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Chen F, Li J, Li L, Tong L, Wang G, Zou X. Multidimensional biological characteristics of ground glass nodules. Front Oncol 2024; 14:1380527. [PMID: 38841161 PMCID: PMC11150621 DOI: 10.3389/fonc.2024.1380527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
The detection rate of ground glass nodules (GGNs) has increased in recent years because of their malignant potential but relatively indolent biological behavior; thus, correct GGN recognition and management has become a research focus. Many scholars have explored the underlying mechanism of the indolent progression of GGNs from several perspectives, such as pathological type, genomic mutational characteristics, and immune microenvironment. GGNs have different major mutated genes at different stages of development; EGFR mutation is the most common mutation in GGNs, and p53 mutation is the most abundant mutation in the invasive stage of GGNs. Pure GGNs have fewer genomic alterations and a simpler genomic profile and exhibit a gradually evolving genomic mutation profile as the pathology progresses. Compared to advanced lung adenocarcinoma, GGN lung adenocarcinoma has a higher immune cell percentage, is under immune surveillance, and has less immune escape. However, as the pathological progression and solid component increase, negative immune regulation and immune escape increase gradually, and a suppressive immune environment is established gradually. Currently, regular computer tomography monitoring and surgery are the main treatment strategies for persistent GGNs. Stereotactic body radiotherapy and radiofrequency ablation are two local therapeutic alternatives, and systemic therapy has been progressively studied for lung cancer with GGNs. In the present review, we discuss the characterization of the multidimensional molecular evolution of GGNs that could facilitate more precise differentiation of such highly heterogeneous lesions, laying a foundation for the development of more effective individualized treatment plans.
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Affiliation(s)
- Furong Chen
- Department of Oncology, The First People’s Hospital of Shuangliu District/West China (Airport) Hospital, Sichuan University, Chengdu, China
| | - Jiangtao Li
- Department of Oncology, The First People’s Hospital of Shuangliu District/West China (Airport) Hospital, Sichuan University, Chengdu, China
| | - Lei Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
- Department of State Key Laboratory of Respiratory Health and Multimobidity, West China Hospital, Sichuan University, Chengdu, China
| | - Lunbing Tong
- Department of Respiratory Medicine, Chengdu Seventh People’s Hospital/Affiliated Cancer Hospital of Chengdu Medical College, Chengdu, China
| | - Gang Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
- Department of State Key Laboratory of Respiratory Health and Multimobidity, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelin Zou
- Department of Respiratory Medicine, Chengdu Seventh People’s Hospital/Affiliated Cancer Hospital of Chengdu Medical College, Chengdu, China
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Xu SJ, Chen C, Tu JH, You CX, Chen RQ, Zhang ZF, Chen SC. Dynamic Analysis of the Impact of Micropapillary Component on Different Recurrence Patterns of Pathological Stage IA3 Lung Adenocarcinoma: A Multicenter, Retrospective Study. Ann Surg Oncol 2024; 31:872-882. [PMID: 37962740 DOI: 10.1245/s10434-023-14520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/15/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND This study aimed to evaluate the dynamic impact of the micropapillary (MIP) component on local recurrence (LR), distant metastasis (DM), and multiple recurrence (MR) of pathological stage IA3 lung adenocarcinoma. METHODS Between July 2012 and July 2020, a total of 351 patients at two medical institutions were enrolled in this study. Cumulative incidence of curves, dynamic risk curves, and time-dependent multivariate analysis was performed to evaluate the effect of the MIP component on patients. RESULTS The 5-year cumulative incidence of total recurrence with or without an MIP component was 34.2% and 12.3%, respectively (p = 0.001). In three recurrence patterns, our findings revealed that the 5-year cumulative incidence of LR (p = 0.048) and DM (p = 0.005) was higher in the 'MIP-present' group than in the 'MIP-absent' group. In the dynamic recurrence curve, the risk of the three recurrence patterns was different and varied over time between the two groups, especially in DM. Moreover, the dynamic cumulative event curve showed that after 1, 2, and 3 years of survival, the cumulative incidence of DM in the group with MIP continued to be higher than that in the group without MIP (all p < 0.05). Time-dependent Cox regression analysis indicated that the MIP component continued to be an independent risk factor for the cumulative incidence of DM in patients with 3-year survival. CONCLUSIONS Of the three recurrence patterns, the MIP component mainly aggravated the risk of DM in patients with pathological stage IA3 lung adenocarcinoma, which persisted for 3 years.
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Affiliation(s)
- Shao-Jun Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian Province, China
| | - Chao Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian Province, China
| | - Jia-Hua Tu
- Department of Thoracic Surgery, The First Hospital of Putian, Putian, Fujian Province, China
| | - Cheng-Xiong You
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian Province, China
| | - Rui-Qin Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian Province, China
| | - Zhi-Fan Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian Province, China
| | - Shu-Chen Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian Province, China.
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Ren Q, Li Q, Shao C, Zhang P, Hu Z, Li J, Wang W, Yu Y. Establishing a prognostic model based on immune-related genes and identification of BIRC5 as a potential biomarker for lung adenocarcinoma patients. BMC Cancer 2023; 23:897. [PMID: 37741993 PMCID: PMC10517491 DOI: 10.1186/s12885-023-11249-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/03/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Lung adenocarcinoma (LUAD) is an extraordinarily malignant tumor, with rapidly increasing morbidity and poor prognosis. Immunotherapy has emerged as a hopeful therapeutic modality for lung adenocarcinoma. Furthermore, a prognostic model (based on immune genes) can fulfill the purpose of early diagnosis and accurate prognostic prediction. METHODS Immune-related mRNAs (IRmRNAs) were utilized to construct a prognostic model that sorted patients into high- and low-risk groups. Then, the prediction efficacy of our model was evaluated using a nomogram. The differences in overall survival (OS), the tumor mutation landscape, and the tumor microenvironment were further explored between different risk groups. In addition, the immune genes comprising the prognostic model were subjected to single-cell RNA sequencing to investigate the expression of these immune genes in different cells. Finally, the functions of BIRC5 were validated through in vitro experiments. RESULTS Patients in different risk groups exhibited sharply significant variations in OS, pathway activity, immune cell infiltration, mutation patterns, and immune response. Single-cell RNA sequencing revealed that the expression level of BIRC5 was significantly high in T cells. Cell experiments further revealed that BIRC5 knockdown markedly reduced LUAD cell proliferation. CONCLUSION This model can function as an instrumental variable in the prognostic, molecular, and therapeutic prediction of LUAD, shedding new light on the optimal clinical practice guidelines for LUAD patients.
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Affiliation(s)
- Qianhe Ren
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qifan Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chenye Shao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Pengpeng Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhuangzhuang Hu
- Department of Urology, Shuyang First People's Hospital, Suqian, China
| | - Jun Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Wei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Yue Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Ren Q, Zhang P, Lin H, Feng Y, Chi H, Zhang X, Xia Z, Cai H, Yu Y. A novel signature predicts prognosis and immunotherapy in lung adenocarcinoma based on cancer-associated fibroblasts. Front Immunol 2023; 14:1201573. [PMID: 37325647 PMCID: PMC10264584 DOI: 10.3389/fimmu.2023.1201573] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Background Extensive research has established the significant correlations between cancer-associated fibroblasts (CAFs) and various stages of cancer development, including initiation, angiogenesis, progression, and resistance to therapy. In this study, we aimed to investigate the characteristics of CAFs in lung adenocarcinoma (LUAD) and develop a risk signature to predict the prognosis of patients with LUAD. Methods We obtained single-cell RNA sequencing (scRNA-seq) and bulk RNA-seq data from the public database. The Seurat R package was used to process the scRNA-seq data and identify CAF clusters based on several biomarkers. CAF-related prognostic genes were further identified using univariate Cox regression analysis. To reduce the number of genes, Lasso regression was performed, and a risk signature was established. A novel nomogram that incorporated the risk signature and clinicopathological features was developed to predict the clinical applicability of the model. Additionally, we conducted immune landscape and immunotherapy responsiveness analyses. Finally, we performed in vitro experiments to verify the functions of EXO1 in LUAD. Results We identified 5 CAF clusters in LUAD using scRNA-seq data, of which 3 clusters were significantly associated with prognosis in LUAD. A total of 492 genes were found to be significantly linked to CAF clusters from 1731 DEGs and were used to construct a risk signature. Moreover, our immune landscape exploration revealed that the risk signature was significantly related to immune scores, and its ability to predict responsiveness to immunotherapy was confirmed. Furthermore, a novel nomogram incorporating the risk signature and clinicopathological features showed excellent clinical applicability. Finally, we verified the functions of EXP1 in LUAD through in vitro experiments. Conclusions The risk signature has proven to be an excellent predictor of LUAD prognosis, stratifying patients more appropriately and precisely predicting immunotherapy responsiveness. The comprehensive characterization of LUAD based on the CAF signature can predict the response of LUAD to immunotherapy, thus offering fresh perspectives into the management of LUAD patients. Our study ultimately confirms the role of EXP1 in facilitating the invasion and growth of tumor cells in LUAD. Nevertheless, further validation can be achieved by conducting in vivo experiments.
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Affiliation(s)
- Qianhe Ren
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengpeng Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haoran Lin
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanlong Feng
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Chi
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Xiao Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhijia Xia
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Huabao Cai
- Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yue Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Sugawara H, Yatabe Y, Watanabe H, Akai H, Abe O, Watanabe SI, Kusumoto M. Radiological precursor lesions of lung squamous cell carcinoma: Early progression patterns and divergent volume doubling time between hilar and peripheral zones. Lung Cancer 2023; 176:31-37. [PMID: 36584605 DOI: 10.1016/j.lungcan.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/28/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study investigated the early progression patterns of lung squamous cell carcinoma (SqCC) on computed tomography (CT) images. MATERIALS AND METHODS In total, 65 patients with SqCC who underwent surgical resection and two CT scans separated by an interval of at least 6 months were enrolled. We categorized the findings of the initial and at-diagnosis CT images into five patterns as previously reported. The volume doubling time (VDT) was calculated for measurable lesions. RESULTS A single nodule pattern on CT images at-diagnosis was most common in 56 (86.2 %) patients, in line with practical clinical findings. However, the patterns were diverse in the initial images, with 28 (43.1 %) patients displaying atypical findings, including multiple nodules (3.1 %), endobronchial lesions (20.0 %), subsolid nodules (10.8 %), and cyst wall thickening (9.2 %). All endobronchial lesions were located in the central/middle zone of the lung field, whereas lesions presented as multiple nodules, subsolid nodules, and cyst wall thickening were predominantly observed in the peripheral zone. The differences in the developed zones were reflected in the median VDT, and the tumors with an initial endobronchial pattern had a significantly shorter VDT than those with a subsolid nodule pattern (median: 140 days vs 276 days, p < 0.001). CONCLUSIONS Lung SqCC initiated with various CT image patterns, although most tumors ultimately developed a single nodule pattern by diagnosis. The initial CT image patterns differed between the hilar and peripheral zones, suggesting a difference in the progression scheme, which was also supported by differences in VDT.
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Affiliation(s)
- Haruto Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan; Department of Radiology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.
| | - Hirokazu Watanabe
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Akai
- Department of Radiology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
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Zhang Z, Zhou L, Yang F, Li X. The natural growth history of persistent pulmonary subsolid nodules: Radiology, genetics, and clinical management. Front Oncol 2022; 12:1011712. [PMID: 36568242 PMCID: PMC9772280 DOI: 10.3389/fonc.2022.1011712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
The high detection rate of pulmonary subsolid nodules (SSN) is an increasingly crucial clinical issue due to the increased number of screening tests and the growing popularity of low-dose computed tomography (LDCT). The persistence of SSN strongly suggests the possibility of malignancy. Guidelines have been published over the past few years and guide the optimal management of SSNs, but many remain controversial and confusing for clinicians. Therefore, in-depth research on the natural growth history of persistent pulmonary SSN can help provide evidence-based medical recommendations for nodule management. In this review, we briefly describe the differential diagnosis, growth patterns and rates, genetic characteristics, and factors that influence the growth of persistent SSN. With the advancement of radiomics and artificial intelligence (AI) technology, individualized evaluation of SSN becomes possible. These technologies together with liquid biopsy, will promote the transformation of current diagnosis and follow-up strategies and provide significant progress in the precise management of subsolid nodules in the early stage of lung cancer.
