The proportion of consolidation to ground-glass opacity on high resolution CT is a good predictor for distinguishing the population of non-invasive peripheral adenocarcinoma

doi:10.1016/j.lungcan.2003.07.001

Lung Cancer

Volume 42, Issue 3, December 2003, Pages 303-310

https://doi.org/10.1016/j.lungcan.2003.07.001 Get rights and content

Abstract

Objective: If non-invasive lung carcinomas are distinguishable on computed tomography (CT), limited surgery can be indicated before operation as a radical procedure. The purpose of this study is to define high resolution CT (HRCT) findings that indicate pathologic T1N0M0 tumor without vessel invasion. Patients and methods: We reviewed HRCT findings and pathological specimens of 98 consecutive patients underwent lobectomy or pneumonectomy with systematic hilar and mediastinal lymph node dissection from January 1996 to October 1999 for 101 pulmonary peripheral adenocarcinomas smaller than 3 cm in diameter on HRCT. A total of 101 consecutive surgically resected peripheral adenocarcinomas of the lung measuring 3.0 cm or less in the maximum dimension on HRCT were examined both radiologically and histologically. All CT scans ware reviewed by three chest radiologists or pulmonologists. The following parameters were measured on HRCT: the greatest diameter of tumor on found on all CT cuts (Td), the greatest diameter of consolidation found on all CT cuts (Cdmax), and the greatest diameter of consolidation found on a particular CT cut (Cd). Consolidation to tumor size ratio at respective maximum dimensions was calculated as Cdmax/Td, and consolidation to tumor size ratio on the slice image with the maximum tumor dimension was calculated as Cd/Td. One pathologist reviewed all pathological specimens to determine the size of tumor, evidence of vessel invasion, etc. without any information of HRCT, and we compared CT findings with pathological findings. Results: There was a statistically significant difference between tumors with pathologic T1N0M0 adenocarcinoma without vessel invasion (least invasive disease: LID) and tumors with lymph node involvement or vessel invasion (invasive disease: ID) in each parameter. However, only when tumors with Cdmax/Td smaller than 0.5 were selected as LID tumors, could ID tumors be eliminated from the LID group. Five-year survival rate of this population is 95.7%. Conclusion: Consolidation to tumor size ratio at respective maximum dimensions was the best predictor of non-invasive peripheral adenocarcinoma.

Introduction

If non-invasive lung carcinomas are distinguishable on computed tomography (CT), limited surgery can be indicated before operation and would result in a radical resection. Although not all pathologic T1N0M0 adenocarcinomas in the lung periphery without vessel invasion (lymphatic and vascular invasion) are necessarily non-invasive pathologically, it is evident that it is the clinical least invasive stage of the disease and these patients with this tumor will yield the best outcome among lung neoplasm patients [1], [2]. Pathologic T1N0M0 peripheral adenocarcinoma without both vascular and lymphatic invasion may be candidates for limited resection. We defined the pathologic T1N0M0 adnocarcinoma in the periphery without vessel invasion as least invasive disease (LID). Encouraged by the survival data, we attempted to define high resolution CT (HRCT) findings that indicate pathologic T1N0M0 tumor without vessel invasion. And this study is in preparation for future prospective study whether these population is candidate for limited surgery.

Section snippets

Materials and methods

From January 1996 to October 1999, 98 consecutive patients underwent lobectomy or pneumonectomy with systematic hilar and mediastinal lymph node dissection for 101 pulmonary peripheral adenocarcinomas smaller than 3 cm in diameter on HRCT. Of the 101 tumors, 74 from January 1996 to June 1998 were studied retrospectively, and 27 from January 1999 to October 1999 were examined prospectively. At first, they underwent conventional helical CT at 10 mm section interval before operation, using the

Results

Patient and tumor characteristics examined for HRCT findings are listed in Table 1. There were 66 cases of LID and 35 cases of ID. The greatest diameter of tumor on found on all CT cuts (Td) ranged from 7 to 29 mm with an average of 17 mm in the LID group and from 9 to 30 mm with an average of 21 mm in the ID group (Table 2). The greatest diameter of consolidation found on all CT cuts (Cdmax) ranged from 0 to 28 mm with an average of 12 mm in the LID group and from 9 to 30 mm with an average of 20 mm

Discussion

Lobectomy or pneumonectomy with systematic mediastinal lymphadenectomy is the standard surgical treatment for non-small-cell lung cancer [8]. However, peripheral lung cancers smaller than 2 cm in diameter have been increasingly found recently. Among a number of reports on limited resection for small sized lung cancer [9], [10], [11], [12], [13], [14], [15], the Lung Cancer Study Group has performed the only prospective randomized trial on limited resection [12]. They concluded that there was a

Acknowledgements

The authors thank Prof. J. Patrick Barron, International Medical Communications Center, Tokyo Medical College, for reviewing the English manuscript. The work was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare.

References (26)

L.E. Errett et al.
Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients
J. Thorac. Cardiovasc. Surg.
(1985)
J.I. Miller
Limited resection of bronchogenic carcinoma in the patient with impaired pulmonary function
Ann. Thorac. Surg.
(1993)
W.H. Warren et al.
Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma
J. Thorac. Cardiovasc. Surg.
(1994)
R.J. Landreneau et al.
Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer
J. Thorac. Cardiovasc. Surg.
(1997)
K. Kodama et al.
Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: a single-institution study
J. Thorac. Cardiovasc. Surg.
(1997)
N. Tsubota et al.
Ongoing prospective study of segmentectomy for small lung tumors
Ann. Thorac. Surg.
(1998)
H. Asamura et al.
Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy?
J. Thorac. Cardiovasc. Surg.
(1996)
T. Takizawa et al.
Lymph node metastasis in small peripheral adenocarcinoma of the lung
J. Thorac. Cardiovasc. Surg.
(1998)
T. Koike et al.
Clinical analysis of small-sized peripheral lung cancer
J. Thorac. Cardiovasc. Surg.
(1998)
S. Takashima et al.
Prognostic significance of high-resolution CT findings in small peripheral adenocarcinoma of the lung: a retrospective study on 64 patients
Lung Cancer
(2002)

H. Matsuguma et al.

Proportion of ground-glass opacity on high-resolution computed tomography in clinical T1N0M0 adenocarcinoma of the lung: a predictor of lymph node metastasis

J. Thorac. Cardiovasc. Surg.

(2002)

A. Takise et al.

Histopathologic prognostic factors in adenocarcinomas of the peripheral lung less than 2 cm in diameter

Cancer

(1988)

T. Kurokawa et al.

Surgically curable “early” adenocarcinoma in the periphery of the lung

Am. J. Surg. Pathol.

(1994)

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The proportion of consolidation to ground-glass opacity on high resolution CT is a good predictor for distinguishing the population of non-invasive peripheral adenocarcinoma

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

J. Thorac. Cardiovasc. Surg.

Ann. Thorac. Surg.

J. Thorac. Cardiovasc. Surg.

J. Thorac. Cardiovasc. Surg.

J. Thorac. Cardiovasc. Surg.

Ann. Thorac. Surg.

J. Thorac. Cardiovasc. Surg.

J. Thorac. Cardiovasc. Surg.

J. Thorac. Cardiovasc. Surg.

Lung Cancer

J. Thorac. Cardiovasc. Surg.

Histopathologic prognostic factors in adenocarcinomas of the peripheral lung less than 2 cm in diameter

Cancer

Surgically curable “early” adenocarcinoma in the periphery of the lung

Am. J. Surg. Pathol.