title: Radiologic and nuclear medicine predictors of tumor invasiveness in patients with clinical stage IA lung adenocarcinoma.
abstract: BACKGROUND
  The aim of this study was to analyze parameters to predict tumor invasiveness according to high-resolution computed tomography and positron emission tomography in patients with clinical stage IA lung adenocarcinoma.
  
  
  METHODS
  A total of 122 patients with clinical stage IA lung adenocarcinoma were enrolled in the study. Receiver operating characteristic (ROC) curves were constructed for three factors--the degree of solid tumor component (solid%), maximum standard uptake value (SUVmax) and tumor size--and cutoff values were determined to reveal the highest sensitivity and specificity to diagnose tumor invasiveness. We created an algorithm for detecting tumor invasiveness (model 1). The data for the three factors were combined and their ROC curves constructed (model 2). A prospective study was conducted to validate the utility of these models.
  
  
  RESULTS
  Multivariate analysis identified solid%, SUVmax, and tumor size as potentially important predictors of tumor invasiveness. In the ROC curve analysis, solid% (area under the curve was 0.882) had the largest area under the curve, followed by the SUV (0.867) and tumor size (0.747). The combination assay using all three factors had the highest sensitivity and specificity for prediction (0.902). Models 1 and 2 were applied to the prospectively enrolled cases, and their utility was reviewed. Both models showed 100% sensitivity, with model 2 showing a slightly higher diagnostic value than model 1.
  
  
  CONCLUSIONS
  The solid portion ratio was a more powerful clinical predictor for lymphovascular invasion than the SUVmax. Our novel scoring model for tumor invasiveness can be employed for preoperative assessment of tumor invasiveness.
authors.affiliation: Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Takara-machi 13-1, Kanazawa, 920-8640, Japan. mtamura@med.kanazawa-u.ac.jp
authors.forename: Masaya
authors.initials: M
authors.lastname: Tamura
authors.forename: Makoto
authors.initials: M
authors.lastname: Oda
authors.forename: Isao
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Waseda
authors.forename: Go
authors.initials: G
authors.lastname: Watanabe
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000368:Aged; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18