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Sato D, Matsubara H, Matsuoka H, Kondo T, Sasanuma H, Sugimura A, Onuki Y, Uchida T, Nakajima H. Lepidic growth component as a favorable prognostic factor in non-small cell lung cancer of ≤3 cm. Thorac Cancer 2022; 13:3274-3283. [PMID: 36218004 PMCID: PMC9715824 DOI: 10.1111/1759-7714.14680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Many non-small cell lung cancer (NSCLC) tumors present complex histology with various components. The effects of the lepidic growth component (LGC) on the prognosis of NSCLC have not been investigated. Here, we investigated whether an LGC is a relevant prognostic factor for NSCLC. METHODS This study retrospectively investigated the clinicopathologic characteristics of 379 patients with NSCLC ≤3 cm who underwent complete surgical resection between 2004 and 2016 at the University of Yamanashi Hospital. The histologic subtypes were classified into NSCLC with or without an LGC. We evaluated the effect of an LGC on the clinicopathologic features and 5-year overall survival of patients with NSCLC. RESULTS On final pathology, 214 (56%) of 379 patients had an LGC, and 165 (44%) did not. Sex, smoking history, ground-glass opacity component, pathologic invasive size, lymph node metastasis, pleural invasion, vessel invasion, pathologic stage, and histologic type were significantly different between the groups. Multivariate analysis of 5-year overall survival, identified age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.035-1.105; p < 0.001), pathologic invasive size (HR, 1.548; 95% CI, 1.088-2.202; p = 0.015) and LGC (HR, 2.11; 95% CI, 1.099-4.051; p = 0.025) as independent prognostic factors. When the pathologic invasive size was matched, the 5-year overall survival of the LGC and non-LGC groups was 93% and 77%, respectively (p = 0.006). CONCLUSIONS LGC is a significantly favorable prognostic factor for NSCLC with a pathologic invasive size of ≤3 cm.
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Affiliation(s)
- Daisuke Sato
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan,Department of Thoracic SurgeryNihon University School of MedicineTokyoJapan
| | | | | | - Tetsuo Kondo
- Department of PathologyUniversity of YamanashiYamanashiJapan
| | | | - Aya Sugimura
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan
| | - Yuichiro Onuki
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan
| | - Tsuyoshi Uchida
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan
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Solitary Pulmonary Capillary Hemangioma: CT and PET-CT Features with Clinicopathologic Correlation. Diagnostics (Basel) 2022; 12:diagnostics12112618. [DOI: 10.3390/diagnostics12112618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the CT and PET-CT features of solitary pulmonary capillary hemangioma (SPCH) with clinicopathologic correlations. This retrospective study included 17 patients with histologically proven SPCH from four tertiary institutions. The clinical, pathological and imaging findings of SPCH were reviewed. The CT features assessed included lesion location, size, density, contour, margin, enhancement, presence of air bronchogram, perivascular lucency and pleural retraction, and 18F-fluorodeoxyglucose uptake on PET-CT. Changes in the size during the follow-up period were also evaluated. Imaging features were correlated with the clinicopathologic findings. The mean age of the patients was 47 years (range 30–60 years). All SPCHs were incidentally detected during screening CT examinations (n = 13, 76%) or during cancer work-up (n = 4, 24%). Most SPCHs appeared as part-solid nodules (n = 15, 88%), the remaining appeared as a pure ground-glass nodule or a pure solid nodule, respectively. Most had smooth contours (n = 16, 94%), while one had a lobulated contour. Nine SPCHs (53%) showed ill-defined margins. Air bronchogram was present in ten (59%) SPCHs, and perivascular lucency in two (12%). All SPCHs exhibited hypoattenuation on contrast-enhanced CT and hypometabolism on PET-CT. During the follow-up period (mean 14.8 ± 17.7 months), the lesions showed no change in size or density in ten SPCHs (59%), decreased or fluctuation in size and density in three (18%). SPCH is often incidentally detected in young and middle-aged adults, commonly as an ill-defined part-solid nodule that may accompany air bronchogram, perivascular lucency, and fluctuation in size or density on CT and hypometabolism on PET-CT.
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Song C, Pan S, Li D, Hao B, Lu Z, Lai K, Li N, Geng Q. Comprehensive analysis reveals the potential value of inflammatory response genes in the prognosis, immunity, and drug sensitivity of lung adenocarcinoma. BMC Med Genomics 2022; 15:198. [PMID: 36117156 PMCID: PMC9484176 DOI: 10.1186/s12920-022-01340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although the relationship between inflammatory response and tumor has been gradually recognized, the potential implications of of inflammatory response genes in lung adenocarcinoma (LUAD) remains poorly investigated. Methods RNA sequencing and clinical data were obtained from multiple independent datasets (GSE29013, GSE30219, GSE31210, GSE37745, GSE42127, GSE50081, GSE68465, GSE72094, TCGA and GTEx). Unsupervised clustering analysis was used to identify different tumor subtypes, and LASSO and Cox regression analysis were applied to construct a novel scoring tool. We employed multiple algorithms (ssGSEA, CIBERSORT, MCP counter, and ESTIMATE) to better characterize the LUAD tumor microenvironment (TME) and immune landscapes. GSVA and Metascape analysis were performed to investigate the biological processes and pathway activity. Furthermore, ‘pRRophetic’ R package was used to evaluate the half inhibitory concentration (IC50) of each sample to infer drug sensitivity. Results We identified three distinct tumor subtypes, which were related to different clinical outcomes, biological pathways, and immune characteristics. A scoring tool called inflammatory response gene score (IRGS) was established and well validated in multiple independent cohorts, which could well divide patients into two subgroups with significantly different prognosis. High IRGS patients, characterized by increased genomic variants and mutation burden, presented a worse prognosis, and might show a more favorable response to immunotherapy and chemotherapy. Additionally, based on the cross-talk between TNM stage, IRGS and patients clinical outcomes, we redefined the LUAD stage, which was called ‘IRGS-Stage’. The novel staging system could distinguish patients with different prognosis, with better predictive ability than the conventional TNM staging. Conclusions Inflammatory response genes present important potential value in the prognosis, immunity and drug sensitivity of LUAD. The proposed IRGS and IRGS-Stage may be promising biomarkers for estimating clinical outcomes in LUAD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01340-7.
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Song C, Lin W, Meng H, Li N, Geng Q. Integrated Analysis Reveals the Potential Significance of HDAC Family Genes in Lung Adenocarcinoma. Front Genet 2022; 13:862977. [PMID: 36072664 PMCID: PMC9441483 DOI: 10.3389/fgene.2022.862977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/22/2022] [Indexed: 11/22/2022] Open
Abstract
Histone deacetylases comprise a family of 18 genes, and classical HDACs are a promising class of novel anticancer drug targets. However, to date, no systematic study has been comprehensive to reveal the potential significance of these 18 genes in lung adenocarcinoma (LUAD). Here, we used a systematic bioinformatics approach to comprehensively describe the biological characteristics of the HDACs in LUAD. Unsupervised consensus clustering was performed to identify LUAD molecular subtypes. The ssGSEA, CIBERSORT, MCP counter, and ESTIMATE algorithms were used to depict the tumor microenvironment (TME) landscape. The Cox proportional hazards model and LASSO regression analyses were used to construct the HDAC scoring system for evaluating the prognosis of individual tumors. In this study, three distinct HDAC-mediated molecular subtypes were determined, which were also related to different clinical outcomes and biological pathways. HDACsCluster-C subtype had lowest PD-L1/PD-1/CTLA4 expression and immune score. The constructed HDAC scoring system (HDACsScore) could be used as an independent predictor to assess patient prognosis and effectively identify patients with different prognosis. High- and low-HDACsScore groups presented distinct genetic features, immune infiltration, and biological processes. The high-HDACsScore group was more likely to benefit from immunotherapy, as well as from the application of common chemotherapeutic agents (cyclopamine, docetaxel, doxorubicin, gemcitabine, paclitaxel, and pyrimethamine). Overall, HDAC family genes play important roles in LUAD, and the three LUAD subtypes and the HDAC scoring system identified in this study would help enhance our perception of LUAD prognostic differences and provide important insights into the efficacy of immunotherapy and chemotherapy.
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Akhtar Z, Laageide L, Robles J, Winters C, Wall GC, Mallen J, Jawa Z. Unusual presentation of lepidic adenocarcinoma in a healthy female. BMC Pulm Med 2022; 22:197. [PMID: 35578218 PMCID: PMC9109452 DOI: 10.1186/s12890-022-01969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/24/2022] [Indexed: 11/26/2022] Open
Abstract
Background Lepidic adenocarcinoma represents a histologic pattern of non-small cell lung cancer that characteristically arises in the lung periphery with tracking alongside pre-existing alveolar walls. Noninvasive and invasive variants of lepidic adenocarcinoma are dependent on parenchymal destruction, vascular, or pleural invasion. The lepidic-predominant lung malignancies are collectively recognized as slow growing with rare metastasis and excellent prognosis. The World Health Organization classification of lung malignancies depends on molecular and histopathological findings. CT findings most commonly include ground-glass characteristics, commonly mistaken for inflammatory or infectious etiology. These tumors are generally surgically resectable and associated with better survival given infrequent nodal and extrathoracic involvement. Rarely these tumors present with diffuse pneumonic-type involvement associated with worse outcomes despite lack of nodal and distant metastases. Case presentation A 63-year-old Caucasian athletic immunocompetent female presented with 2 months of progressive shortness of breath, fatigue, loss of appetite and 15 pound weight loss. History was only notable for well controlled essential hypertension and hypothyroidism. Contrast computed tomography angiogram and positron emission tomography revealed diffuse hypermetabolic interstitial and airspace abnormalities of the lungs without lymphadenopathy (or distant involvement) in addition to right hydropneumothorax and left pleural effusion. Baseline laboratory testing was unremarkable, and extensive bacterial and fungal testing returned negative. Bronchoscopy and video-assisted thoracoscopic surgery was subsequently performed with pleural fluid cytology, lung and pleural biopsies returning positive for lepidic adenocarcinoma with 2% programmed death ligand 1 expression and genomic testing positive for PTEN gene deletion. Prior to treatment, the patient perished on day 15 of admission. Conclusion We present a rare case of lepidic predominant adenocarcinoma with extensive bilateral aerogenous spread in the context of no lymphovascular invasion in a healthy, low risk patient. This case presentation may add to the body of knowledge regarding the different behavior patterns of lepidic predominant adenocarcinomas.
