title: Estimation of the pathological invasive size of pulmonary adenocarcinoma using high-resolution computed tomography of the chest: A consideration based on lung and mediastinal window settings.
abstract: OBJECTIVE
  Since the proposal of the new classification of pulmonary adenocarcinoma (PADC), the size of pathological invasion has become more important. We aimed to determine whether high-resolution computed tomography (HRCT) could be used to preoperatively evaluate PADC invasive size.
  
  
  METHODS
  We investigated 360 complete resected cT1a-1b-2aN0 PADCs. We examined the correlation of pathological invasive size with three HRCT parameters [whole tumor dimension in the lung window (LD), consolidation dimension in the lung window (CD), and tumor dimension in the mediastinal window (MD)]. HRCT prediction of an invasive size of ≤5 mm was determined using receiver operating characteristic curve analysis.
  
  
  RESULTS
  Pathological invasive size correlated well with both CD (r(2)=0.710) and MD (r(2)=0.743) comparably, and moderately with LD (r(2)=0.514). CD and MD tended to be slightly larger and smaller, respectively, than the actual invasive size. Invasive size roughly approximated to MD+3mm, and an invasive size of ≤5 mm was best predicted by MD, followed by CD. MD of ≤2 mm and 0mm predicted an invasive size of ≤5 mm with 64.1% and 47.4% sensitivity and 96.5% and 98.9% specificity, respectively. Lymphovascular invasion was best predicted by MD followed by CD. Pleural invasion and lymph node metastasis was predicted well by both MD and CD.
  
  
  CONCLUSIONS
  Preoperative estimation of the invasive size of PADC and evaluation of other parameters of invasiveness were possible using MD. This approach using HRCT may play a complementary role in more thorough clinical staging of PADC.
authors.affiliation: Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakakura
authors.affiliation: Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Inaba
authors.affiliation: Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yatabe
authors.affiliation: Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mizuno
authors.affiliation: Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kuroda
authors.affiliation: Innovative Clinical Research Center, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yoshimura
authors.affiliation: Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. Electronic address: ysakao@aichi-cc.jp.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Sakao
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D057234:Preoperative Period; D012372:ROC Curve; D014057:Tomography, X-Ray Computed / Q000379:methods*; D047368:Tumor Burden
keywords: High-resolution computed tomography; Lung cancer staging; Pathological invasive size; Pulmonary adenocarcinoma