Do hemodynamic studies of stage T1 lung cancer enable the prediction of hilar or mediastinal nodal metastasis?
OBJECTIVE
We aimed to identify CT enhancement characteristics that predict hilar or mediastinal nodal metastasis in patients with stage T1 lung cancer.


METHODS
Eighty-four patients (50 men and 34 women; age range, 39-80 years; mean age, 61 years) with stage T1 lung cancer underwent a hemodynamic and a conventional morphologic CT study before curative surgical resection. Peak enhancement (maximum attenuation over the entire time course), net enhancement (peak enhancement minus preenhancement attenuation), maximum enhancement ratio (MER), time to peak enhancement, slope of enhancement on dynamic studies, nodule size, presence of tumor necrosis or thickening of bronchovascular bundles, and marginal characteristics on morphologic studies were analyzed and correlated with the presence of histologically determined mediastinal or hilar nodal metastasis.


RESULTS
Mediastinal or hilar nodal metastases were found at surgery in 26 (31%) of 84 patients: mediastinal nodes in 13 (15%) and hilar nodes in 19 (23%). Six (7%) had both mediastinal and hilar nodal metastasis. Peak enhancement, net enhancement, and MER were significantly associated (p = 0.001, 0.002, and 0.008, respectively) with the presence of mediastinal or hilar nodal metastasis. A peak attenuation of 110 H or greater and a net enhancement of 60 H or greater predicted nodal metastasis with accuracies of 73% (61/84 nodules) and 73% (61/84 nodules) and odd ratios of 4.98 and 5.94, respectively.


CONCLUSIONS
Stage T1 lung cancers showing peak enhancement of 110 H or greater or net enhancement of 60 H or greater on dynamic CT indicate a high likelihood of hilar or mediastinal nodal metastasis.
Shim
Sung Shine
SS
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
Lee
Kyung Soo
KS
Chung
Myung Jin
MJ
Kim
Hojoong
H
Kwon
O Jung
OJ
Kim
Seonwoo
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000503:physiopathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D014057:Tomography, X-Ray Computed