Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China.
Department of Medical Imaging, Shishi Hospital, Fujian, 362700, China.
Lung Cancer. 2019 Sep;135:110-115. doi: 10.1016/j.lungcan.2019.05.012. Epub 2019 May 12.
Lung cancer associated with cystic airspaces (LCCA) is a rare entity. The diagnosis and treatment is often delayed due to lack of comprehension of this disease. We aimed to elucidate LCCA's clinicopathological characteristics and investigate imaging features correlated with pathological invasiveness.
The preoperative computed tomographic (CT) scans of 10,835 patients diagnosed with NSCLC between January 2015 and December 2016 were reviewed by two thoracic radiologists for association with a cystic airspace. A clinicopathological and radiological feature analysis was done.
A total number of 123 LCCA patients were identified and four morphologic patterns were recognized: I, thin-walled type (n = 23, 18.7%); II, thick-walled type (n = 34, 27.6%); III, a cystic airspace with a mural nodule (CWN) type (n = 43, 35.0%); and IV, mixed type (n = 23, 18.7%). A solid component in the cyst wall predicted histological invasiveness in all four types of LCCA. The proportion of moderately/poorly (M/P)-differentiated subtype in type III (85.0%) was higher than in other three patterns (which were 50.0%, 50.0%, and 69.6%, respectively). Multivariate analysis revealed that type III pattern (odds ratio [OR], 6.5; 95% confidence interval [CI], 1.1-36.4; P = 0.035), part-solid/solid component in wall (part-solid: OR, 27.2; 95% CI, 5.6-3131.6; P < 0.001; solid: OR 614.6; 95% CI, 36.4-10,368.6; P < 0.001), and irregular inner surface of cyst (OR 7.0; 95% CI 1.9-26.2; P = 0.004) were independent risk factors for the M/P-differentiated subtype. EGFR mutations were the predominant genetic alterations in each type of LCCAs, but no significant difference was found among them.
In LCCA, morphological patterns and wall components were two important predictors for determining pathological invasiveness.
肺癌相关的含气腔（LCCA）是一种罕见的实体。由于对这种疾病缺乏了解，诊断和治疗往往会被延误。我们旨在阐明 LCCA 的临床病理特征，并研究与病理侵袭性相关的影像学特征。
回顾了 2015 年 1 月至 2016 年 12 月期间诊断为 NSCLC 的 10835 例患者的术前计算机断层扫描（CT）扫描，两名胸部放射科医生对其与含气腔的关系进行了评估。对临床病理和影像学特征进行了分析。
共发现 123 例 LCCA 患者，识别出 4 种形态学类型：I 型，薄壁型（n=23，18.7%）；II 型，厚壁型（n=34，27.6%）；III 型，含气腔伴壁结节（CWN）型（n=43，35.0%）；IV 型，混合型（n=23，18.7%）。在所有 4 种类型的 LCCA 中，囊壁的实性成分均预测组织学侵袭性。III 型中中/低分化（M/P）亚型的比例（85.0%）高于其他三种类型（分别为 50.0%、50.0%和 69.6%）。多变量分析显示，III 型模式（比值比[OR]，6.5；95%置信区间[CI]，1.1-36.4；P=0.035）、囊壁部分实性/实性成分（部分实性：OR，27.2；95%CI，5.6-3131.6；P<0.001；实性：OR 614.6；95%CI，36.4-10,368.6；P<0.001）和囊内表面不规则（OR 7.0；95%CI 1.9-26.2；P=0.004）是 M/P 分化亚型的独立危险因素。每种类型的 LCCA 中 EGFR 突变都是主要的遗传改变，但彼此之间没有发现显著差异。
在 LCCA 中，形态学模式和囊壁成分是确定病理侵袭性的两个重要预测因素。