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Affiliation(s)
- Zaheer Akhtar
- PGY3 Internal Medicine Resident, Department of Medical Education, UnityPoint Health, Des Moines, IA, USA. .,Department of Medicine, UnityPoint Health, Des Moines, IA, USA.
| | - Leah Laageide
- Department of Medicine, UnityPoint Health, Des Moines, IA, USA
| | - Julian Robles
- Department of Medicine, UnityPoint Health, Des Moines, IA, USA
| | | | - Geoffrey C Wall
- Drake College of Pharmacy and Health Sciences, Des Moines, IA, USA
| | - James Mallen
- Department of Pulmonology, The Iowa Clinic and UnityPoint Health, Des Moines, IA, USA
| | - Zeeshan Jawa
- John Stoddard and Mission Cancer Center, Des Moines, IA, USA
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12
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He XQ, Li X, Wu Y, Wu S, Luo TY, Lv FJ, Li Q. Differential Diagnosis of Nonabsorbable Inflammatory and Malignant Subsolid Nodules with a Solid Component ≤5 mm. J Inflamm Res 2022; 15:1785-1796. [PMID: 35300212 PMCID: PMC8923683 DOI: 10.2147/jir.s355848] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the differential clinical and computed tomography (CT) characteristics of pulmonary nonabsorbable inflammatory and malignant subsolid nodules (SSNs) with a solid component ≤5 mm. Patients and Methods We retrospectively analyzed 576 consecutive patients who underwent surgical resection and had SSNs with a solid component ≤5 mm on CT images. These patients were divided into inflammatory and malignant groups according to pathology. Their clinical and imaging data were analyzed and compared. Multiple logistic regression analysis was used to identify independent prognostic factors differentiating inflammatory from malignant SSNs. Furthermore, 146 consecutive patients were included as internal validation cohort to test the prediction efficiency of this model. Results Significant differences in 11 clinical characteristics and CT features were found between both groups (P < 0.05). Presence of respiratory symptoms, distribution of middle/lower lobe, irregular shape, part-solid nodule (PSNs), CT value of ground-glass opacity (GGO) areas <−657 Hu, presence of abnormal intra-nodular vessel sign, and interlobular septal thickening were the most effective factors for diagnosing nonabsorbable inflammatory SSNs, with an AUC (95% CI), accuracy, sensitivity, and specificity of 0.843 (95% CI: 0.811–0.872), 89.76%, 72.86%, and 81.23%, respectively. The internal validation cohort obtained an AUC (95% CI), accuracy, sensitivity, and specificity of 0.830 (95% CI: 0.759–0.887), 83.56%, 73.91%, and 76.42%, respectively. Conclusion Nonabsorbable inflammatory and malignant SSNs with a solid component ≤5 mm exhibited different clinical and imaging characteristics.
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Affiliation(s)
- Xiao-Qun He
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xian Li
- Department of Pathology, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yan Wu
- Nursing School, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shun Wu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Tian-You Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Qi Li, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yu Zhong District, Chongqing, 400016, People’s Republic of China, Tel +86 15823408652, Fax +86 23 68811487, Email
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Usuda K, Ishikawa M, Iwai S, Yamagata A, Iijima Y, Motono N, Matoba M, Doai M, Hirata K, Uramoto H. Pulmonary Nodule and Mass: Superiority of MRI of Diffusion-Weighted Imaging and T2-Weighted Imaging to FDG-PET/CT. Cancers (Basel) 2021; 13:cancers13205166. [PMID: 34680313 PMCID: PMC8533899 DOI: 10.3390/cancers13205166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 09/25/2021] [Accepted: 10/12/2021] [Indexed: 12/01/2022] Open
Abstract
Simple Summary Although diffusion-weighted imaging (DWI) can be valuable for differential diagnosis of lung cancer from benign pulmonary nodules and masses (PNMs), the diagnostic capability may not be perfect. This study’s purpose was to compare the diagnostic efficacy of 18-fluoro-2-deoxy-glucose positron emission tomography–computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) of DWI and T2-weighted imaging (T2WI) in PNMs. There were 278 lung cancers and 50 benign PNMs that were examined by FDG-PET/CT and MRI. The sensitivity of the maximum standardized uptake value (SUVmax) was significantly lower than that of the apparent diffusion coefficient (ADC) and the T2 contrast ratio (T2 CR). The accuracy of SUVmax was significantly lower than that of ADC and that of T2 CR. The sensitivity and accuracy of MRI were significantly higher than those of FDG-PET/CT. MRI can replace FDG-PET/CT for differential diagnosis of PNMs. Abstract The purpose of this retrospective study was to compare the diagnostic efficacy of FDG-PET/CT and MRI in discriminating malignant from benign pulmonary nodules and masses (PNMs). There were 278 lung cancers and 50 benign PNMs that were examined by FDG-PET/CT and MRI. The T2 contrast ratio (T2 CR) was designated as the ratio of T2 signal intensity of PNM divided by T2 signal intensity of the rhomboid muscle. The optimal cut-off values (OCVs) for differential diagnosis were 3.605 for maximum standardized uptake value (SUVmax), 1.459 × 10−3 mm2/s for apparent diffusion coefficient (ADC), and 2.46 for T2 CR. Areas under the receiver operating characteristics curves were 67.5% for SUVmax, 74.3% for ADC, and 72.4% for T2 CR, respectively. The sensitivity (0.658) of SUVmax was significantly lower than that (0.838) of ADC (p < 0.001) and that (0.871) of T2 CR (p < 0.001). The specificity (0.620) of SUVmax was that the same as (0.640) ADC and (0.640) of T2 CR. The accuracy (0.652) of SUVmax was significantly lower than that (0.808) of ADC (p < 0.001) and that (0.835) of T2 CR (p < 0.001). The sensitivity and accuracy of DWI and T2WI in MRI were significantly higher than those of FDG-PET/CT. Ultimately, MRI can replace FDG PET/CT for differential diagnosis of PNMs saving healthcare systems money while not sacrificing the quality of care.
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Affiliation(s)
- Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa 920-0293, Japan; (M.I.); (S.I.); (A.Y.); (Y.I.); (N.M.); (H.U.)
- Shimada Hospital, Fukui 910-0855, Japan
- Correspondence: ; Tel.: +81-76-286-2211; Fax: +81-76-286-1207
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa 920-0293, Japan; (M.I.); (S.I.); (A.Y.); (Y.I.); (N.M.); (H.U.)
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa 920-0293, Japan; (M.I.); (S.I.); (A.Y.); (Y.I.); (N.M.); (H.U.)
| | - Aika Yamagata
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa 920-0293, Japan; (M.I.); (S.I.); (A.Y.); (Y.I.); (N.M.); (H.U.)
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa 920-0293, Japan; (M.I.); (S.I.); (A.Y.); (Y.I.); (N.M.); (H.U.)
| | - Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa 920-0293, Japan; (M.I.); (S.I.); (A.Y.); (Y.I.); (N.M.); (H.U.)
| | - Munetaka Matoba
- Department of Radiology, Kanazawa Medical University, Ishikawa 920-0293, Japan; (M.M.); (M.D.)
| | - Mariko Doai
- Department of Radiology, Kanazawa Medical University, Ishikawa 920-0293, Japan; (M.M.); (M.D.)
| | - Keiya Hirata
- MRI Center, Kanazawa Medical University Hospital, Ishikawa 920-0293, Japan;
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa 920-0293, Japan; (M.I.); (S.I.); (A.Y.); (Y.I.); (N.M.); (H.U.)
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14
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Deng C, Zheng Q, Zhang Y, Jin Y, Shen X, Nie X, Fu F, Ma X, Ma Z, Wen Z, Wang S, Li Y, Chen H. Validation of the Novel International Association for the Study of Lung Cancer Grading System for Invasive Pulmonary Adenocarcinoma and Association With Common Driver Mutations. J Thorac Oncol 2021; 16:1684-1693. [PMID: 34302987 DOI: 10.1016/j.jtho.2021.07.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/16/2021] [Accepted: 07/08/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION We aimed to validate the use of the novel grading system proposed by the International Association for the Study of Lung Cancer pathology committee for prognosis stratification of invasive pulmonary adenocarcinomas (ADCs) in Chinese patients. Correlations between the grading system, common driver mutations, and adjuvant chemotherapy (ACT) were also investigated. METHODS From 2008 to 2016, the histologic patterns of a large cohort of 950 patients with invasive ADCs (stage I-III) were retrospectively analyzed and classified according to the proposed grading system. Subsequently, tumor grading was correlated with genetic data, ACT, and patient outcome. RESULTS Compared with conventional predominant pattern-based groups, the novel grading system carried improved survival discrimination (area under the curve = 0.768 for recurrence-free survival and 0.775 for overall survival). The area under the curve was not further improved when incorporated lymphovascular invasion status. EGFR mutations (p < 0.001) were correlated with moderate grade, whereas KRAS mutations (p = 0.041) and ALK fusions (p = 0.021) were significantly more prevalent in poor grade. The reclassification of the grading system based on EGFR mutation status revealed excellent survival discrimination (p < 0.001). In particular, patients on stage Ib to III with novel high-grade ADCs had an improved prognosis with ACT. CONCLUSIONS The novel International Association for the Study of Lung Cancer grading system is a practical and efficient discriminator for patient prognosis and should be part of an integrated pathologic-genetic subtyping to improve survival prediction. In addition, it may support patient stratification for aggressive adjuvant chemotherapy.
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Affiliation(s)
- Chaoqiang Deng
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Qiang Zheng
- Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yan Jin
- Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xuxia Shen
- Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xiao Nie
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Pathology, Jiangyin People's Hospital, Jiangsu, People's Republic of China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Xiangyi Ma
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Zelin Ma
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Zhexu Wen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Shengping Wang
- Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Yuan Li
- Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
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15
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Seyrek Y, Cansever L, Bedirhan MA. Clinical and surgical approaches for malignant pulmonary lesions after a previous extrapulmonary malignancy. ANZ J Surg 2021; 91:2174-2181. [PMID: 34180584 DOI: 10.1111/ans.17045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In our study, since the operative histopathological distinction of new malignant pulmonary lesions as either a primary lung cancer or a pulmonary metastasis is difficult, we aimed to identify the clinical variables which might allow distinction between a new lung cancer and a pulmonary metastasis, and the appropriate surgical management. METHODS We divided 55 cases into two groups: patients with new lung cancer (NLC, n = 32) and patients with pulmonary metastases (PM, n = 23). Based on the primary organ, the previous malignancy was classified into four categories: head and neck, colorectal, genitourinary, and breast cancer. The parameters included in the study were age, sex, smoking history, a family history of cancer, disease-free interval, primary organ, treatments for previous malignancies, size, and SUV max of the lung lesion on 18F-fluorodeoxyglucose positron emission tomography scan and high-resolution computed tomography findings of the lung lesion. RESULTS A predisposition for larger lesions was found in the NLC group. In addition, in the NLC group, disease-free interval was noted to be longer, patients were significantly older and SUV-max values of solitary pulmonary lesions were significantly higher than in the PM group. Pulmonary lesions in patients with prior head and neck cancers were more likely to develop NLC. No significant difference in statistical analysis was observed between the groups in terms of sex, smoking, a family history of cancer, a history of adjuvant therapy, radiological pulmonary lesions signs, and localization. CONCLUSION PL monitoring on CT surveillance is essential, particularly in patients with previous head and neck cancers, who appear to have a higher risk for NLC. If pathological MLN accompanies PL in a patient with previous extrapulmonary malignancy, cervical mediastinoscopy may help acquire a possible PL diagnosis besides mediastinal staging. Intraoperative frozen section may have difficulty in distinguishing between PM and NLC when the lesion is of the same histological type as the previous malignancy. When precise distinction cannot be achieved by frozen section, we speculate that DFI, age, and radiological findings of the PL may help thoracic surgeons take initiative peroperatively while designating the subsequent surgical intervention. Lastly, pulmonary segmentectomy is also better be considered along with lobectomy in NLC cases.
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Affiliation(s)
- Yunus Seyrek
- Thoracic Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Istanbul, Turkey
| | - Levent Cansever
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ali Bedirhan
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Watanabe K, Sakamaki K, Ito H, Yokose T, Yamada K, Nakayama H, Masuda M. Impact of the micropapillary component on the timing of recurrence in patients with resected lung adenocarcinoma. Eur J Cardiothorac Surg 2021; 58:1010-1018. [PMID: 32386405 DOI: 10.1093/ejcts/ezaa138] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES A micropapillary (MIP) component is reported to be associated with a poor prognosis in patients with completely resected lung adenocarcinoma. The purpose of this study was to investigate the impact of an MIP component on the timing of postoperative recurrence using hazard curves. METHODS A total of 1289 patients with lung adenocarcinoma who underwent complete pulmonary resection from 2008 to 2015 were studied. Hazard curves representing the changes in hazard over time were evaluated. RESULTS The hazard curve displayed an initial wide, high peak within 1 year after surgery in patients with an MIP component, whereas some gentle peaks around the second year were noted in patients without an MIP component. The presence of an MIP component was associated with a worse recurrence-free survival and an early recurrence in stage I patients but not in advanced-stage patients. In multivariable Cox regression, the presence of an MIP component and lymph node metastasis, pleural invasion and gender were associated with a poor prognosis. CONCLUSIONS Patients with an MIP component retained a high risk of early recurrence after surgery, and the risk for recurrence persisted over the long term. Even after complete resection in stage I lung adenocarcinoma patients, an MIP component remains correlated with a poor prognosis.
