title: Correlation between whole tumor size and solid component size on high-resolution computed tomography in the prediction of the degree of pathologic malignancy and the prognostic outcome in primary lung adenocarcinoma.
abstract: BACKGROUND
  The presence of ground glass opacity (GGO) on high-resolution computed tomography (HRCT) is well known to be pathologically closely associated with adenocarcinoma in situ.
  
  
  OBJECTIVE
  To determine whether it is more useful to evaluate the whole tumor size or only the solid component size to predict the pathologic high-grade malignancy and the prognostic outcome in lung adenocarcinoma.
  
  
  METHODS
  Using HRCT data of 232 patients with adenocarcinoma who underwent curative resection, we retrospectively measured the whole tumor and solid component sizes with lung window setting (WTLW and SCLW) and whole tumor sizes with a mediastinal window setting (WTMW).
  
  
  RESULTS
  There was significant correlation between the WTLW and the measurements of pathological whole tumor (pWT) (r = 0.792, P < 0.0001). The SCLW and WTLW values significantly correlated with the area of pathological invasive component (pIVS) (r = 0.762, P < 0.0001 and r = 0.771, P < 0.0001, respectively). The receiver operating characteristics area under the curve for WTLW, SCLW, and WTMW used to identify lymph node metastasis or lymphatic or vascular invasion were 0.693, 0.817, and 0.824, respectively. Kaplan-Meier curves of disease-free survival (DFS) and overall survival (OS) were better divided according to SCLW and WTMW, compared with WTLW. Multivariate analysis of DFS and OS revealed that WTMW was an independent prognostic factor (HR = 0.72, 95% confidence interval [CI] = 0.58-0.90, P = 0.004 and HR = 0.74, 95% CI = 0.57-0.96, P = 0.022, respectively).
  
  
  CONCLUSIONS
  The predictive values of the solid tumor size visualized on HRCT especially in the mediastinal window for pathologic high-grade malignancy and prognosis in lung adenocarcinoma were greater than those of whole tumor size.
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan Department of Chest Surgery, St. Marianna University School of Medicine, Kanagawa, Japan saji-q@ya2.so-net.ne.jp.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Saji
authors.affiliation: Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Matsubayashi
authors.affiliation: Department of Radiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Akata
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yujin
authors.initials: Y
authors.lastname: Kudo
authors.affiliation: Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Nagao
authors.affiliation: Department of Radiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Jinho
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kakihana
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kajiwara
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ohira
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ikeda
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Lung adenocarcinoma; ground glass nodule; high-resolution computed tomography; prognosis; solid component