title: Pleural Tags on CT Scans to Predict Visceral Pleural Invasion of Non-Small Cell Lung Cancer That Does Not Abut the Pleura.
abstract: OBJECTIVE
  To evaluate the association of pleural tags with visceral pleural invasion of non-small cell lung cancer (NSCLC) that does not abut the pleural surface.
  
  
  METHODS
  This retrospective study was approved by the institutional review board. Informed consent was waived. The study of NSCLC that does not abut the pleura in 141 patients (44 patients [31.2%] with visceral pleural invasion proved by pathologic analysis and 97 patients [68.8%] without pleural invasion) was conducted at a single tertiary center. The pleural tags were classified into three types (type 1, one or more linear pleural tag; type 2, one or more linear pleural tag with soft tissue component at the pleural end; and type 3, one or more soft tissue cord-like pleural tag) and prioritized into types 3, 2, and 1 when more than one type was present. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio (LR) were calculated.
  
  
  RESULTS
  In the absence of pleural tags, no pleural invasion was found. The presence of type 2 pleural tags was moderately associated with visceral pleural invasion with the following results: positive LR, 5.06; accuracy, 71%; sensitivity, 36.4%; specificity, 92.8%; PPV, 76.2%; and NPV, 69.6%. Type 1 pleural tags provided weak evidence to rule out visceral pleural invasion (positive LR, 0.38). Type 3 pleural tags indicated minimal increase in the likelihood of visceral pleural invasion (positive LR, 1.68).
  
  
  CONCLUSIONS
  Type 2 pleural tags on conventional CT images can increase the accuracy of early diagnosis of visceral pleural invasion by NSCLC that does not abut the pleura.
authors.affiliation: From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
authors.forename: Jui-Sheng
authors.initials: JS
authors.lastname: Hsu
authors.affiliation: From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
authors.forename: I-Ting
authors.initials: IT
authors.lastname: Han
authors.affiliation: From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
authors.forename: Tzu-Hsueh
authors.initials: TH
authors.lastname: Tsai
authors.affiliation: From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
authors.forename: Shiou-Fu
authors.initials: SF
authors.lastname: Lin
authors.affiliation: From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
authors.forename: Twei-Shiun
authors.initials: TS
authors.lastname: Jaw
authors.affiliation: From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
authors.forename: Gin-Chung
authors.initials: GC
authors.lastname: Liu
authors.affiliation: From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
authors.forename: Shah-Hwa
authors.initials: SH
authors.lastname: Chou
authors.affiliation: From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
authors.forename: Inn-Wen
authors.initials: IW
authors.lastname: Chong
authors.affiliation: From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
authors.forename: Chiao-Yun
authors.initials: CY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging* / Q000473:pathology; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014781:Viscera / Q000000981:diagnostic imaging / Q000473:pathology