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
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)
- et al.
Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients
J. Thorac. Cardiovasc. Surg.
(1985) Limited resection of bronchogenic carcinoma in the patient with impaired pulmonary function
Ann. Thorac. Surg.
(1993)- et al.
Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma
J. Thorac. Cardiovasc. Surg.
(1994) - et al.
Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer
J. Thorac. Cardiovasc. Surg.
(1997) - 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) - et al.
Ongoing prospective study of segmentectomy for small lung tumors
Ann. Thorac. Surg.
(1998) - 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) - et al.
Lymph node metastasis in small peripheral adenocarcinoma of the lung
J. Thorac. Cardiovasc. Surg.
(1998) - et al.
Clinical analysis of small-sized peripheral lung cancer
J. Thorac. Cardiovasc. Surg.
(1998) - 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)
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.
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.
Cited by (134)
CT imaging of HIV-associated pulmonary disorders in COVID-19 pandemic
2023, Clinical ImagingPrognostic Impact of the Histologic Lepidic Component in Pathologic Stage IA Adenocarcinoma
2022, Journal of Thoracic OncologyA single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer
2022, Journal of Thoracic and Cardiovascular SurgeryRadiologic Features of Resected Lung Adenocarcinoma With Epithelial–Mesenchymal Transition
2021, Annals of Thoracic Surgery