title: CT Features Associated with Epidermal Growth Factor Receptor Mutation Status in Patients with Lung Adenocarcinoma.
abstract: Purpose To retrospectively identify the relationship between epidermal growth factor receptor (EGFR) mutation status, predominant histologic subtype, and computed tomographic (CT) characteristics in surgically resected lung adenocarcinomas in a cohort of Asian patients. materials and Methods This study was approved by the institutional review board, with waiver of informed consent. Preoperative chest CT findings were retrospectively evaluated in 385 surgically resected lung adenocarcinomas. A total of 30 CT descriptors were assessed. EGFR mutations at exons 18-21 were determined by using the amplification refractory mutation system. Multiple logistic regression analyses were performed to identify independent factors of harboring EGFR mutation status. The final model was selected by using the backward elimination method, and two areas under the receiver operating characteristic curve (ROC) were compared with the nonparametric approach of DeLong, DeLong, and Clarke-Pearson. Results EGFR mutations were found in 168 (43.6%) of 385 patients. Mutations were found more frequently in (a) female patients (P < .001); (b)those who had never smoked (P < .001); (c)those with lepidic predominant adenocarcinomas (P = .001) or intermediate pathologic grade (P < .001); (e) smaller tumors (P < .001); (f)tumors with spiculation (P = .019), ground-glass opacity (GGO) or mixed GGO (P < .001), air bronchogram (P = .006), bubblelike lucency (P < .001), vascular convergence (P = .024), thickened adjacent bronchovascular bundles (P = .027), or pleural retraction (P < .001); and (g) tumors without pleural attachment (P = .004), a well-defined margin (P = .010), marked heterogeneous enhancement (P = .001), severe peripheral emphysema (P = .002), severe peripheral fibrosis (P = .013), or lymphadenopathy (P = .028). The most important and significantly independent prognostic factors of harboring EGFR-activating mutation for the model with both clinical variables and CT features were those who had never smoked and those with smaller tumors, bubblelike lucency, homogeneous enhancement, or pleural retraction when adjusting for histologic subtype, pathologic grade, or thickened adjacent bronchovascular bundles. ROC curve analysis showed that use of clinical variables combined with CT features (area under the ROC curve = 0.778) was superior to use of clinical variables alone (area under the ROC curve = 0.690). Conclusion CT imaging features of lung adenocarcinomas in combination with clinical variables can be used to prognosticate EGFR mutation status better than use of clinical variables alone. (©) RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla.
authors.forename: Jongphil
authors.initials: J
authors.lastname: Kim
authors.affiliation: From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla.
authors.forename: Fangyuan
authors.initials: F
authors.lastname: Qu
authors.affiliation: From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla.
authors.forename: Shichang
authors.initials: S
authors.lastname: Liu
authors.affiliation: From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla.
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.affiliation: From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla.
authors.forename: Yoganand
authors.initials: Y
authors.lastname: Balagurunathan
authors.affiliation: From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla.
authors.forename: Zhaoxiang
authors.initials: Z
authors.lastname: Ye
authors.affiliation: From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, PR China (Y.L., F.Q., S.L., H.W., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., H.W., Y.B., R.J.G.), Biostatistics and Bioinformatics (J.K.), and Radiology (R.J.G.), H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gillies
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000235:genetics*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D066246:ErbB Receptors