Subtypes of peripheral adenocarcinoma of the lung: differentiation by thin-section CT

Abstract

The purpose of this study was to scrutinize morphological characteristics of thin-section CT of the histopathological subtypes of adenocarcinoma of the lung. The subjects consisted of 83 patients with 87 adenocarcinomas measuring 3 cm or less in the largest. The tumors were divided into three groups (group I: Noguchi's histological subtypes type A and B tumors, group II: type C tumors, and group III: type D, E, and F tumors). In each group, tumor size, shape (round versus polygonal), presence of air bronchogram, bubble-like areas, coarse spiculation, pleural tag, and ratio of ground glass attenuation (GGA) were evaluated. Most of the group II lesions showed polygonal shape, whereas tumors in other groups were round in shape (P<0.01). Air bronchogram and bubble-like areas of low attenuation was seen more frequently in group II compared with those in group III (P<0.01). GGA areas were largest in group I and smallest in group III (P<0.01). We believe thin-section CT findings reflect the histopathological subtypes of adenocarcinoma of the lung. The presence of air bronchogram and bubble-like areas of low attenuation areas in particular is useful to differentiate replacement growth tumors from non-replacement growth tumors.

Prognostic Significance of Tumor Size of Small Lung Adenocarcinomas Evaluated with Mediastinal Window Settings on Computed Tomography

“…The solid type adenocarcinoma on CT was highly associated with non-lepidic predominant adenocarcinoma, such as acinar predominant, papillary predominant and solid predominant with mucin production [2], [3], [5]. In invasive adenocarcinoma, lepidic predominant adenocarcinomas have a much better prognosis than non-lepidic predominant adenocarcinomas [1], [2], [5], [9]–[11].…”

The IASLC Lung Cancer Staging Project: Background Data and Proposals for the Application of TNM Staging Rules to Lung Cancer Presenting as Multiple Nodules with Ground Glass or Lepidic Features or a Pneumonic Type of Involvement in the Forthcoming Eighth Edition of the TNM Classification

“…Studies involving primarily solitary sub-solid nodules note that lesions are reported as adenocarcinoma (with BAC features) in ~10% (7-30%) of pure GGN and ~50% (15-80%) of part-solid (>50% ground glass) lesions. 11,23,31,[33][34][35][36][37][38][39][40][41][42] Thus, while there is a general trend, radiographic findings do not correlate well with the histologic diagnosis. To an extent this suboptimal correlation may reflect ambiguities in the histologic terms (i.e.…”

Prognostic Importance of Volumetric Measurements in Stage I Lung Adenocarcinoma

“…In 2011, a new classification of adenocarcinoma (1) was developed to standardize diagnostic criteria and terminology applied to the wide spectrum of entities encompassed in this histologic subtype, which can range from indolent to lethal tumors. Results from several studies (2)(3)(4)(5) have shown by using computed tomographic (CT) imaging that morphologic structure of adenocarcinoma can be predictive of tumor grade and patient prognosis. As emphasized in the recently published recommendations for subsolid nodules from the Fleischner Society (6), measurement of solid components and determination of the relative percentages of solid versus ground-glass portions of subsolid nodules are important because an increase in the extent of a solid component is associated with a higher likelihood of an invasive tumor.…”