Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: Histopathologic features and their prognostic implications

Abstract

Purpose-To study the histopathologic features of CT screen-detected Stage IA adenocarcinomas to determine whether survival differed by the proportion of bronchioloalveolar component (BAC) or by the presence of multiple lesions in node-negative patients.Methods-Five pathologists with expertise in pulmonary pathology examined 279 resected cases of adenocarcinomas, 30 mm or less in length diagnosed by CT screening for lung cancer. The panel determined the consensus diagnosis for each case, identified additional cancers, and classified each case as solitary or non-solitary. The presence and proportion of BAC was also documented.Results-Of the cases of adenocarcinoma, 20 (7%) were BAC subtype, 246 (88%) mixed subtype and 13 (5%) adenocarcinoma-OTHER. BAC cases manifested as non-solid and part solid nodules, mixed as solid and part-solid, and other as solid only. Kaplan-Meier 10-year survival rates were 100% for BAC and adeno-MIXED with 90-99% BAC cases, 95% for mixed with 1-90% BAC, 90% for those without a BAC component, and 75% for other cases. Conflicts of interestThe authors other than Claudia I. Henschke and David F. Yankelevitz indicated no potential conflicts of interest. The potential conflicts of Claudia I. Henschke and David F. Yankelevitz are not related to pathology, but could be interpreted as being related to screening. carcinomas and 44 of these were node negative; the non-solitary node-negative cases had the same excellent prognosis as solitary node-negative cases. NIH Public AccessAuthor Manuscript Lung Cancer. Author manuscript; available in PMC 2010 April 5.Conclusions-The proportion of BAC component was a positive prognostic factor and correlated with CT consistency. Contrary to staging predictions, cases of non-solitary node-negative adenocarcinoma had the same excellent prognosis as solitary node-negative cases, suggesting that most of the small, node-negative multiple carcinomas probably represent multiple primaries rather than intrapulmonary metastasis.

Invasiveness and Malignant Potential of Pulmonary Lesions Presenting as Pure Ground-Glass Opacities

“…Multiple studies [1][2][3][4][5][6][7] have shown a 100% 5-year disease-free survival rate, if complete resection is performed for patients with solitary lung adenocarcinoma exhibiting pure lepidic growth (<2-3 cm). Corresponding to adenocarcinoma in situ (AIS) in the International Association for the Study of Lung Cancer/American Thoracic Society/ European Respiratory Society international multidisciplinary classification of lung adenocarcinoma, 8) these tumors are a good indication for sublobar resection.…”

Early-stage pulmonary adenocarcinoma (T1N0M0): a clinical, radiological, surgical, and pathological correlation of 104 cases. The MD Anderson Cancer Center Experience

“…Thus, among our patient population, 48 patients had a previous history of malignancy, while in 56 patients the pulmonary neoplasm was the only malignancy established. Univariable and multivariable statistical analyses looking at the clinical aspects, such as 36 20 o2 cm e Yoshizawa et al 37 8 Not provided Sakurai et al 38 25 0.5-3.0 cm Yim et al 40 42 is, in our opinion, not a reliable predictor of such, as none of our patients had recurrent disease during the specified follow-up period. We did, however, note a trend towards better prognosis, although not statistically significant, in all those tumors with a lepidic component (P ¼ 0.058).…”

“…The authors stated that they had reviewed 11 thousand citations from which they selected 312 that 'met specified eligibility.' The citations supporting their notion, interestingly, have been presented as series of bronchioloalveolar carcinomas or small adenocarcinomas (o2 cm) [29][30][31][32][33][34][35][36][37][38][39][40][41] (Table 5). In some of these, the actual size of the tumor has been at best vague leaving the impression that some of these lesions may not even qualify as adenocarcinoma, but would rather have to be classified as atypical adenomatous hyperplasia (tumors with lepidic growth and size r0.5 cm).…”

Akciğer Kanserinde Evreleme: Yenilikler

“…Bu tümörler diğer solid tümörlere göre çok daha uzun "doubling" zamanına sahiptir. Multifokal tümör varlığı, diğer kanser tiplerine göre bu hastalarda sağkalım sürele-rinde daha az etkilidir [18].…”