Mimae Takahiro, Miyata Yoshihiro, Tsutani Yasuhiro, Mimura Takeshi, Nakayama Haruhiko, Okumura Sakae, Yoshimura Masahiro, Okada Morihito
Department of Surgical Oncology, Hiroshima University, Hiroshima.
Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama.
Jpn J Clin Oncol. 2015 Apr;45(4):367-72. doi: 10.1093/jjco/hyv005. Epub 2015 Jan 27.
Small pulmonary nodules are often followed up. This study aimed to establish radiographic criteria with which to accurately and reproducibly predict indolent cancers including adenocarcinoma in situ.
We examined correlations between pre-operative factors and surgical outcomes, including pathological findings and prognosis among 609 patients with clinical Stage IA lung adenocarcinoma that had been completely resected at multiple institutions. Indolent cancers were defined as tumors without lymphatic, blood vessel, pleural invasion or lymph node involvement (LY0V0PL0N0) regardless of stromal invasion.
Pathological assessments of specimens of 35 of 85 (41%) pure ground glass opacity tumors including 3 (23%) of 13 pure ground glass opacity tumors ≤ 1 cm, revealed partially invasive components. Receiver operating characteristic curves for LY0V0PL0N0 revealed solid tumor size ≤ 6 mm on high-resolution computed tomography or maximum standardized uptake values ≤ 0.6 on 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography as radiographic indolent tumor criteria for predicting indolent tumors. Among 216 (35.5%) of 609 patients who met these criteria, none developed recurrence over a median follow-up of 41.6 months.
Pure ground glass opacity lesions on high-resolution computed tomography could pathologically include invasive components and would not correspond to adenocarcinoma in situ. Solid tumor size on high-resolution computed tomography and maximum standardized uptake values on positron emission tomography/computed tomography can predict indolent LY0V0PL0N0 lung tumors that can be followed up.
小型肺结节常需进行随访。本研究旨在建立影像学标准，以准确且可重复地预测包括原位腺癌在内的惰性癌。
我们研究了609例在多家机构接受了完整切除的临床IA期肺腺癌患者术前因素与手术结果之间的相关性，包括病理结果和预后。惰性癌定义为无论有无间质浸润，均无淋巴管、血管、胸膜侵犯或淋巴结受累（LY0V0PL0N0）的肿瘤。
85例纯磨玻璃密度影肿瘤中的35例（41%），包括13例直径≤1 cm的纯磨玻璃密度影肿瘤中的3例（23%），其标本的病理评估显示有部分浸润成分。LY0V0PL0N0的受试者工作特征曲线显示，高分辨率计算机断层扫描上实性肿瘤大小≤6 mm或2-[18F]氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描上最大标准化摄取值≤0.6，可作为预测惰性肿瘤的影像学惰性肿瘤标准。在符合这些标准的609例患者中的216例（35.5%）中，中位随访41.6个月期间均未出现复发。
高分辨率计算机断层扫描上的纯磨玻璃密度影病变在病理上可能包含浸润成分，并不等同于原位腺癌。高分辨率计算机断层扫描上的实性肿瘤大小和正电子发射断层扫描/计算机断层扫描上的最大标准化摄取值可预测可进行随访的惰性LY0V0PL0N0肺肿瘤。
