title: Diameter of Solid Tumor Component Alone Should be Used to Establish T Stage in Lung Adenocarcinoma.
abstract: OBJECTIVE
  The computed tomographic (CT) appearance of so-called ground glass components within lung adenocarcinomas correlate with noninvasive tumor histology, and solid radiographic components correlate with invasive histology. We hypothesized that T stage might be more accurately applied by considering the solid component nodule diameter rather than total nodule diameter.
  
  
  METHODS
  We identified 74 patients with a solitary lung adenocarcinoma who underwent resection without receiving neoadjuvant therapy. Maximum total diameter and solid diameter of the nodules were measured on CT scans performed within 3 months of surgery. Cox proportional hazard modeling and Kaplan-Meier analyses were performed to determine whether total nodule diameter or solid component diameter was more predictive of overall survival.
  
  
  RESULTS
  Thirty-three patients (45 %) had a solid nodule and 41 patients (55 %) had a part-solid nodule. Most patients were white (59 %) and female (69 %), and 42 % had never smoked. Seventy-four percent underwent lobectomy and 23 % sublobar resection. Sixty-six percent had pathologic stage I disease, 22 % stage II, and 12 % stage IIIA. Mean ± SD total and solid nodule diameters were 32.1 ± 17.5 and 24.8 ± 18.0 mm, respectively (p = 0.01). Among patients with part-solid nodules, multivariate modeling incorporating significant univariate predictors of survival (age, gender, procedure, N descriptor) revealed that maximum solid diameter was associated with overall survival (hazard ratio 1.4, p = 0.01), while maximum total diameter was not.
  
  
  CONCLUSIONS
  In a largely non-Asian cohort undergoing resection for adenocarcinoma, radiographic diameter of the solid component of a part-solid lesion on CT predicts overall survival better than total lesion diameter. These data provide further evidence to support altering the T descriptor for lung adenocarcinoma for part-solid nodules.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA. bryan.burt@bcm.edu.|Division of General Thoracic Surgery, Baylor College of Medicine, Houston, TX, USA. bryan.burt@bcm.edu.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Burt
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Ann N
authors.initials: AN
authors.lastname: Leung
authors.affiliation: University of Osaka, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yanagawa
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Chen
authors.affiliation: Division of General Thoracic Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Shawn S
authors.initials: SS
authors.lastname: Groth
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Chuong D
authors.initials: CD
authors.lastname: Hoang
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Viswam S
authors.initials: VS
authors.lastname: Nair
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D015996:Survival Rate; D047368:Tumor Burden