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Affiliation(s)
- Katsuya Watanabe
- Department of General Thoracic Surgery, Yokohama Medical Center, Yokohama, Japan.,Department of General Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ito
- Department of General Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Kozo Yamada
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Nakayama
- Department of General Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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Zhang H, Huang W, Liu C, Giaccone G, Zhao X, Sun X, Li J, Cheng R, Huang Q, Mo H, Zhang Z, Zhang B, Wang C. The Prognostic Value of Non-Predominant Micropapillary Pattern in a Large Cohort of Resected Invasive Lung Adenocarcinoma Measuring ≤3 cm. Front Oncol 2021; 11:657506. [PMID: 34026636 PMCID: PMC8137894 DOI: 10.3389/fonc.2021.657506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/06/2021] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to analyze the influence of non-predominant micropapillary pattern in small sized invasive lung adenocarcinoma. A total of 986 lung adenocarcinoma patients with tumor size ≤3 cm were identified and classified according to the IALSC/ATS/ERS classification. Emphasis was placed on the impact of non-predominant micropapillary pattern on disease-free survival (DFS) and overall survival (OS). The relationship between lung adenocarcinoma subtype and lymph node involvement, EGFR mutation and KRAS mutation was also evaluated. A nomogram was developed to predict the probability of 3- and 5-year OS for these patients. The concordance index and calibration plot were used to validate this model. Among all 986 patients, the percentages of lymph node involvement were: 58.1, 50.0, 33.5, 21.4, 21.1, 10.9, 0, and 0% for micropapillary predominant, solid predominant, acinar predominant, papillary predominant, invasive mucinous adenocarcinoma (IMA), lepidic predominant, minimally invasive adenocarcinoma (MIA), adenocarcinoma in situ (AIS), respectively. The frequency of EGFR mutation in the cases of lepidic predominant, acinar predominant, MIA, micropapillary predominant, papillary predominant, solid predominant, IMA, and AIS were 51.1, 45.2, 44.4, 36.8, 29.3, 26.8, 8.3, and 0%, respectively. A non-predominant micropapillary pattern was observed in 344 (38.4%) invasive adenocarcinoma (IAC), and its presence predicted a poorer DFS (median: 56.0 months vs. 66.0 months, P <0.001) and OS (median: 61.0 months vs. 70.0 months, P <0.001). After propensity score matching, non-predominant micropapillary pattern retained its unfavorable effect on DFS (P = 0.007) and OS (P = 0.001). Multivariate analysis showed that non-predominant micropapillary pattern was identified as an independent prognostic factor for DFS (P = 0.003) and OS (P <0.001) in IAC. The nomogram showed good calibration and reliable discrimination ability (C-index = 0.775) to evaluated the 3- and 5-year OS. This retrospective analysis of patients with small sized IAC suggests the value of non-predominant micropapillary pattern to predict poor prognosis. A reliable nomogram model was constructed to provide personalized survival predictions.
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Affiliation(s)
- Hua Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wuhao Huang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Chang Liu
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | | | - Xiaoliang Zhao
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiaoyan Sun
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jingjing Li
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Runfen Cheng
- Department of Lung Cancer Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qiujuan Huang
- Department of Lung Cancer Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Huilan Mo
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhenfa Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Bin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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18
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Zhao Q, Han X, Peng L. A case report of pneumonic-type adenocarcinoma diagnosed by transbronchial cryobiopsy after the patient's death. Medicine (Baltimore) 2021; 100:e24296. [PMID: 33592874 PMCID: PMC7870163 DOI: 10.1097/md.0000000000024296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/23/2020] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Due to its nonspecific manifestations, pneumonic-type adenocarcinoma can be easily misdiagnosed as pneumonia, tuberculosis, or other diseases, especially in developing countries where many patients in the early stage refuse invasive examinations. Early recognition of pneumonic-type adenocarcinoma is essential. PATIENT CONCERNS We report a case of pneumonia lung adenocarcinoma diagnosed by frozen lung biopsy after death. DIAGNOSES A 75-year-old male patient was admitted to the hospital on April 24, complaining of 5 months of recurrent coughing, expectoration, and panting, and his symptoms had been worsening over the past month. INTERVENTIONS After obtaining informed consent from the patient's family, transbronchial cryobiopsy was performed at the bedside. OUTCOMES After a positive rescue, the patient died. Pathological examination indicated adenocarcinoma. LESSONS At present, surgery is still the first choice for the treatment of pneumonic lung cancer, and early diagnosis can remove the tumor as much as possible. Transbronchial cryobiopsy can be used for the collection of pathological samples, especially for the early diagnosis of pneumonic lung cancer.
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Affiliation(s)
- Qiquan Zhao
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Dazu District, Dazu
| | - Xiaoli Han
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Li Peng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China
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19
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Kawaguchi Y, Nakao M, Omura K, Iwamoto N, Ozawa H, Kondo Y, Ichinose J, Matsuura Y, Okumura S, Mun M. The utility of three-dimensional computed tomography for prediction of tumor invasiveness in clinical stage IA lung adenocarcinoma. J Thorac Dis 2021; 12:7218-7226. [PMID: 33447410 PMCID: PMC7797862 DOI: 10.21037/jtd-20-2131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background It is critical to have an accurate measurement of solid tumor size in order to predict the invasiveness of small lung adenocarcinomas. Some lesions cannot be measured accurately via High-resolution computed tomography (HRCT) due to their irregular shape and unclear borders. For this reason, we evaluated the relative efficacy of three-dimensional (3D) CT for predicting invasive adenocarcinoma. Methods We evaluated 195 patients with clinical stage IA adenocarcinomas, including 109 with lesions documented as invasive that were surgically resected at our institute during 2017. All lesions were categorized as either (I) lesions that were difficult to evaluate (i.e., hazy lesions; HL) or (II) more typical lesions (TL). The relationships between solid tumor size as determined by HRCT, solid tumor volume as determined by 3D CT and pathologic diagnosis were evaluated. Results Fifty-seven patients (29%) were diagnosed with HL. We set the cut-off value for the solid volume at 225 mm3 as predictive for invasive adenocarcinoma. When evaluating all 195 patients as a group, the accuracy, sensitivity, and specificity based on the solid tumor volume were similar to those based on the solid tumor size. When we limit our analysis to the HL group, the specificity based on solid tumor volume (65.5%) was higher than that based on solid tumor size (44.8%) with a difference that approached statistical significance (P=0.070). Conclusions 3D CT was equivalent to HRCT for predicting invasive adenocarcinoma and may be particularly useful for diagnosing lesions that are difficult to evaluate on HRCT.
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Affiliation(s)
- Yohei Kawaguchi
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kenshiro Omura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoya Iwamoto
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroki Ozawa
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuto Kondo
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
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Lambe G, Durand M, Buckley A, Nicholson S, McDermott R. Adenocarcinoma of the lung: from BAC to the future. Insights Imaging 2020; 11:69. [PMID: 32430670 PMCID: PMC7237554 DOI: 10.1186/s13244-020-00875-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/17/2020] [Indexed: 02/04/2023] Open
Abstract
Adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic predominant adenocarcinoma and invasive mucinous adenocarcinoma are relatively new classification entities which replace the now retired term, bronchoalveolar carcinoma (BAC). The radiographic appearance of these lesions ranges from pure, ground glass nodules to large, solid masses. A thorough understanding of the new classification is essential to radiologists who work with MDT colleagues to provide accurate staging and treatment. A 2-year review was performed of all surgically resected cases of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma in our institution. Cases are broken down by age, gender, tumour type and tumour location. A pictorial review is presented to illustrate the radiologic and pathologic features of each entity.
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21
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Azzeddine R, Rhorfi IA, Zegmout A, Souhi H, Elouazzani H, Abid A, Chahdi H, Tbouda M. Typical presentation of pulmonary lepidic adenocarcinoma: a rare case report. Pan Afr Med J 2020; 36:11. [PMID: 32550974 PMCID: PMC7282614 DOI: 10.11604/pamj.2020.36.11.22660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/04/2020] [Indexed: 11/15/2022] Open
Abstract
Bronchioloalveolar carcinoma (BAC) is a rare subtype of adenocarcinoma of lung with distinct features and distinctive characteristics. It accounts approximately for 4% of lung cancers. In the following study we report a rare observation of a 50 years old female with a clinical, radiological and histological presentation, which is typical of an invasive mucinous lepidic adenocarcinoma formerly named BAC.
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Affiliation(s)
- Rajae Azzeddine
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | | | - Adil Zegmout
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Hicham Souhi
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Hanane Elouazzani
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Ahmed Abid
- Department of Pneumology, Military Hospital Mohamed V, Rabat, Morocco
| | - Hafsa Chahdi
- Department of Pathology, Military Hospital Mohamed V, Rabat, Morocco
| | - Mohamed Tbouda
- Department of Pathology, Military Hospital Mohamed V, Rabat, Morocco
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22
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Lung Cancer Incidence and Mortality with Extended Follow-up during Screening. J Thorac Oncol 2020; 14:1692-1694. [PMID: 31558228 DOI: 10.1016/j.jtho.2019.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/25/2022]
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23
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Gao C, Li J, Wu L, Kong D, Xu M, Zhou C. The Natural Growth of Subsolid Nodules Predicted by Quantitative Initial CT Features: A Systematic Review. Front Oncol 2020; 10:318. [PMID: 32292716 PMCID: PMC7119340 DOI: 10.3389/fonc.2020.00318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The detection rate for pulmonary nodules, particularly subsolid nodules (SSNs), has been significantly improved. The purpose of this review is to summarize the relationship between quantitative features of initial CT imaging and the subsequent natural growth of SSNs to explore potential reasons for these findings. Methods: Relevant studies were collected from a literature search of PubMed, Embase, Web of Science, and Cochrane. Data extraction was performed on the patients' basic information, CT methods, and acquisition methods, including quantitative CT features, and statistical methods. Results: A total of 10 relevant articles were included in our review, which included 850 patients with 1,026 SSNs. Overall, the results were variable, and the key findings were as follows. Seven studies looked at the relationship between the diameter and growth of SSNs, showing that SSNs with larger diameters were associated with increased growth. An additional three studies which focused on the relationship between CT attenuation and the growth of SSNs showed that SSNs with a high CT attenuation were associated with increased growth. Conclusion: CT attenuation may be useful in predicting the natural growth of SSNs, and mean CT attenuation may be more useful in predicting the natural growth of pure ground glass nodules (GGNs) than part-solid GGNs. While evaluation by diameter did have some limitations, it demonstrates value in predicting the growth of SSNs.
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Affiliation(s)
- Chen Gao
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaying Li
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Linyu Wu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Maosheng Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Changyu Zhou
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Ye J, Ling J, Lv Y, Chen J, Cai J, Chen M. Pulmonary adenocarcinoma appearing as ground-glass opacity nodules identified using non-enhanced and contrast-enhanced CT texture analysis: A retrospective analysis. Exp Ther Med 2020; 19:2483-2490. [PMID: 32256725 PMCID: PMC7086215 DOI: 10.3892/etm.2020.8511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/04/2019] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to investigate the ability of CT-based texture analysis to differentiate invasive adenocarcinoma (IA) from pre-invasive lesions (PIL) or minimally IA (MIA) appearing as ground-glass opacity (GGO) nodules, and to further compare the performance of non-enhanced CT (NECT) images with that of contrast-enhanced CT (CECT) images. A total of 77 patients with GGO nodules and surgically confirmed pulmonary adenocarcinoma were included in the present retrospective study. Each GGO nodule was manually segmented and its texture features were extracted from NECT and CECT images using in-house developed software coded in MATLAB (MathWorks). The independent-samples t-test was used to select the texture features with statistically significant differences between IA and MIA/PIL. Multivariate logistic regression and receiver operating characteristics (ROC) curve analyses were performed to identify predictive features. Of the 77 GGO nodules, 12 were atypical adenomatous hyperplasia or adenocarcinoma in situ (15.6%), 36 were MIA (46.8%) and 29 were IA (37.7%). IA and MIA/PIL exhibited significant differences in most histogram features and gray-level co-occurrence matrix features (P<0.05). Multivariate logistic regression and ROC curve analyses revealed that smaller energy and higher entropy were significant differentiators of IA from MIA and PIL, irrespective of whether NECT images [area under the curve (AUC): 0.839, 0.859] or CECT images (AUC: 0.818, 0.820) are used. Texture analysis of CT images, regardless of whether NECT or CECT is used, has the potential to distinguish IA from PIL or MIA, particularly the parameters of energy and entropy. Furthermore, NECT images were simpler to obtain and no contrast agent was required; thus, analysis with NECT may be a preferred choice.
