Morphological computed tomography features of surgically resectable pulmonary squamous cell carcinomas: impact on prognosis and comparison with adenocarcinomas.
OBJECTIVE
To characterize the morphological computed tomography (CT) features of pulmonary squamous cell carcinomas (SQCC) submitted to therapeutic resection; to correlate these features with patients' outcomes; and to compare with pulmonary adenocarcinomas (ADC).


METHODS
Two chest radiologists retrospectively evaluated CT exams of 123 patients with SQCC resected between 2002 and 2008. Tumors' size, location (central vs. peripheral), shape, margins, attenuation, enhancement, presence of calcification, cavitation, internal air bronchograms and pleural tags were assigned by consensus. Prevalence of features was compared with patients' survival data and a previously studied population of ADC surgically resected at the same time period.


RESULTS
Cavitation correlated negatively with overall (hazard ratio=3.04), disease-specific (HR=3.67) and disease-free survival (HR=2.69), independent from age, gender, tumor pathological stage, size, and location. In relation to ADC, SQCC presented different shape, margins, attenuation, enhancement, with more cavitation, rare internal air bronchograms, and less pleural tags. Differences were also significant when comparing only the peripheral type of tumors.


CONCLUSIONS
Cavitation at CT was an independent and negative predictive factor for SQCC. Different CT morphological features were described for SQCC and ADC. Image evaluation of lung lesions should go beyond measuring and addressing adjacent structures invasion. Adequate imaging characterization not only helps to differentiate benign versus malignant disease and to determine malignancy staging, it may also imply the histologic subtype and improve the prognostic assessment of lung cancer patients.
Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes 3900, Campus Universitario Monte Alegre, 14048 900 Ribeirao Preto, SP, Brazil. Electronic address: marcelk46@yahoo.com.br.
Marcel
M
Koenigkam Santos
Chest Clinic (Thoraxklinik) at University of Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg, Germany.
Thomas
T
Muley
Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany.
Arne
A
Warth
Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Radiology, University of Brasilia, Brasilia, Brazil.
Wagner Diniz
WD
de Paula
Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Thoracic and Cardiovascular Imaging, University of Bordeaux, Bordeaux, France.
Mathieu
M
Lederlin
Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg, Germany.
Philipp Albert
PA
Schnabel
German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
Heinz-Peter
HP
Schlemmer
Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg, Germany.
Hans-Ulrich
HU
Kauczor
Chest Clinic (Thoraxklinik) at University of Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg, Germany.
Claus Peter
CP
Heussel
German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Chest Clinic (Thoraxklinik) at University of Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg, Germany.
Michael
M
Puderbach
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015588:Observer Variation; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
Adenocarcinoma of lung; Computed tomography; Morphology; Squamous cell carcinoma of lung; Survival