Chest
Volume 127, Issue 3, March 2005, Pages 871-878
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Clinical Investigations: Surgery
Surgically Curable Peripheral Lung Carcinoma: Correlation of Thin-Section CT Findings With Histologic Prognostic Factors and Survival

https://doi.org/10.1378/chest.127.3.871Get rights and content

Study objectives

To define characteristics of surgically curable, early cancers of the lung, we retrospectively studied relationships between thin-section CT (TS-CT) scans, pathologic features, and outcome data in 287 patients with resected small-diameter (< 20 mm) peripheral lung carcinoma. Cases included 260 adenocarcinomas, 16 squamous cell carcinomas, 6 small cell carcinomas, 3 large cell carcinomas, and 2 others

Measurements and results

All tumors were classified by tumor shadow disappearance rate (TDR) on TS-CT as having either an “air-containing” or “solid-density” pattern. Adenocarcinomas are typically classified into these patterns. Air-containing patterns (n = 136) showed 1% pleural involvement and 2% vascular invasion, with no lymphatic permeation by pathology. Solid-density patterns (n = 124) showed 34% pleural involvement, 42% vascular invasion, and 29% lymphatic permeation. No cases of relapse or death were observed in cases with the air-containing pattern, in contrast to the high relapse and death rate in solid-density cases (p < 0.0001). All non-adenocarcinoma cases (n = 25) had a solid-density pattern, with 4% pleural involvement, 52% vascular invasion, and 44% lymphatic permeation. The overall 5-year survival rate for non-adenocarcinoma was 60%, similar to that for solid-density adenocarcinoma

Conclusions

When peripheral lung cancers < 20 mm in diameter show air-containing patterns on TS-CT images, surgical outcomes may be favorable with curable disease

Section snippets

Materials and Methods

We retrospectively reviewed the records and CT images of 287 patients with peripheral lung cancers < 20 mm in diameter between 1992 and 2002. The majority of patients were found by screening for lung cancer. Those found by chance during follow-up of other diseases were the second most common. The patients who visited our hospital with complaints suggestive of lung cancer ranked third. Informed consent was obtained from each patient before operation. Chest CT images were obtained by an

Results

Patient characteristics are summarized in Table 1. A total of 287 patients (128 men and 159 women; age range, 26 to 86 years; mean age, 65 years) were included in the study, and consisted of 260 cases of adenocarcinoma and 27 cases of non-adenocarcinoma (16 squamous cell, 6 small cell, 3 large cell, and 2 of other histology). Among the adenocarcinoma cases, there were 62 cases with the largest diameter of the lesion < 10 mm, 88 cases were 10 to 15 mm, and 110 cases were 16 to 20 mm.

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Discussion

Tumor size in lung adenocarcinoma cancer is not as good a prognostic factor as it is for squamous cell carcinoma, we often encounter small lung adenocarcinomas that have mediastinal lymph node involvement or even distant metastasis. Peripheral lung adenocarcinomas smaller than 3 cm frequently recur, resulting in cancer deaths (5-year disease-free survival for T1N0 disease of approximately 70%).4 It is important to established reliable prognostic factors for small peripheral lung adenocarcinoma.

Conclusion

Air-containing adenocarcinoma patterns may correspond to an early stage of disease when they occur in the periphery of the lung and are < 20 mm in diameter.

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This work was supported in part by Grant for Scientific Research Expenses for Health Labour and Welfare Programs and the Foundation for the Promotion of Cancer Research, and by Second-Term Comprehensive 10-year Strategy for Cancer Control

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