Department of Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 E. 68th St, Box 141, New York, NY, 10065, USA.
Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, 402 E. 67th St, New York, NY, 10065, USA.
Eur Radiol. 2019 Sep;29(9):4555-4562. doi: 10.1007/s00330-019-06059-1. Epub 2019 Feb 26.
Imaging features of thymomas such as lobulation, infiltration into lung, and adjacent lung abnormality have been associated with lung invasion but are unreliable. The goal of this study was to develop a more objective and reproducible method for predicting lung invasion by thymomas.
Fifty-four thymomas resected from 2007 to 2017 were included for analysis. Pre-operative CT scans for these thymomas were reviewed, and multiple features were evaluated, including the interface of each thymoma with the adjacent lung. A multilobulated thymoma with at least one acute angle between lobulations was considered suspicious for lung invasion. Two blinded radiologists then tested this hypothesis by reviewing all 54 CT scans and using this single criterion to predict lung invasion.
Twelve thymomas invaded the lung. All lung-invasive thymomas were multilobulated. Twenty-nine thymomas had a multilobulated interface with the lung. Multilobulated thymomas were more likely to invade the lung than thymomas with a single lobulation or no lobulation (p = 0.0008). Using the criterion of multilobulation with at least one acute angle between lobulations to predict lung invasion, the two readers achieved a sensitivity of 67-83%, specificity of 93-98%, positive predictive value of 77-89%, and negative predicted value of 91-95%. Nine lung-invasive thymomas also invaded mediastinal structures or disseminated to the pleura.
A multilobulated thymoma with at least one acute angle between lobulations predicts lung invasion with a high degree of accuracy. When lung invasion is suspected, the findings are indicative of a locally aggressive tumor, and the pleura and mediastinal structures should also be closely inspected for invasion.
• A multilobulated thymoma with at least one acute angle between lobulations is predictive of lung invasion. • Coronal and sagittal reformations and thin sections are helpful in challenging cases. • Lung invasion indicates a locally aggressive tumor, and the pleura and other mediastinal structures should also be closely inspected for invasion.
胸腺瘤的影像学特征，如分叶、浸润肺和邻近肺异常，与肺浸润有关，但不可靠。本研究的目的是开发一种更客观和可重复的方法来预测胸腺瘤的肺浸润。
纳入了 2007 年至 2017 年间切除的 54 例胸腺瘤进行分析。对这些胸腺瘤的术前 CT 扫描进行了回顾性分析，并评估了多个特征，包括每个胸腺瘤与相邻肺的界面。具有至少一个锐角的多叶性胸腺瘤被认为有肺浸润的嫌疑。然后，两名盲法放射科医生通过回顾所有 54 例 CT 扫描，并使用这一单一标准来预测肺浸润，来验证这一假说。
有 12 例胸腺瘤侵犯了肺。所有肺浸润性胸腺瘤均为多叶性。29 例胸腺瘤与肺的界面呈多叶性。多叶性胸腺瘤比单叶性或无叶性胸腺瘤更有可能侵犯肺（p=0.0008）。使用多叶性且叶间至少有一个锐角的标准来预测肺浸润，两名读者的灵敏度为 67-83%，特异性为 93-98%，阳性预测值为 77-89%，阴性预测值为 91-95%。9 例肺浸润性胸腺瘤还侵犯了纵隔结构或播散到胸膜。
至少有一个锐角的多叶性胸腺瘤可高度准确地预测肺浸润。当怀疑有肺浸润时，这些发现表明肿瘤具有局部侵袭性，应仔细检查胸膜和纵隔结构是否有侵犯。
至少有一个锐角的多叶性胸腺瘤可预测肺浸润。
冠状面和矢状面重建以及薄层有助于解决有挑战的病例。
肺浸润表明肿瘤具有局部侵袭性，应仔细检查胸膜和其他纵隔结构是否有侵犯。