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Affiliation(s)
- Jing Ye
- Department of Medical Imaging, Yangzhou University Clinical College Subei People's Hospital, Yangzhou, Jiangsu 225002, P.R. China
| | - Jun Ling
- Department of Medical Imaging, Yangzhou University Clinical College Subei People's Hospital, Yangzhou, Jiangsu 225002, P.R. China
| | - Yan Lv
- Department of Medical Imaging, Yangzhou University Clinical College Subei People's Hospital, Yangzhou, Jiangsu 225002, P.R. China
| | - Juan Chen
- Department of Medical Imaging, Yangzhou University Clinical College Subei People's Hospital, Yangzhou, Jiangsu 225002, P.R. China
| | - Junhui Cai
- Department of Medical Imaging, Yangzhou University Clinical College Subei People's Hospital, Yangzhou, Jiangsu 225002, P.R. China
| | - Mingxiang Chen
- Department of Medical Imaging, Yangzhou University Clinical College Subei People's Hospital, Yangzhou, Jiangsu 225002, P.R. China
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25
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Ito H, Suzuki K, Mizutani T, Aokage K, Wakabayashi M, Fukuda H, Watanabe SI. Long-term survival outcome after lobectomy in patients with clinical T1 N0 lung cancer. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)30054-4. [PMID: 32067786 DOI: 10.1016/j.jtcvs.2019.12.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/30/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess long-term outcomes after lobectomy in patients with clinical T1 N0 lung cancer based on thin-section computed tomography. METHODS We collected the data of patients with pathological adenocarcinoma who had undergone lobectomy. The patients were categorized into 4 groups according to a consolidation tumor ratio and tumor size. Groups A and B included tumors with consolidation tumor ratio ≤0.5 and size ≤3 cm. Group A consisted of tumors ≤2 cm. Group B consisted of the remaining tumors. Groups C and D consisted of tumors with consolidation tumor ratio >0.5. Group C consisted of those with tumors ≤2 cm and Group D consisted of tumors of size 2 to 3 cm. The 10-year overall survival and recurrence-free survival rates were examined. RESULTS Among the 543 patients, the 10-year overall survival was 80.4% and the 10-year recurrence-free survival rate was 77.1%. The 10-year overall survival for group A was 94.0%, 92.7% for group B, 84.1% for group C, and 68.8% for group D, and the 10-year recurrence-free survival rate for each group was 94.0%, 89.0%, 79.7%, and 66.1%, respectively. Group A + B showed better overall survival than group C + D (hazard ratio, 2.78; 95% confidence interval, 1.45-5.06) and better 10-year recurrence-free survival (hazard ratio, 2.74; 95% confidence interval, 1.55-4.88). No patient in group A had recurrence. CONCLUSIONS Those patients with total tumor size ≤3 cm and consolidation tumor ratio ≤0.5 showed excellent prognosis and might be suitable candidates for sublobar resection. If noninferior survival of segmentectomy compared with lobectomy is confirmed in an ongoing Japan Clinical Oncology Group trial, segmentectomy will be included in the standard of care.
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Affiliation(s)
- Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
| | - Kenji Suzuki
- Department of Thoracic Surgery, Juntendo University, Tokyo, Japan
| | - Tomonori Mizutani
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masashi Wakabayashi
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Hamanaka K, Takayama H, Koyama T, Matsuoka S, Takeda T, Agatsuma H, Yamada K, Hyogotani A, Kawakami S, Ito KI. Interobserver size measurement variability in part-solid lung adenocarcinoma using pre-operative computed tomography. J Thorac Dis 2019; 11:2924-2931. [PMID: 31463121 DOI: 10.21037/jtd.2019.07.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background In the current lung cancer tumor-node-metastasis classification, solid tumor size is used for tumor diameter measurement as the dense component. However, measuring solid tumor size is sometimes difficult and inter-observer variability may increase, particularly in part-solid nodules with ground-glass opacity (GGO). This study aimed to investigate inter-observer size measurement variability in lung adenocarcinoma. Methods Of 47 patients with part-solid lung adenocarcinoma who had undergone surgery at our department from January to December 2016, five surgeons and one radiologist undertook unidimensional solid and total size tumor measurements using pre-operative axial computed tomography images, and we assessed inter-observer size measurement variability. Variability was then subclassified into five groups, according to computer tomography-identified tumor morphological characteristics, namely: (I) minimally invasive; (II) peribronchovascular; (III) spiculation/atelectasis; (IV) adjacent to cystic lesion, and; (V) diffuse consolidation and GGO. Results The mean inter-observer variability was 9.7 mm (solid size) and 7.7 mm (total size). Analysis of the maximum and minimum measurement size values for each patient undertaken showed that the most experienced surgeon and the radiologist measured the minimum size more frequently. To correct for differences in mean tumor diameter in each group, a comparison was made using a coefficient of variation (CV) calculated as the ratio of the standard deviation to the mean. Group I characteristics showed the largest coefficient value for variation in solid size measurement. Conclusions Inter-observer measurement variability for solid size was larger than for total size in lung adenocarcinoma. Large variability in group I indicated the difficulty of size measurement for low-grade malignant potential nodules such as adenocarcinoma in situ, minimally invasive adenocarcinoma, and early-stage invasive adenocarcinoma. The possibility of unavoidable size measurement variability should be recognized when deciding on surgical procedures for these diseases.
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Affiliation(s)
- Kazutoshi Hamanaka
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroki Takayama
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Tsutomu Koyama
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shunichiro Matsuoka
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Tetsu Takeda
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroyuki Agatsuma
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Kyoko Yamada
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Akira Hyogotani
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, Nagano, Japan
| | - Ken-Ichi Ito
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
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Gao C, Xiang P, Ye J, Pang P, Wang S, Xu M. Can texture features improve the differentiation of infiltrative lung adenocarcinoma appearing as ground glass nodules in contrast-enhanced CT? Eur J Radiol 2019; 117:126-131. [PMID: 31307637 DOI: 10.1016/j.ejrad.2019.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To investigate the validity and efficacy of comparing texture features from contrast-enhanced images with non-enhanced images in identifying infiltrative lung adenocarcinoma represented as ground glass nodules (GGN). MATERIALS AND METHODS A retrospective cohort study was conducted with patients presenting with lung adenocarcinoma and treated at a single centre between January 2015 to December 2017. All patients underwent standard and contrast-enhanced thoracic CT scans with 0.5 mm collimation and 1 mm slice reconstruction thickness before surgery. A total of 34 lung adenocarcinoma patients (representing 34 lesions) were analysed; including 21 instances of invasive adenocarcinoma (IAC) lesions, 4 instances of adenocarcinoma in situ (AIS) lesions, and 9 minimally invasive adenocarcinoma (MIA) lesions. After radiologists manually segmented the lesions, texture features were quantitatively extracted using Artificial Intelligence Kit (AK) software. Then, multivariate logistic regression analysis based on standard and contrast-enhanced CT texture features was employed to analyse the invasiveness of lung adenocarcinoma lesions appearing as GGNs. A receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of those models. RESULTS A total of 21 quantitative texture features were extracted using the AK software. After dimensionality reduction, 5 and 3 features extracted from thin-section unenhanced and contrast-enhanced CT, respectively, were used to establish the model. The area under the ROC curve (AUC) values for unenhanced CT and enhanced CT features were 0.890 and 0.868, respectively. There was no significant difference (P = 0.190) in the AUC between models based on non-enhanced and contrast-enhanced CT texture features. CONCLUSION Compared with unenhanced CT, texture features extracted from contrast-enhanced CT provided no benefit in improving the differential diagnosis of infiltrative lung adenocarcinoma from non-infiltrative malignancies appearing as GGNs.
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Affiliation(s)
- Chen Gao
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ping Xiang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianfeng Ye
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Peipei Pang
- GE Healthcare Life Sciences, Hangzhou, China
| | - Shiwei Wang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Maosheng Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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Yu J, Hu Y, Xu Y, Wang J, Kuang J, Zhang W, Shao J, Guo D, Wang Y. LUADpp: an effective prediction model on prognosis of lung adenocarcinomas based on somatic mutational features. BMC Cancer 2019; 19:263. [PMID: 30902072 PMCID: PMC6431052 DOI: 10.1186/s12885-019-5433-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/03/2019] [Indexed: 02/08/2023] Open
Abstract
Background Lung adenocarcinoma is the most common type of lung cancers. Whole-genome sequencing studies disclosed the genomic landscape of lung adenocarcinomas. however, it remains unclear if the genetic alternations could guide prognosis prediction. Effective genetic markers and their based prediction models are also at a lack for prognosis evaluation. Methods We obtained the somatic mutation data and clinical data for 371 lung adenocarcinoma cases from The Cancer Genome Atlas. The cases were classified into two prognostic groups (3-year survival), and a comparison was performed between the groups for the somatic mutation frequencies of genes, followed by development of computational models to discrete the different prognosis. Results Genes were found with higher mutation rates in good (≥ 3-year survival) than in poor (< 3-year survival) prognosis group of lung adenocarcinoma patients. Genes participating in cell-cell adhesion and motility were significantly enriched in the top gene list with mutation rate difference between the good and poor prognosis group. Support Vector Machine models with the gene somatic mutation features could well predict prognosis, and the performance improved as feature size increased. An 85-gene model reached an average cross-validated accuracy of 81% and an Area Under the Curve (AUC) of 0.896 for the Receiver Operating Characteristic (ROC) curves. The model also exhibited good inter-stage prognosis prediction performance, with an average AUC of 0.846 for the ROC curves. Conclusion The prognosis of lung adenocarcinomas is related with somatic gene mutations. The genetic markers could be used for prognosis prediction and furthermore provide guidance for personal medicine. Electronic supplementary material The online version of this article (10.1186/s12885-019-5433-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jiaxian Yu
- Department of Cell Biology and Genetics, Shenzhen University Health Science Center, Shenzhen, 518060, China
| | - Yueming Hu
- Department of Cell Biology and Genetics, Shenzhen University Health Science Center, Shenzhen, 518060, China
| | - Yafei Xu
- Department of Cell Biology and Genetics, Shenzhen University Health Science Center, Shenzhen, 518060, China
| | - Jue Wang
- State Key Laboratory of Agrobiotechnology and School of Life Science, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jiajie Kuang
- Department of Cell Biology and Genetics, Shenzhen University Health Science Center, Shenzhen, 518060, China
| | - Wei Zhang
- Sehnzhen GenRead Technology Co., Ltd., Shenzhen, 518000, China
| | - Jianlin Shao
- Zhejiang Hospital, 12 Lingyin Rd, Hangzhou, 310003, China
| | - Dianjing Guo
- State Key Laboratory of Agrobiotechnology and School of Life Science, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Yejun Wang
- Department of Cell Biology and Genetics, Shenzhen University Health Science Center, Shenzhen, 518060, China.
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Wang L, Anraku M, Sato M, Nitadori JI, Nagayama K, Kitano K, Nakajima J. Impact of the 8th Edition of the UICC-TNM Classification on Clinical Stage 0-IA Lung Adenocarcinoma: Does the New Classification Predict Postoperative Prognosis More Precisely than the Previous One? Ann Thorac Cardiovasc Surg 2018; 24:223-229. [PMID: 29848840 PMCID: PMC6197998 DOI: 10.5761/atcs.oa.18-00051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/01/2018] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Early lung adenocarcinoma has been more frequently found recently. The 8th edition of the Union for International Cancer Control (UICC)-Tumor Node Metastasis (TNM) classification for lung cancer has been effective since January 2017. This study aims to elucidate advantages of the current classification for patients with clinical stage 0-IA lung adenocarcinoma, in comparison with the older one. METHODS We retrospectively reviewed the data of clinical stage IA (7th edition) lung adenocarcinoma patients who underwent surgery at our institute from 2001 to 2012, and reclassified them by the 8th edition. Survival analysis was used to evaluate the impact of the two classifications. RESULTS In all, 281 cases were eligible. Clinical T-factors (8th) were significant prognostic factors for overall survival (P = 0.001), recurrence-free survival (P <0.001), and cancer-specific survival (P = 0.001). However, those in the previous edition were not (P = 0.894, P = 0.144, and P = 0.822, respectively). CONCLUSION The 8th edition of the UICC-TNM classification predicts postoperative prognosis more precisely than the 7th one in clinical stage 0-IA lung adenocarcinoma. It is probably because the stage distribution of the population, which included in the research project the 8th edition based on, has been changed, and the new edition develops more accurate staging criteria for ground-glass nodule (GGN).
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Affiliation(s)
- Liming Wang
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
- Department of Thoracic Surgery, The 1st Affiliated Hospital of China Medical University, Shenyang, China
| | - Masaki Anraku
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun-Ichi Nitadori
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kazuhiro Nagayama
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kentaro Kitano
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Eriguchi D, Shimada Y, Imai K, Furumoto H, Okano T, Masuno R, Matsubayashi J, Kajiwara N, Ohira T, Ikeda N. Predictive accuracy of lepidic growth subtypes in early-stage adenocarcinoma of the lung by quantitative CT histogram and FDG-PET. Lung Cancer 2018; 125:14-21. [PMID: 30429012 DOI: 10.1016/j.lungcan.2018.08.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the accuracy of computed tomography (CT) and F-18 fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) to distinguish lepidic growth adenocarcinoma (LGA), including adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and lepidic-predominant adenocarcinoma, all of which have favorable survival outcomes, from the more aggressive and invasive non-LGA subtypes. MATERIALS AND METHODS We identified 225 patients with c-0/I adenocarcinoma of the lung who underwent PET/CT and 3DCT followed by complete resection. Maximum standardized uptake values (SUVmax) of FDG and several histogram parameters were analyzed. Histological grades were classified according to the predominant subtype (G1: lepidic; G3: micropapillary or solid; and G2: subtypes other than G1/G3). RESULTS The proportion of pathological invasive factors (lymphatic vessel involvement/blood vessel invasion/pleural invasion/lymph node metastasis) of patients with preinvasive adenocarcinoma, G1, G2, and G3 tumors were 0%, 3.6%, 48.0%, and 100%, respectively; p < 0.001). Multivariate analysis with CT-related parameters demonstrated that 75th percentile CT attenuation value (75th%, p < 0.001) and maximum CT attenuation value (maxCT, p = 0.009) were associated with incidence of non-LGA, whereas the value of SUVmax demonstrated a significant correlation (p < 0.001). When all patients were dichotomized according to ground-glass opacities (GGO)/solid-dominancy for CT maximum diameter, a significant correlation with non-LGA was shown in patients with solid-dominant tumor on SUVmax (p < 0.001) and with GGO-dominant tumor on 75th% (p = 0.006) and maxCT (p = 0.007). The combination of one of the two significant histogram parameters and SUVmax revealed higher predictive performance for pathological high malignant features (positive pathological invasive factors, non-LGA, and the highly malignant subtype covering G2 with moderately or poorly-differentiated carcinoma and G3) than the individual use of either factor. CONCLUSION The 75th%, maxCT, and SUVmax were highly useful in distinguishing LGA from non-LGA in c-0/I adenocarcinoma.
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Affiliation(s)
| | | | - Kentaro Imai
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Tetsuya Okano
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryuhei Masuno
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | | | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
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Wang Y, Zheng D, Zheng J, Huang Q, Han B, Zhang J, Zhao H, Chen H. Predictors of recurrence and survival of pathological T1N0M0 invasive adenocarcinoma following lobectomy. J Cancer Res Clin Oncol 2018. [PMID: 29532227 DOI: 10.1007/s00432-018-2622-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND This retrospective research was designed to investigate the relationship between pT1N0M0 invasive adenocarcinoma (IADC) harboring solid (SOL) and/or micropapillary (MIP) components and its prognosis following lobectomy. METHODS Clinical data of pT1N0M0 IADC patients were retrospectively collected from Shanghai Chest Hospital. Survival curves were plotted by Kaplan-Meier methods. Multivariable cox regressions were conducted to discover the independent risk factors of recurrence-free survival (RFS) and overall survival (OS), through which nomograms were performed to visualize the risk of recurrences and outcomes in personalized information. RESULTS Totally, 1965 patients were enrolled, including 248 harboring SOL/MIP and 1717 not. IADC demonstrated worse 5-year RFS (81.9 vs. 92.2%, p < 0.001) and OS (85.7 vs. 94.4%, p < 0.001) when harboring SOL and/or MIP components. And this status became an independent factor associated with poorer RFS (HR 2.445, 95% CI 1.565-3.821, p < 0.001) and OS (HR 2.139, 95% CI 1.180-3.878, p = 0.012) instead of novel classification of IADC predominant patterns. No difference existed between SOL/MIP predominant and minor patterns. In addition, age > 60, smoking, post-chemotherapy and T1b were all indicating poorer RFS and smoking was also related with worse OS. The c-indexes of nomograms were 0.723 for RFS (95% CI, 0.662-0.784) and 0.703 for OS (95% CI, 0.629-0.777) respectively. CONCLUSIONS Once the pT1N0M0 IADC harboring SOL/MIP, it strongly indicated the worse clinical recurrence and survival outcome, no matter whether the SOL and/or MIP was predominant. Smoking was correlated with worse prognosis for those patients. Age > 60 and stage T1b also indicated poorer RFS. Whether post-chemotherapy was harmful to pT1N0M0 IADC patients needed further research.
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Affiliation(s)
- Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Difan Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
| | - Jiajie Zheng
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qingyuan Huang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Li W, Wang X, Zhang Y, Li X, Li Q, Ye Z. Radiomic analysis of pulmonary ground-glass opacity nodules for distinction of preinvasive lesions, invasive pulmonary adenocarcinoma and minimally invasive adenocarcinoma based on quantitative texture analysis of CT. Chin J Cancer Res 2018; 30:415-424. [PMID: 30210221 PMCID: PMC6129571 DOI: 10.21147/j.issn.1000-9604.2018.04.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To identify the differences among preinvasive lesions, minimally invasive adenocarcinomas (MIAs) and invasive pulmonary adenocarcinomas (IPAs) based on radiomic feature analysis with computed tomography (CT). Methods A total of 109 patients with ground-glass opacity lesions (GGOs) in the lungs determined by CT examinations were enrolled, all of whom had received a pathologic diagnosis. After the manual delineation and segmentation of the GGOs as regions of interest (ROIs), the patients were subdivided into three groups based on pathologic analyses: the preinvasive lesions (including atypical adenomatous hyperplasia and adenocarcinoma in situ) subgroup, the MIA subgroup and the IPA subgroup. Next, we obtained the texture features of the GGOs. The data analysis was aimed at finding both the differences between each pair of the groups and predictors to distinguish any two pathologic subtypes using logistic regression. Finally, a receiver operating characteristic (ROC) curve was applied to accurately evaluate the performances of the regression models.
Results We found that the voxel count feature (P<0.001) could be used as a predictor for distinguishing IPAs from preinvasive lesions. However, the surface area feature (P=0.040) and the extruded surface area feature (P=0.013) could be predictors of IPAs compared with MIAs. In addition, the correlation feature (P=0.046) could distinguish preinvasive lesions from MIAs better. Conclusions Preinvasive lesions, MIAs and IPAs can be discriminated based on texture features within CT images, although the three diseases could all appear as GGOs on CT images. The diagnoses of these three diseases are very important for clinical surgery.
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Affiliation(s)
- Wei Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xuexiang Wang
- Department of Radiology, Tianjin Hongqiao Hospital, Tianjin 300130, China
| | - Yuwei Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xubin Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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Yue X, Liu S, Liu S, Yang G, Li Z, Wang B, Zhou Q. HRCT morphological characteristics distinguishing minimally invasive pulmonary adenocarcinoma from invasive pulmonary adenocarcinoma appearing as subsolid nodules with a diameter of ≤3 cm. Clin Radiol 2017; 73:411.e7-411.e15. [PMID: 29273229 DOI: 10.1016/j.crad.2017.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/15/2017] [Indexed: 12/17/2022]
Abstract
AIM To differentiate retrospectively the morphological characteristics at high-resolution computed tomography (CT) between minimally invasive pulmonary adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IAC) appearing as subsolid nodules (SNs) with a diameter of ≤3 cm and to provide information to help operative decision-making. MATERIALS AND METHODS The patient notes of 260 patients with SNs of ≤3 cm in diameter (98 with MIA and 162 with IAC) confirmed at surgery and histopathology from September 2008 to June 2012 were reviewed retrospectively at the Department of Radiology, Weifang Respiratory Disease Hospital. Sixty-seven patients had pure ground-glass nodules (PGGNs) and 193 had mixed ground-glass nodules (MGGNs). Patients were grouped according to the final pathology: minimally invasive MIA and IAC. The HRCT characteristics were compared between the two groups. RESULTS There were statistically significant differences in the pattern, shape, diameter of solid components, proportion of solid components, CT radiodensity values of the ground-glass and solid components, borders, margins, air bronchograms, microvascular signs, and pleural indentations of the nodules between the two groups (all p<0.05). Multivariate and receiver operating characteristic (ROC) analyses indicated significant predictors of MIAs were as follows: small lesion diameter (≤14.7 mm), solid components ≤7 mm, <50% of solid components, low CT radiodensity values of the solid components (≤-107 HU), air bronchograms in the ground-glass opacity components, and microvascular signs. CONCLUSION The morphological characteristics at high-resolution CT can be used to differentiate between MIAs and IACs appearing as SNs with a diameter of ≤3 cm and provide information to help operative decision-making.
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Affiliation(s)
- X Yue
- Shandong Medical Imaging Research Institute, Shandong University, Shandong, China; Department of Radiology, Weifang Respiratory Disease Hospital, Shandong, China
| | - S Liu
- Department of Cardiology, Weifang People's Hospital, Shandong, China
| | - S Liu
- Department of Radiology, Weifang Respiratory Disease Hospital, Shandong, China
| | - G Yang
- Department of Respiratory, Weifang Respiratory Disease Hospital, Shandong, China
| | - Z Li
- Department of Radiology, Weifang Respiratory Disease Hospital, Shandong, China
| | - B Wang
- Department of Radiology, Institute of Medical Imaging, Binzhou Medical University, Shandong, China.
| | - Q Zhou
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
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Yang Y, Mao Y, Yang L, He J, Gao S, Mu J, Xue Q, Wang D, Zhao J, Gao Y, Zhang Z, Ding N, Yang D. Prognostic factors in curatively resected pathological stage I lung adenocarcinoma. J Thorac Dis 2017; 9:5267-5277. [PMID: 29312735 DOI: 10.21037/jtd.2017.11.65] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Patients with pathological stage I (p I) lung adenocarcinoma show variabilities in prognosis even after complete resection. The factors resulting in heterogeneities of prognosis remain controversy. The aim of this study was to identify the risk factors affecting recurrence/metastasis and survival in patients with curatively resected p I lung adenocarcinoma. Methods A total of 252 patients with p I lung adenocarcinoma underwent curative resection between January 1st, 2009 to September 30th, 2011 were retrospectively reviewed to analyze the associations of recurrence and survival with the following clinicopathological variables: gender, age, cigarette smoking, family cancer history, tumor size, TNM stage, tumor differentiation, visceral pleural invasion, bronchial involvement, lymphovascular invasion, postoperative adjuvant treatment, pathological subtypes and micropapillary pattern. Results Among those 252 patients, 48 had local recurrence or distant metastasis, the rest 204 patients had no relapse until the last follow-up. Cox univariate survival analysis revealed that tumor size (P<0.001), TNM stage [disease-free survival (DFS), P<0.001; overall survival (OS), P=0.004], tumor differentiation (P<0.001), bronchial involvement (P<0.001), lymphovascular invasion (DFS, P=0.021; OS, P=0.001) and micropapillary pattern (DFS, P<0.001; OS, P=0.003) were significantly associated with DFS and OS, while cigarette smoking (P=0.029) and pathological subtypes (P=0.041) were found to be risk factors for DFS either. In multivariate analysis, tumor differentiation (P<0.001) was an independent risk factor for both DFS and OS, TNM stage (P=0.007), bronchial involvement (P=0.004) and micropapillary pattern (P=0.001) only for DFS, while tumor size (P=0.009) and lymphovascular invasion (P=0.010) were found to be independent risk factors only for OS. Conclusions Tumor size, TNM stage, tumor differentiation, bronchial involvement, lymphovascular invasion and micropapillary pattern could be considered as risk factors for predicting local recurrence or distant metastasis and survival in curatively resected p I lung adenocarcinoma patients.
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Affiliation(s)
- Yikun Yang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lin Yang
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Juwei Mu
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dali Wang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhirong Zhang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ningning Ding
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ding Yang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Divisi D, Barone M, Zaccagna G, Crisci R. Fluorine-18 fluorodeoxyglucose positron emission tomography in the management of solitary pulmonary nodule: a review. Ann Med 2017; 49:626-635. [PMID: 28590774 DOI: 10.1080/07853890.2017.1339906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Solitary pulmonary nodules are common radiologic findings and their detection has increased due to the introduction and improvement of diagnostics. Since a nodule can be an expression of early lung cancers, a proper classification and management are required because its treatment might lead to decreased morbidity and mortality. In this regard, prominent guidelines are available although they are characterized sometimes by discordant and misleading evidences. Furthermore, the same results of studies in the literature appear conflicting. Aim of this work is to evaluate the role of imaging through an extensive literature review but focusing on 18-fluorine fluorodeoxyglucose positron emission tomography combined with computed tomography (18F-FDG-PET/CT) in order to assess the limits and future perspectives of solitary pulmonary nodule characterization in early detection of lung cancer. Key messages Detection of solitary pulmonary nodules has increased. Management of solitary pulmonary nodules is still debated. Future perspectives of early solitary pulmonary nodule characterization.
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Affiliation(s)
- Duilio Divisi
- a Department of Thoracic Surgery , University of L'Aquila, "G. Mazzini" Hospital , Teramo , Italy
| | - Mirko Barone
- a Department of Thoracic Surgery , University of L'Aquila, "G. Mazzini" Hospital , Teramo , Italy
| | - Gino Zaccagna
- a Department of Thoracic Surgery , University of L'Aquila, "G. Mazzini" Hospital , Teramo , Italy
| | - Roberto Crisci
- a Department of Thoracic Surgery , University of L'Aquila, "G. Mazzini" Hospital , Teramo , Italy
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Nakadate A, Nakadate M, Sato Y, Nakagawa T, Yoshida K, Suzuki Y, Yoshida Y. Predictors of primary lung cancer in a solitary pulmonary lesion after a previous malignancy. Gen Thorac Cardiovasc Surg 2017; 65:698-704. [PMID: 28887727 DOI: 10.1007/s11748-017-0825-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/26/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE A solitary pulmonary lesion in patients with a history of malignancy may be either primary lung cancer or a metastatic lung tumor or benign nodule. We retrospectively examined the preoperative predictive factors for determining the type of pathology. METHODS We used an exact logistic regression analysis to identify radiological and clinical predictors of primary lung cancer. The study included 187 patients who underwent pulmonary resection for a solitary pulmonary lesion and had received previous treatment for a malignancy. RESULTS There were 107 patients with primary lung cancer, 74 with metastatic lung tumors, and 6 with benign lesions. The previous malignancy included colorectal cancer in 71 patients. A disease-free interval exceeding 5 years and ground-glass opacity were found in 27.0% (20/74) and 1.4% (1/74) of metastatic lung tumors, respectively. Multivariate logistic regression analysis demonstrated that spiculation [adjusted odds ratio (a-OR), 1.74; 95% confidence interval (CI), 1.09-2.86], pleural indentation (a-OR 1.99, 95% CI 1.24-3.29), and ground-glass opacity (a-OR 5.28, 95% CI 2.61-13.1) on high-resolution computed tomography, maximum standardized uptake value (a-OR 1.14, 95% CI 1.02-1.29), current and former smokers (a-OR 1.96, 95% CI 1.21-3.30), and previous malignancy other than colorectal cancer (a-OR 2.02, 95% CI 1.26-3.37) were associated with primary lung cancer. CONCLUSIONS A combination of radiological findings, smoking history, and type of previous malignancy can improve the ability to predict primary lung cancer in the presence of a solitary pulmonary lesion that appears after previous treatment for a malignancy.
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Affiliation(s)
- Akie Nakadate
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Masashi Nakadate
- Department of Radiology, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Yasunori Sato
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Tassei Nakagawa
- Department of Radiology, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Katsuya Yoshida
- Department of Radiology, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Yoshio Suzuki
- Department of Pathology, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Yukihiro Yoshida
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan.
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Zhou QJ, Zheng ZC, Zhu YQ, Lu PJ, Huang J, Ye JD, Zhang J, Lu S, Luo QQ. Tumor invasiveness defined by IASLC/ATS/ERS classification of ground-glass nodules can be predicted by quantitative CT parameters. J Thorac Dis 2017; 9:1190-1200. [PMID: 28616268 DOI: 10.21037/jtd.2017.03.170] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND To investigate the potential value of CT parameters to differentiate ground-glass nodules between noninvasive adenocarcinoma and invasive pulmonary adenocarcinoma (IPA) as defined by IASLC/ATS/ERS classification. METHODS We retrospectively reviewed 211 patients with pathologically proved stage 0-IA lung adenocarcinoma which appeared as subsolid nodules, from January 2012 to January 2013 including 137 pure ground glass nodules (pGGNs) and 74 part-solid nodules (PSNs). Pathological data was classified under the 2011 IASLC/ATS/ERS classification. Both quantitative and qualitative CT parameters were used to determine the tumor invasiveness between noninvasive adenocarcinomas and IPAs. RESULTS There were 154 noninvasive adenocarcinomas and 57 IPAs. In pGGNs, CT size and area, one-dimensional mean CT value and bubble lucency were significantly different between noninvasive adenocarcinomas and IPAs on univariate analysis. Multivariate regression and ROC analysis revealed that CT size and one-dimensional mean CT value were predictive of noninvasive adenocarcinomas compared to IPAs. Optimal cutoff value was 13.60 mm (sensitivity, 75.0%; specificity, 99.6%), and -583.60 HU (sensitivity, 68.8%; specificity, 66.9%). In PSNs, there were significant differences in CT size and area, solid component area, solid proportion, one-dimensional mean and maximum CT value, three-dimensional (3D) mean CT value between noninvasive adenocarcinomas and IPAs on univariate analysis. Multivariate and ROC analysis showed that CT size and 3D mean CT value were significantly differentiators. Optimal cutoff value was 19.64 mm (sensitivity, 53.7%; specificity, 93.9%), -571.63 HU (sensitivity, 85.4%; specificity, 75.8%). CONCLUSIONS For pGGNs, CT size and one-dimensional mean CT value are determinants for tumor invasiveness. For PSNs, tumor invasiveness can be predicted by CT size and 3D mean CT value.
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Affiliation(s)
- Qian-Jun Zhou
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Zhi-Chun Zheng
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Yong-Qiao Zhu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Pei-Ji Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jia Huang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jian-Ding Ye
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Qing-Quan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
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[Combined use of thin-section CT and 18F-FDG PET/CT for characterization of solitary pulmonary nodules]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37. [PMID: 28377340 PMCID: PMC6780437 DOI: 10.3969/j.issn.1673-4254.2017.03.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate whether fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) combined with thin-section CT improves the diagnostic performance for solitary pulmonary nodules (SPNs). METHODS A total of 267 patients underwent examinations with 18F-FDG PET/CT and thin-section CT for evaluating the SPNs with undetermined nature, which was further confirmed by pathological examination or clinical follow-up. The performance of two diagnostic criteria based on findings in PET/CT alone (Criterion 1) and in PET/CT combined with thin-section CT (Criterion 2) were compared. RESULTS Thin-section CT provided greater diagnostic information for SPNs in 84.2% of the patients. Compared with Criterion 1, the diagnosis based on Criterion 2 significantly increased the diagnostic sensitivity (80.4% vs 91%, P<0.01) and accuracy (76.4% vs 87.2%, P<0.01) for lung cancer. The lesion size and the CT features including lobulation, air bronchogram, and feeding vessel, but not SUVmax, were all helpful for characterizing non-solid SPNs. Thin-section CT rectified diagnostic errors in 50% (20/40) of the cancerous lesions, which had been diagnosed as benign by PET due to their low metabolism. For non-solid SPNs, Criterion 2 showed a significantly higher diagnostic sensitivity than Criterion 1 (90.0% vs 40.0%, P=0.000) but their diagnostic specificity were comparable (75.2% vs 58.3%, P=0.667). For solid nodules, the use of thin-section CT resulted in no significant improvement in the diagnostic performance (P>0.05). CONCLUSION The combination of PET/CT and thin-section CT creates a synergistic effect for the characterization of SPNs, especially non-solid nodules.
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Gao JW, Rizzo S, Ma LH, Qiu XY, Warth A, Seki N, Hasegawa M, Zou JW, Li Q, Femia M, Lv TF, Song Y. Pulmonary ground-glass opacity: computed tomography features, histopathology and molecular pathology. Transl Lung Cancer Res 2017; 6:68-75. [PMID: 28331826 PMCID: PMC5344841 DOI: 10.21037/tlcr.2017.01.02] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/15/2016] [Indexed: 12/20/2022]
Abstract
The incidence of pulmonary ground-glass opacity (GGO) lesions is increasing as a result of the widespread use of multislice spiral computed tomography (CT) and the low-dose CT screening for lung cancer detection. Besides benign lesions, GGOs can be a specific type of lung adenocarcinomas or their preinvasive lesions. Evaluation of pulmonary GGO and investigation of the correlation between CT imaging features and lung adenocarcinoma subtypes or driver genes can be helpful in confirming the diagnosis and in guiding the clinical management. Our review focuses on the pathologic characteristics of GGO detected at CT, involving histopathology and molecular pathology.
