Surgically curable peripheral lung carcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival.
OBJECTIVE
To define characteristics of surgically curable, early cancers of the lung, we retrospectively studied relationships between thin-section CT (TS-CT) scans, pathologic features, and outcome data in 287 patients with resected small-diameter (< 20 mm) peripheral lung carcinoma. Cases included 260 adenocarcinomas, 16 squamous cell carcinomas, 6 small cell carcinomas, 3 large cell carcinomas, and 2 others.


RESULTS
All tumors were classified by tumor shadow disappearance rate (TDR) on TS-CT as having either an "air-containing" or "solid-density" pattern. Adenocarcinomas are typically classified into these patterns. Air-containing patterns (n = 136) showed 1% pleural involvement and 2% vascular invasion, with no lymphatic permeation by pathology. Solid-density patterns (n = 124) showed 34% pleural involvement, 42% vascular invasion, and 29% lymphatic permeation. No cases of relapse or death were observed in cases with the air-containing pattern, in contrast to the high relapse and death rate in solid-density cases (p < 0.0001). All non-adenocarcinoma cases (n = 25) had a solid-density pattern, with 4% pleural involvement, 52% vascular invasion, and 44% lymphatic permeation. The overall 5-year survival rate for non-adenocarcinoma was 60%, similar to that for solid-density adenocarcinoma.


CONCLUSIONS
When peripheral lung cancers < 20 mm in diameter show air-containing patterns on TS-CT images, surgical outcomes may be favorable with curable disease.
Shimizu
Kunihiko
K
Toho University School of Medicine, Department of Internal Medicine, Division of Respiratory Medicine, Omorinishi 6-11-1, Otaku, Tokyo, Japan. kshimizu@med.toho-u.ac.jp
Yamada
Kouzou
K
Saito
Haruhiro
H
Noda
Kazumasa
K
Nakayama
Haruhiko
H
Kameda
Youichi
Y
Nakata
Koichiro
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010994:Pleura / Q000473:pathology; D011379:Prognosis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed