Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, Japan.
Clin Lung Cancer. 2018 May;19(3):e303-e312. doi: 10.1016/j.cllc.2017.12.005. Epub 2017 Dec 19.
Measuring the size of invasiveness on computed tomography (CT) for the T descriptor size was deemed important in the 8th edition of the TNM lung cancer classification. We aimed to correlate the maximal dimensions of the solid portions using both lung and mediastinal window settings on CT imaging with the pathologic invasiveness (> 0.5 cm) in lung adenocarcinoma patients.
The study population consisted of 378 patients with a histologic diagnosis of adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IVA)-lepidic, IVA-acinar and/or IVA-papillary, and IVA-micropapillary and/or solid adenocarcinoma. A panel of 15 radiologists was divided into 2 groups (group A, 9 radiologists; and group B, 6 radiologists). The 2 groups independently measured the maximal and perpendicular dimensions of the solid components and entire tumors on the lung and mediastinal window settings. The solid proportion of nodule was calculated by dividing the solid portion size (lung and mediastinal window settings) by the nodule size (lung window setting). The maximal dimensions of the invasive focus were measured on the corresponding pathologic specimens by 2 pathologists.
The solid proportion was larger in the following descending order: IVA-micropapillary and/or solid, IVA-acinar and/or papillary, IVA-lepidic, MIA, and AIS. For both groups A and B, a solid portion > 0.8 cm in the lung window setting or > 0.6 cm in the mediastinal window setting on CT was a significant indicator of pathologic invasiveness > 0.5 cm (P < .001; receiver operating characteristic analysis using Youden's index).
A solid portion > 0.8 cm on the lung window setting or solid portion > 0.6 cm on the mediastinal window setting on CT predicts for histopathologic invasiveness to differentiate IVA from MIA and AIS.
在第 8 版 TNM 肺癌分期中，人们认为在计算机断层扫描（CT）上测量 T 描述符大小的侵袭程度很重要。我们旨在通过 CT 成像上的肺窗和纵隔窗设置来比较肺腺癌患者中实性部分的最大尺寸与病理侵袭性（>0.5cm）的相关性。
研究人群包括 378 例组织学诊断为原位腺癌（AIS）、微浸润性腺癌（MIA）、侵袭性肺腺癌（IVA）-贴壁型、IVA-腺泡型和/或 IVA-乳头型、IVA-微乳头型和/或实体性腺癌的患者。一组 15 名放射科医生分为两组（A 组 9 名放射科医生，B 组 6 名放射科医生）。两组独立测量肺窗和纵隔窗设置下实性成分和整个肿瘤的最大和垂直尺寸。通过将实性部分大小（肺窗和纵隔窗设置）除以结节大小（肺窗设置）来计算结节的实性比例。由 2 名病理学家在相应的病理标本上测量侵袭灶的最大尺寸。
实性比例按以下降序排列：IVA-微乳头型和/或实体性腺癌、IVA-腺泡型和/或乳头型、IVA-贴壁型、MIA 和 AIS。对于 A 组和 B 组，肺窗设置中实性部分>0.8cm 或纵隔窗设置中实性部分>0.6cm 的 CT 是病理侵袭性>0.5cm 的显著指标（P<.001；使用 Youden 指数的受试者工作特征分析）。
肺窗设置中实性部分>0.8cm 或纵隔窗设置中实性部分>0.6cm 的 CT 可预测组织病理学侵袭性，有助于将 IVA 与 MIA 和 AIS 区分开来。
