title: Advanced adenocarcinoma of the lung: comparison of CT characteristics of patients with anaplastic lymphoma kinase gene rearrangement and those with epidermal growth factor receptor mutation.
abstract: OBJECTIVE
  To study the differences in computed tomographic (CT) characteristics between patients with advanced lung adenocarcinoma who have anaplastic lymphoma kinase (ALK) gene rearrangement and those who have epidermal growth factor receptor (EGFR) mutations.
  
  
  METHODS
  This retrospective study was approved by the institutional review board. Informed consent was waived. Patients with stage IV adenocarcinoma (n = 198) were enrolled from November 2004 to December 2013, including 68 patients with ALK rearrangement and 130 with EGFR mutation. Two independent radiologists evaluated the main tumor in each patient and determined its size, type, margins, lymph node metastasis, and intrathoracic metastasis (lung, pleural or pericardial, or bone). A multiple logistic regression model was applied to discriminate clinical and CT characteristics between the types of mutation.
  
  
  RESULTS
  The κ index for assessment of tumor and node stage between radiologists was 0.8530 to 0.9388. Most of the main tumors in patients with both types of mutation appeared as solid masses. In univariate analysis, patients with an ALK rearrangement were younger (P < .001) and were more likely to be men (P = .001), to have never smoked (P = .002), and to have pleural or pericardial metastases (P < .05) compared with those with EGFR mutations. In multivariate analysis, lobulated margins (odds ratio, 4.815; 95% confidence interval [CI]: 1.789, 12.961; P = .002), N2 or N3 lymph node involvement (odds ratio, 2.445; 95% CI: 1.005, 5.950; P = .049), and lymphangitic lung metastasis (odds ratio, 8.485; 95% CI: 2.238, 32.170; P = .002) were more common in patients with ALK rearrangement than in those with EGFR mutation. The area under the receiver operating characteristic curve was 0.855.
  
  
  CONCLUSIONS
  Adenocarcinomas with ALK rearrangement appeared as solid masses with lobulated margins at CT and were more likely to be associated with lymphangitic metastasis, advanced lymph node metastasis, and pleural or pericardial metastasis than were tumors with EGFR mutations.
authors.affiliation: From the Departments of Pulmonary and Critical Care Medicine (C.M.C., W.S.K.), Oncology (C.M.C.), Radiology and Research Institute of Radiology (M.Y.K.), and Clinical Epidemiology and Biostatistics (J.B.L.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea; and Department of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Seoul, Korea (H.J.H.).
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Choi
authors.forename: Mi Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Hye Jeon
authors.initials: HJ
authors.lastname: Hwang
authors.forename: Jung Bok
authors.initials: JB
authors.lastname: Lee
authors.forename: Woo Sung
authors.initials: WS
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077548:Anaplastic Lymphoma Kinase; D001707:Biopsy, Needle; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000473:pathology; D003287:Contrast Media; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D015321:Gene Rearrangement; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007472:Iohexol / Q000031:analogs & derivatives; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000473:pathology; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D011857:Radiographic Image Interpretation, Computer-Assisted; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases