Peripheral lung adenocarcinomas: 10 mm or less in diameter

doi:10.1016/S0003-4975(03)00340-0

The Annals of Thoracic Surgery

Volume 76, Issue 2, August 2003, Pages 350-355

https://doi.org/10.1016/S0003-4975(03)00340-0 Get rights and content

Abstract

Background

Few reports have been published regarding peripheral lung adenocarcinomas that are 10 mm or less in diameter. This is considered to be the smallest tumor size detectable by present diagnostic modalities.

Methods

Clinicopathologic studies were performed in 57 patients with peripheral lung adenocarcinomas of 10 mm or less in diameter. Outcomes were compared with two other groups that consisted of 32 patients with adenocarcinomas between 11 and 15 mm in diameter and 35 patients with adenocarcinomas between 16 and 20 mm in diameter. Tumors were curatively resected between 1992 and 2002.

Results

The mean age was 61.7 years. The following three features were more frequent: female sex (78.9%), nonsmokers (77.2%), and cases with carcinoma detected by computed tomography despite negative chest radiography (96.5%). Negative lymphatic invasion (94.7%) was significantly higher. Three cases showed lymphatic invasion that was classified as types E or F, according to Noguchi’s classification. There were no cases of lymph node metastasis, pleural involvement, or intrapulmonary metastasis. Well-differentiated type was in 93.0%. Types A and B, which are noninvasive alveolar replacement-type adenocarcinomas, were significantly dominant (86.0%). The 5-year postoperative survival rate was 97.3%, which was significantly better than in the other two groups (75.5%, 78.1%).

Conclusions

Histopathologic features of most peripheral lung adenocarcinomas of 10 mm or less in diameter were types A and B. Types A and B were considered fundamentally indicated for thoracoscopic wedge resections. However, the other types required the standard operation.

Section snippets

Material and methods

Subjects consisted of 57 patients without preoperative treatment who had a peripheral lung adenocarcinoma of 10 mm or less in diameter (group 1). They were selected from 414 patients who underwent resection of a primary lung cancer in the Department of General Thoracic Surgery at Shizuoka Saiseikai General Hospital between April 1, l992, and June 30, 2002. Group 1 was compared with group 2, which consisted of 32 patients with an adenocarcinoma of 11 to 15 mm in diameter that was curatively

Clinical characteristics

The data are listed in Table 1. The mean age in group 1 was 61.7 years. Subjective symptoms were observed in only one case. There was no statistically significant difference in age and symptoms among the three groups. Group 1 consisted of a significantly larger number of women (45 cases, 78.9%) than the other two groups (50.0% in group 2 and 57.1% in group 3; p = 0.005, p = 0.03, respectively). Nonsmokers were prevalent in all groups, especially in group 1 with 44 cases (77.2%), which was

Comment

The percentage of women with small-sized lung adenocarcinomas has been reported as 52.2% [3] and 58.3% [9], which are equivalent to the percentages found in groups 2 and 3. However, the 78.9% found in group 1 was significantly higher than those. The risk of smoking in lung adenocarcinoma has remained low when compared with other histologic types of lung cancer, although it is now increasing in the United States and Japan. The risk of death as a result of lung adenocarcinoma for smokers has been

References (25)

T. Takizawa et al.
Lymph node metastasis in small peripheral adenocarcinoma of the lung
J Thorac Cardiovasc Surg
(1998)
C. Konaka et al.
Peripheral non-small cell lung cancers 2.0 cm or less in diameterproposed criteria for limited pulmonary resection based upon clinicopathological presentation
Lung Cancer
(1998)
T. Naruke et al.
Lymph node mapping and curability at various levels of metastasis in resected lung cancer
J Thorac Cardiovasc Surg
(1978)
S. Sone et al.
Mass screening for lung cancer with mobile spiral computed tomography scanner
Lancet
(1998)
N. Altorki et al.
Detection of early-stage lung cancercomputed tomographic scan or chest radiograph?
J Thorac Cardiovasc Surg
(2001)
C.I. Henschke et al.
Early Lung Cancer Action Projectoverall design and findings from baseline screening
Lancet
(1999)
R.J. Ginsberg et al.
Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group
Ann Thorac Surg
(1995)
R.C. Read et al.
Survival after conservative resection for T1 N0 M0 non-small cell lung cancer
Ann Thorac Surg
(1990)
K. Suzuki et al.
Predictors of lymph node and intrapulmonary metastasis in clinical stage I A non-small cell lung carcinoma
Ann Thorac Surg
(2001)
J.R. Izbicki et al.
Mode of spread in the early phase of lymphatic metastasis in non-small-cell lung cancersignificance of nodal micrometastasis
J Thorac Cardiovasc Surg
(1996)

S. Watanabe et al.

Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized (2 cm or less) lung cancer? Retrospective analysis of 225 patients

Eur J Cardiothorac Surg

(2001)

A. Takise et al.

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

Cancer

(1988)

Cited by (50)

Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage i non-small cell lung cancer Read at the 40th Annual Meeting of the Western Thoracic Surgical Association, Dana Point, California, June 25-28, 2014.
2015, Journal of Thoracic and Cardiovascular Surgery
Accurate cancer localization and negative resection margins are necessary for successful segmentectomy. In this study, we evaluate a newly developed software package that permits automated segmentation of the pulmonary parenchyma, allowing 3-dimensional assessment of tumor size, location, and estimates of surgical margins.
A pilot study using a newly developed 3-dimensional computed tomography analytic software package was performed to retrospectively evaluate preoperative computed tomography images of patients who underwent segmentectomy (n = 36) or lobectomy (n = 15) for stage 1 non–small cell lung cancer. The software accomplishes an automated reconstruction of anatomic pulmonary segments of the lung based on bronchial arborization. Estimates of anticipated surgical margins and pulmonary segmental volume were made on the basis of 3-dimensional reconstruction.
Autosegmentation was achieved in 72.7% (32/44) of preoperative computed tomography images with slice thicknesses of 3 mm or less. Reasons for segmentation failure included local severe emphysema or pneumonitis, and lower computed tomography resolution. Tumor segmental localization was achieved in all autosegmented studies. The 3-dimensional computed tomography analysis provided a positive predictive value of 87% in predicting a marginal clearance greater than 1 cm and a 75% positive predictive value in predicting a margin to tumor diameter ratio greater than 1 in relation to the surgical pathology assessment.
This preoperative 3-dimensional computed tomography analysis of segmental anatomy can confirm the tumor location within an anatomic segment and aid in predicting surgical margins. This 3-dimensional computed tomography information may assist in the preoperative assessment regarding the suitability of segmentectomy for peripheral lung cancers.
Clinicopathologic features of resected subcentimeter lung cancer
2015, Annals of Thoracic Surgery
Citation Excerpt :
Several studies have demonstrated that lung cancer 1 cm or less in diameter has the potential to spread locally, regionally, and systemically [2, 5]. The proportions of lymph node metastasis and the 5-year survival rates in resected subcentimeter lung cancer were 0% to 15% and 64.1% to 97.3%, respectively, as shown in Table 4 [2–5, 13–18]. The present study is important because it collected clinicopathologic data from a large number of patients with subcentimeter lung cancer.
Subcentimeter lung cancers are still rare, and their pathobiologic behavior and management have not yet been fully clarified.
From 1993 through 2011, 291 patients with resected lung cancers 1.0 cm or less in diameter were studied regarding their clinicopathologic characteristics. According to appearance on high-resolution computed tomography (HRCT), the tumors were classified into four types: type 1 (n = 50), nonsolid ground-glass opacity (GGO) lesion; type 2 (n = 89), part-solid GGO lesion including 50% or more GGO within the lesion; type 3 (n = 62), part-solid GGO lesion including less than 50% GGO within the lesion, and type 4 (n = 90), solid lesion.
Although none of types 1 to 3 tumors had lymph node metastases, these were found in 10% of type 4 tumors. Recurrence was observed in 13 patients, almost all of whom had type 4 tumors. The lone exception was a patient with a type 3 tumor in whom local recurrence developed on a surgical staple line. The 5-year overall survival rates were 100% in type 1 and type 2, 98% in type 3, and 88% in type 4. Type 4 had a significantly worse prognosis than the other types.
Subcentimeter lung cancers with a GGO component on HRCT (types 1 to 3) can be considered “early” lung cancers. In these cases, limited resection may be warranted to achieve a cure because they had no lymph node metastasis. By contrast, lobectomy should still be considered the standard operation of choice for type 4 tumors.
Impact of histologic subtyping on outcome in lobar vs sublobar resections for lung cancer: A pilot study
2014, Chest
The 2011 International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification of pulmonary adenocarcinomas introduces adenocarcinoma in situ and minimally invasive carcinoma and categorizes adenocarcinoma with more extensive invasion by the predominant subtype. Data have shown that wedge or segmentectomy (W/S) may be appropriate for in situ and minimally invasive adenocarcinoma, but whether sublobar resection is appropriate for tumors with more extensive invasion is unclear. The aim of this pilot study is to evaluate whether there are any trends regarding the impact of invasion and subtypes of carcinoma regarding survival in lobectomy vs W/S procedures using a comprehensive histologic evaluation.
Eighty-five surgical specimens (59 lobectomies, 26 W/Ss) were reviewed. Histologic type, size, pleural, lymphovascular invasion, and necrosis were recorded. Adenocarcinomas were classified by 2011 IASLC/ATS/ERS guidelines with each histologic pattern recorded as a percentage of the total tumor. Statistical analysis was performed using SAS, version 9.2. Proportional hazards regression analysis was used to evaluate survival according to resection type (lobectomy or W/S) adjusting for tumor size and the predominant histology.
Multivariate analysis did not show a statistically significant difference in survival between lobectomy and W/S specimens adjusting for tumor size, regardless of histologic subtype or other negative predictors of prognosis (P = .7704).
Our findings corroborate the prognostic significance of the 2011 adenocarcinoma subtyping classification and additionally suggest that lobectomy does not offer an overall survival advantage over W/S regardless of histologic subtype. Therefore, this finding suggests that limited resection may be appropriate for small size tumors, particularly those ≤ 2 cm with invasive histology.
Treatment of non-small cell lung carcinoma in early stages
2013, Cirugia Espanola
El tratamiento del carcinoma brongénico es multidisciplinar. Se dispone de diferentes estrategias terapéuticas, siendo la cirugía la que presenta mejores resultados en aquellos pacientes con carcinoma broncogénico en estadios precoces. Otras opciones como la radioterapia estereotáctica quedan relegadas a pacientes con pequeños tumores y mala reserva cardiopulmonar, o a aquellos que rechacen la cirugía. La quimioterapia adyuvante no está justificada en pacientes con enfermedad en estadio i, planteándose doble quimioterapia adyuvante basada en cisplatino tras la cirugía en aquellos con estadios ii y IIIA.
Treatment of lung carcinoma is multidisciplinary. There are different therapeutic strategies available, although surgery shows the best results in those patients with lung carcinoma in early stages. Other options such as stereotactic radiation therapy are relegated to patients with small tumors and poor cardiopulmonary reserve or to those who reject surgery. Adjuvant chemotherapy is not justified in patients with stage i of the disease and so double adjuvant chemotherapy should be considered. This adjuvant chemotherapy should be based on cisplatin after surgery in those patients with stages ii and IIIA.
American College of Chest Physicians and Society of Thoracic Surgeons Consensus Statement for Evaluation and Management for High-Risk Patients with Stage I Non-small Cell Lung Cancer
2012, Chest
Citation Excerpt :
A substantial body of literature has emerged over the last decade resurrecting interest in sublobar resection. Single-institution series consistently demonstrate equivalent regional recurrence and survival for anatomic segmentectomy compared with lobectomy for small node-negative tumors (Table 2).53–59 Increasing age is associated with increased risk following lung resection.60,61