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Affiliation(s)
- Jian-Wei Gao
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Stefania Rizzo
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Li-Hong Ma
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Xiang-Yu Qiu
- The Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Arne Warth
- The Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Translational Lung Research Centre Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nobuhiko Seki
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Mizue Hasegawa
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
- Department of Respiratory Medicine, Tokyo Women’s Medical University, Yachiyo Medical Center, Tokyo, Japan
| | - Jia-Wei Zou
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qian Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Marco Femia
- Università degli studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy
| | - Tang-Feng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - written on behalf of the AME Lung Cancer Collaborative Group
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Department of Radiology, European Institute of Oncology, Milan, Italy
- The Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Translational Lung Research Centre Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
- Department of Respiratory Medicine, Tokyo Women’s Medical University, Yachiyo Medical Center, Tokyo, Japan
- Università degli studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy
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Schroeder JR, Gleason JB, Bastos B, Mehta JP. Where is the Air? J Clin Diagn Res 2017; 11:OJ01-OJ02. [PMID: 28384921 DOI: 10.7860/jcdr/2017/18172.9172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/11/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Jonathan Ryan Schroeder
- Fellow Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic , Florida
| | - James Benjamin Gleason
- Fellow Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic , Florida
| | - Bruno Bastos
- Attending Physician, Department of Hematology and Oncology, Cleveland Clinic , Florida
| | - Jinesh P Mehta
- Attending Physician, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic , Florida
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Yoshiya T, Mimae T, Tsutani Y, Tsubokawa N, Sasada S, Miyata Y, Kushitani K, Takeshima Y, Murakami S, Ito H, Nakayama H, Okada M. Prognostic Role of Subtype Classification in Small-Sized Pathologic N0 Invasive Lung Adenocarcinoma. Ann Thorac Surg 2016; 102:1668-1673. [DOI: 10.1016/j.athoracsur.2016.04.087] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/24/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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Feng ZM, Zhuang ZJ, He WB, Ding JP, Yang WJ, Chen XY. Lung Cancer with Diffuse Ground-glass Shadow in Two Lungs and Respiratory Failure. Chin Med J (Engl) 2016; 129:1873-6. [PMID: 27453241 PMCID: PMC4976580 DOI: 10.4103/0366-6999.186632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Zhe-Min Feng
- Department of Respiratory Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Zhen-Jie Zhuang
- Translational Medicine Center, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Wen-Bo He
- Department of Respiratory Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Jian-Ping Ding
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Wen-Jun Yang
- Department of Pathology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
| | - Xue-Yuan Chen
- Department of Respiratory Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China
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Yoo RE, Goo JM, Hwang EJ, Yoon SH, Lee CH, Park CM, Ahn S. Retrospective assessment of interobserver agreement and accuracy in classifications and measurements in subsolid nodules with solid components less than 8mm: which window setting is better? Eur Radiol 2016; 27:1369-1376. [DOI: 10.1007/s00330-016-4495-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 12/19/2022]
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Yip R, Yankelevitz DF, Hu M, Li K, Xu DM, Jirapatnakul A, Henschke CI. Lung Cancer Deaths in the National Lung Screening Trial Attributed to Nonsolid Nodules. Radiology 2016; 281:589-596. [PMID: 27378239 DOI: 10.1148/radiol.2016152333] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To validate the recommendation of performing annual follow-up of nonsolid nodules (NSNs) identified by computed tomographic (CT) screening for lung cancer, all cases of lung cancer manifesting as NSN in the National Lung Screening Trial (NLST) were reviewed. Materials and Methods Institutional review board and informed consent were waived for this study. The NLST database was searched to identify all participants with at least one NSN on CT scan with lung cancer as the cause of death (COD) documented by the NLST endpoint verification process. Among the 26 722 participants, 2534 (9.4%) had one or more NSNs, and lung cancer as the COD occurred for 48 participants. On review, 21 of the 48 patients had no NSN in the cancerous lobe, which left 27 patients whose CT scans were reviewed by four radiologists: Group A (n = 12) were cases of lung cancer as the COD because of adenocarcinoma, and group B (n = 15) were cases of lung cancer as the COD because of other cell types. Frequency of lung cancer as the COD because of NSN and the time from randomization to diagnosis within these groups was determined. Results Six of the 12 patients in group A had no NSN in the cancerous lobe whereas the remaining six patients had a dominant solid or part-solid nodule in the lobe that rapidly grew in four patients, was multifocal in one patient, and had a growing NSN in one patient in whom diagnosis was delayed for over 3 years. Five of the 15 patients in group B had no NSN, and for the remaining 10 patients, lung cancer as the COD was not because of NSN. Conclusion It seems unlikely that patients with lung cancer as the COD occurred with solitary or dominant NSN as long as annual follow-up was performed. This lends further support that lung cancers that manifest as NSNs have an indolent course and can be managed with annual follow-up. © RSNA, 2016.
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Affiliation(s)
- Rowena Yip
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - David F Yankelevitz
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Minxia Hu
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Kunwei Li
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Dong Ming Xu
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Artit Jirapatnakul
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Claudia I Henschke
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
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Concordant and Discordant EGFR Mutations in Patients With Multifocal Adenocarcinomas: Implications for EGFR-Targeted Therapy. Clin Ther 2016; 38:1567-76. [PMID: 27368115 DOI: 10.1016/j.clinthera.2016.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Adenocarcinoma remains the most common subtype of lung cancer in the United States. Most patients present with tumors that are invasive and often metastatic, but in some patients, multiple precursor in situ or minimally invasive adenocarcinoma tumors develop that can be synchronous and metachronous. These precursor lesions harbor the same spectrum of genetic mutations found in purely invasive adenocarcinomas, such as EGFR, KRAS, and p53 mutations. It is less clear, however, whether separate lesions in patients who present with multifocal disease share common underlying genetic driver mutations. METHODS Here we review the relevant literature on molecular driver alterations in adenocarcinoma precursor lesions. We then report 4 patients with multifocal EGFR mutant adenocarcinomas in whom we performed molecular testing on 2 separate lesions. FINDINGS In 2 of these patients, the mutations are concordant, and in 2 patients, the mutations are discordant. A review of the literature demonstrates increasing evidence that lesions with discordant mutations may confer a more favorable prognosis because they are unlikely to represent metastases. IMPLICATIONS Our findings suggest that the emergence of the dominant EGFR driver alteration is often independent between lesions in patients with multifocal adenocarcinomas, and thus the same targeted therapy may not be effective for all lesions. However, genetic testing of multiple lesions can help to distinguish separate primary tumors from metastatic disease.
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Chen C, Zhu WD, Zhang XH, Zhu YH, Huang JA. Value of Ki-67 and computed tomography in the assessment of peripheral lung adenocarcinoma. Br J Biomed Sci 2016; 73:32-7. [PMID: 27182675 DOI: 10.1080/09674845.2016.1146434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study was designed to determine whether proliferation antigen Ki-67 and/or a computed tomography (CT) value could be used to evaluate the clinical-pathological features of peripheral lung adenocarcinoma. MATERIALS AND METHODS A total of 116 eligible lung cancer patients were enrolled. Nodule size, lymph node metastasis, differentiation, Ki-67 expression and CT findings were assessed. The relationship between clinic parameters and the CT feature was analysed statistically. RESULTS The percentage of lesions that had ground-glass opacity or localised air bronchogram was significantly greater in low CT value group (<30, p < 0.05). No significant association was observed between CT value and size in the subgroup with CT value > 0 (p = 0.66). As a proliferative marker of lung cancer, Ki-67 was present in a total of 115 (99.9%) of the 116 evaluable primary lung cancers. There was a statistically significant correlation between the Ki-67 index and CT value (p < 0.05). Compared to CT value, Ki-67 index possessed higher sensitivity to predict the differentiation and lymph node metastasis of peripheral lung adenocarcinoma, adding of CT value would enhance its specificity. CONCLUSION Combination of Ki-67 expression and CT value determination was useful for the classification of differentiation and metastatic or proliferative potential of peripheral lung adenocarcinoma.
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Affiliation(s)
- Cheng Chen
- a Respiratory Department , The First Affiliated Hospital of Soochow University , Suzhou , China
| | - Wei-Dong Zhu
- b Pathology Department , The First Affiliated Hospital of Soochow University , Suzhou , China
| | - Xiao-Hui Zhang
- a Respiratory Department , The First Affiliated Hospital of Soochow University , Suzhou , China
| | - Ye-Han Zhu
- a Respiratory Department , The First Affiliated Hospital of Soochow University , Suzhou , China
| | - Jian-An Huang
- a Respiratory Department , The First Affiliated Hospital of Soochow University , Suzhou , China
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Detterbeck FC, Marom EM, Arenberg DA, Franklin WA, Nicholson AG, Travis WD, Girard N, Mazzone PJ, Donington JS, Tanoue LT, Rusch VW, Asamura H, Rami-Porta R. The IASLC Lung Cancer Staging Project: Background Data and Proposals for the Application of TNM Staging Rules to Lung Cancer Presenting as Multiple Nodules with Ground Glass or Lepidic Features or a Pneumonic Type of Involvement in the Forthcoming Eighth Edition of the TNM Classification. J Thorac Oncol 2016; 11:666-680. [PMID: 26940527 DOI: 10.1016/j.jtho.2015.12.113] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification. METHODS A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification. RESULTS Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases. CONCLUSION For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively-for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.
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Affiliation(s)
| | - Edith M Marom
- Department of Diagnostic Imaging, Tel-Aviv University, Ramat Gan, Israel
| | - Douglas A Arenberg
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom
| | - William D Travis
- Department of Pathology, Sloan-Kettering Cancer Center, New York, New York
| | - Nicolas Girard
- Respiratory Medicine Service, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Peter J Mazzone
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Lynn T Tanoue
- Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Valerie W Rusch
- Thoracic Surgery Service, Sloan-Kettering Cancer Center, New York, New York
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University, School of Medicine, Tokyo, Japan
| | - Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mutua Terrassa; Centros de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
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Jacobson FL. Lung Cancer Screening With Low-Dose Computed Tomography Beyond the National Lung Screening Trial. J Natl Cancer Inst 2015; 107:djv286. [DOI: 10.1093/jnci/djv286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Kim CH, Lee HS, Park JH, Choi JH, Jang SH, Park YB, Lee MG, Hyun IG, Kim KI, Kim HS, Cho SW, Lee WY, Kim EJ, Kim H, Shim JW, Choi YH. Prognostic role of p53 and Ki-67 immunohistochemical expression in patients with surgically resected lung adenocarcinoma: a retrospective study. J Thorac Dis 2015; 7:822-33. [PMID: 26101637 DOI: 10.3978/j.issn.2072-1439.2015.05.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/16/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE p53 mutations and the Ki-67 protein are frequently observed in various types of human cancer; the abnormal expression of p53 and Ki-67 in the tumor is associated with poor survival of lung cancer patients. We aimed to assess the prognostic role of immunohistochemical (IHC) expression of p53 and Ki-67 in lung adenocarcinoma tissue. METHODS Tumor samples from 136 patients who had undergone surgical resection for lung adenocarcinoma were retrospectively evaluated for p53 and Ki-67 expression by immunohistochemistry. Associations of clinical and pathologic variables with p53 and Ki-67 were determined using the χ(2) test. After excluding two patients (follow-up loss), 134 cases were evaluated for associations between p53, Ki-67, clinical and pathologic variables, and survival by using the Cox proportional hazards regression model and Kaplan-Meier method. RESULTS In the 136 patients, p53 was positive in 71.0% (93/131), and Ki-67 showed high in 49.2% (61/124). Unlike p53, Ki-67 was associated with male sex, smoking, and poor tumor differentiation (P=0.004, P=0.001 and P=0.006). Of these, poor tumor differentiation strongly was correlated with high level of Ki-67 expression (P=0.008). Neither p53 nor Ki-67 was associated with increased risk of death (P=0.318, P=0.053); however, age ≥60 years and lymph node involvement were significant predictors of death (P=0.039 and P=0.042). The log-rank test revealed a significant association between Ki-67 and lower survival in all patients (χ(2)=5637; P=0.018); however, the risk was limited to stage III cases (χ(2)=5.939; P=0.015). Unlike p53, patients with high level of Ki-67 expression showed lower 3-year actuarial survival than those without (log-rank test, χ(2)=4.936; P=0.026). CONCLUSIONS IHC expression of Ki-67 in lung adenocarcinoma tissue shows stronger association with poor tumor differentiation, and negatively affects patients' survival in advanced-stage lung cancer; however, the role of p53 on patient outcome needs further study.
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Affiliation(s)
- Cheol-Hong Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Hee Sung Lee
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Ju-Hee Park
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jeong-Hee Choi
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Seung-Hun Jang
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong-Bum Park
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Myung Goo Lee
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - In Gyu Hyun
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Kun Il Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyoung Soo Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung Woo Cho
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Won Yong Lee
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Eung-Joong Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Haeyoung Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jung Weon Shim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Hee Choi
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
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Abstract
The development of widespread lung cancer screening programs has the potential to dramatically increase the number of thoracic computed tomography (CT) examinations performed annually in the United States, resulting in a greater number of newly detected, indeterminate solitary pulmonary nodules (SPNs). Additional imaging studies, such as fluorodeoxyglucose F 18 (FDG)-positron emission tomography (PET), have been shown to provide valuable information in the assessment of indeterminate SPNs. Newer technologies, such as contrast-enhanced dual-energy chest CT and FDG-PET/CT, also have the potential to facilitate diagnosis of potentially malignant SPNs.
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