cm, lower lobe (75%), parahilar (75%), hilar involvement (41.7%), oval shape (41.7%), circumscribed (25%) or lobulated (75%) margins, lower mean postcontrast attenuation of 57.3 HU, fissural extension (50%), calcification (50%), and no organ metastasis other than to the lung. PLC (56 patients) was seen in the elderly with a mean age of 54.8 years; the mass showed a mean size of 5.7 cm, irregular shape (83.9%), spiculated margins (73.2%), higher mean postcontrast attenuation (77.3 HU), chest wall infiltration (30.4%), and distant metastasis (58.9%) at baseline imaging. A statistically significant difference (p < 0.05) was seen between sarcoma and carcinoma in the mean age, size, site, shape, margins, postcontrast attenuation, presence of calcifications, fissural extension, and distant metastasis. Conclusion The distinct imaging features of sarcoma help in differentiating it from carcinoma. This can also be used to corroborate with histopathology to achieve concordance and guide clinicians on further approach.

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Section: Discussionsupporting

confidence: 47%

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Mohan,

Dhamija,

Bakhshi

et al. 2024

Indian J Radiol Imaging

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“…Several malignancies are associated with PLC; primary lung cancer is a common cause of PLC. [1][2][3] The role of 18 F-FDG PET/CT in staging, prediction of prognosis, and assessment of response to therapy in lung cancer is well established, and literature suggests an incremental role of 18 F-FDG PET/CT in detection of the PLC as well. [4][5][6] PLC usually responds poorly to chemotherapy and is associated with poor prognosis.…”

Section: Figurementioning

confidence: 99%

“…PLC is associated with infiltration of the malignant cells through the lymphatics in the pulmonary vasculature from the primary site. Several malignancies are associated with PLC; primary lung cancer is a common cause of PLC 1–3 . The role of 18 F-FDG PET/CT in staging, prediction of prognosis, and assessment of response to therapy in lung cancer is well established, and literature suggests an incremental role of 18 F-FDG PET/CT in detection of the PLC as well 4–6 .…”

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confidence: 99%

Complete Metabolic Response in Adenocarcinoma Lung With Lymphangitic Carcinomatosis

et al. 2022

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Pulmonary lymphangitic carcinomatosis refers to the tumor spread into the lymphatic system of the lungs and is considered a poor prognostic marker. We present an interesting case of adenocarcinoma of right lung evaluated with 18F-FDG PET/CT for baseline staging, with extensive bilateral lung involvement and lymphangitic carcinomatosis pattern. Subsequently, the patient received 3 cycles of carboplatin- and pemetrexed-based chemotherapy regimen along with oral ceritinib. Complete metabolic response and significant reduction in size of the primary lung lesion was noted on response evaluation with 18F-FDG PET/CT, which is a rare phenomenon.

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Prognostic value of pretherapeutic FDG PET/CT in non-small cell lung cancer with pulmonary lymphangitic carcinomatosis

Park

Kwon

et al. 2023

Sci Rep

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Pulmonary lymphangitic carcinomatosis (PLC) is associated with a poor prognosis in patients with non-small cell lung cancer (NSCLC). We sought to determine prognostic value of pretherapeutic fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in NSCLC with radiologically diagnosed PLC. We retrospectively reviewed 50 NSCLC patients with radiologically diagnosed PLC. Among eight clinical variables and five imaging parameters, metabolic PLC burden, which represents the overall tumor burden of PLC, and cPLC, which represents the location and extent of PLC in a three-grade system, were used. In multivariate analyses for progression-free survival, metabolic PLC burden (P = 0.0181), cPLC (P = 0.0401), and clinical stage (P = 0.0284) were identified as independent prognostic factors. High metabolic PLC burden had a worse prognosis, and the prognosis of cPLC3 was significantly worse than that of cPLC1 or cPLC2. In univariate analyses for overall survival, only age (P = 0.0073) was identified a prognostic factor. In conclusion, FDG PET/CT parameters were identified as independent prognostic factors in NSCLC with radiologically diagnosed PLC. Furthermore, a combination of anatomical and metabolic information about PLC obtained using FDG PET/CT provides insight into the overall tumor burden of PLC and is useful in predicting prognosis.

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Prognosis of pulmonary lymphangitic carcinomatosis in patients with non-small cell lung cancer

Cited by 6 publications

References 27 publications

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Complete Metabolic Response in Adenocarcinoma Lung With Lymphangitic Carcinomatosis

Prognostic value of pretherapeutic FDG PET/CT in non-small cell lung cancer with pulmonary lymphangitic carcinomatosis

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