The standard treatment of stage I non-small cell lung cancer (NSCLC) is lobectomy with systematic mediastinal lymph node evaluation. Unfortunately, up to 25% of patients with stage I NSCLC are not candidates for lobectomy because of severe medical comorbidity.
A panel of experts was convened through the Thoracic Oncology Network of the American College of Chest Physicians and the Workforce on Evidence-Based Surgery of the Society of Thoracic Surgeons. Following a literature review, the panel developed 13 suggestions for evaluation and treatment through iterative discussion and debate until unanimous agreement was achieved.
Pretreatment evaluation should focus primarily on measures of cardiopulmonary physiology, as respiratory failure represents the greatest interventional risk. Alternative treatment options to lobectomy for high-risk patients include sublobar resection with or without brachytherapy, stereotactic body radiation therapy, and radiofrequency ablation. Each is associated with decreased procedural morbidity and mortality but increased risk for involved lobe and regional recurrence compared with lobectomy, but direct comparisons between modalities are lacking.
Therapeutic options for the treatment of high-risk patients are evolving quickly. Improved radiographic staging and the diagnosis of smaller and more indolent tumors push the risk-benefit decision toward parenchymal-sparing or nonoperative therapies in high-risk patients. Unbiased assessment of treatment options requires uniform reporting of treatment populations and outcomes in clinical series, which has been lacking to date.
Percutaneous computed tomography-guided coaxial core biopsy for small pulmonary lesions with ground-glass attenuation
2012, Journal of Thoracic Oncology
The aim of this study was to investigate the diagnostic value of percutaneous computed tomography (CT)-guided coaxial transthoracic needle biopsy (TNB) for small pulmonary lesions (≤3 cm) with persistent ground-glass opacity (GGO).
From January 2004 to February 2010, consecutive patients with persistent small GGO lesions (≤3 cm) who underwent CT-guided TNB were analyzed. The pathologic results of CT-guided TNB were compared with final diagnoses, and the GGO percentage on CT was correlated with the stromal invasion in surgical pathology.
We performed CT-guided TNB on 1612 patients during the study period. Among them, 55 patients had persistent small GGO lesions (size range 0.5–3.0 cm; 1.72 ± 0.73 cm), 47 were diagnosed with lung adenocarcinomas, and 8 with benign nonspecific lesions. Minor procedure-related complications occurred in 26 patients (47.3%) with small pneumothorax and 11 patients (20.0%) with self-limited mild hemoptysis. The final diagnoses of the 43 patients receiving lobectomy were invasive adenocarcinoma (n = 23), pure bronchioloalveolar carcinoma (n = 19), and mucosa-associated lymphoid tissue lymphoma (n = 1). The diagnostic accuracy was 93.0% (40/43) using CT-guided TNB. Pure GGO lesions had a higher incidence of pure bronchioloalveolar carcinoma than GGO-dominant lesions (70.0% versus 21.7%; p = 0.004). Compared with surgical pathology, stromal invasion was underestimated in 43.5% (10/23) of the TNB specimens, especially in pure GGO lesions (83%, 5/6). In logistic regression analysis, the GGO percentage correlated inversely with stromal tumor invasion (p = 0.0028).
CT-guided coaxial TNB is a safe and useful method for diagnosing small (≤3 cm) persistent GGO lesions. Stromal invasion may be underestimated by TNB in GGO lesions.

View all citing articles on Scopus

View full text

Original article: general thoracicPeripheral lung adenocarcinomas: 10 mm or less in diameter

Abstract

Background

Methods

Results

Conclusions

Section snippets

Material and methods

Clinical characteristics

Comment

J Thorac Cardiovasc Surg

Lung Cancer

J Thorac Cardiovasc Surg

Lancet

J Thorac Cardiovasc Surg

Lancet

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized (2 cm or less) lung cancer? Retrospective analysis of 225 patients

Eur J Cardiothorac Surg

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

Cancer

Original article: general thoracic
Peripheral lung adenocarcinomas: 10 mm or less in diameter