Koenigkam Santos Marcel, Muley Thomas, Warth Arne, de Paula Wagner Diniz, Lederlin Mathieu, Schnabel Philipp Albert, Schlemmer Heinz-Peter, Kauczor Hans-Ulrich, Heussel Claus Peter, Puderbach Michael
Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes 3900, Campus Universitario Monte Alegre, 14048 900 Ribeirao Preto, SP, Brazil.
Chest Clinic (Thoraxklinik) at University of Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg, Germany.
Eur J Radiol. 2014 Jul;83(7):1275-1281. doi: 10.1016/j.ejrad.2014.04.019. Epub 2014 May 1.
To characterize the morphological computed tomography (CT) features of pulmonary squamous cell carcinomas (SQCC) submitted to therapeutic resection; to correlate these features with patients' outcomes; and to compare with pulmonary adenocarcinomas (ADC).
Two chest radiologists retrospectively evaluated CT exams of 123 patients with SQCC resected between 2002 and 2008. Tumors' size, location (central vs. peripheral), shape, margins, attenuation, enhancement, presence of calcification, cavitation, internal air bronchograms and pleural tags were assigned by consensus. Prevalence of features was compared with patients' survival data and a previously studied population of ADC surgically resected at the same time period.
Cavitation correlated negatively with overall (hazard ratio=3.04), disease-specific (HR=3.67) and disease-free survival (HR=2.69), independent from age, gender, tumor pathological stage, size, and location. In relation to ADC, SQCC presented different shape, margins, attenuation, enhancement, with more cavitation, rare internal air bronchograms, and less pleural tags. Differences were also significant when comparing only the peripheral type of tumors.
Cavitation at CT was an independent and negative predictive factor for SQCC. Different CT morphological features were described for SQCC and ADC. Image evaluation of lung lesions should go beyond measuring and addressing adjacent structures invasion. Adequate imaging characterization not only helps to differentiate benign versus malignant disease and to determine malignancy staging, it may also imply the histologic subtype and improve the prognostic assessment of lung cancer patients.
描述接受治疗性切除的肺鳞状细胞癌（SQCC）的形态学计算机断层扫描（CT）特征；将这些特征与患者的预后相关联；并与肺腺癌（ADC）进行比较。
两名胸部放射科医生回顾性评估了2002年至2008年间接受切除的123例SQCC患者的CT检查。通过共识确定肿瘤的大小、位置（中央型与周围型）、形状、边缘、密度、强化、钙化、空洞、内部空气支气管征和胸膜尾征的情况。将这些特征的发生率与患者的生存数据以及同期接受手术切除的先前研究的ADC人群进行比较。
空洞与总生存期（风险比=3.04）、疾病特异性生存期（HR=3.67）和无病生存期（HR=2.69）呈负相关，独立于年龄、性别、肿瘤病理分期、大小和位置。与ADC相比，SQCC呈现出不同的形状、边缘、密度、强化，空洞更多，内部空气支气管征少见，胸膜尾征更少。仅比较周围型肿瘤时差异也很显著。
CT上的空洞是SQCC的独立负性预测因素。描述了SQCC和ADC不同的CT形态学特征。肺部病变的影像评估应超越测量和判断邻近结构侵犯情况。充分的影像特征不仅有助于鉴别良性与恶性疾病以及确定恶性肿瘤分期，还可能提示组织学亚型并改善肺癌患者的预后评估。
