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Prognostic Significance of Thin-Section CT Scan Findings in Small-Sized Lung Adenocarcinoma^*

^* From the Department of Respiratory Medicine (Dr. Hashizume), Yamato City Hospital, Kanagawa, Japan; and the Departments of Thoracic Oncology (Drs. Yamada, Saito, Oshita, and Noda), Thoracic Surgery (Drs Kato, Ito, and Nakayama), Research Institute (Dr. Okamoto), and Pathology (Dr. Kameda), Kanagawa Cancer Center, Yokohama, Japan.

Correspondence to: Toshihiko Hashizume, MD, Yamato City Hospital, Department of Respiratory Medicine, Fukami-nishi 8-3-6, Yamato-city, Kanagawa, 242-8602 Japan; e-mail: toshi{at}yk9.so-net.ne.jp

Abstract

Objectives: The purpose of this study is to evaluate the prognostic importance of thin-section (TS) CT scan findings in small-sized lung adenocarcinomas.

Patients and methods: We reviewed TS-CT scan findings and pathologic specimens from 359 consecutive patients who underwent surgical resection for peripheral lung adenocarcinomas 20 mm in diameter during the period from July 1997 to May 2006. By using TS-CT scan images, tumors were defined as air-containing types if the maximum diameter of tumor opacity on mediastinal window images was less than or equal to half of that seen on lung window images, and as a solid-density type if the maximum diameter on the mediastinal window images was more than half of that on lung window images. We compared TS-CT scan findings to pathologic findings (ie, lymph node metastasis, pleural invasion, vessel invasion, and lymphatic invasion) and prognosis. The following prognostic factors were analyzed by ² test and Cox proportional hazard model: age; gender; tumor size; pathologic stage; TS-CT scan findings; histologic subtypes defined by Noguchi et al (ie, Noguchi type); pleural involvement; lymphatic invasion; and vascular invasion.

Results: No pathologic invasive findings or recurrence were found in patients with air-containing-type tumors. Pathologic invasive findings and recurrence were found in 10 to 30% of patients with solid-density-type tumors. The air-containing type tumors seen on TS-CT scans and Noguchi type A or B tumors were demonstrated as prognostic factors for good outcome by ² test (p < 0.001). Multivariate analyses revealed lymphatic permeation as a significant prognostic factor.

Conclusion: The TS-CT scan findings were important predictive factors for postsurgical outcome in patients with lung adenocarcinoma.

Key Words: bronchioloalveolar cell carcinoma • ground-glass opacity • limited surgery • noninvasive cancer