Issa Nomair, Arfanis Elias, Hager Thomas, Aigner Clemens, Dietz-Terjung Sarah, Theegarten Dirk, Kühl Hilmar, Welter Stefan
Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany.
Institute of Pathology, University Clinic Essen, University of Duisburg-Essen, Essen, Germany.
J Thorac Dis. 2019 Jul;11(7):2822-2831. doi: 10.21037/jtd.2019.07.04.
The histologic presence of aggressive local growth of pulmonary metastases is associated with an increased risk for local intrapulmonary recurrence after enucleation or wedge resection. Patient tailored resection planning is possible when morphologic pattern of aggressive growth could be identified based on preoperative CT scans.
Radiomorphology and microscopic growth characteristics from 232 pulmonary metastases from 87 patients were prospectively compared for the presence or absence of aggressive patterns of local intrapulmonary dissemination.
Microscopic aggressive local growth was found: pleural involvement (18.5%), lymphatic invasion (6.9%), vascular invasion (7.3%), interstitial growth (38.4%), micro satellite nodules (24.5%), spread through air spaces (STAS) (13.4%), and a smooth, slightly blurred or irregular surface in 34.1%, 43.1% and 22.8%. The radiologic margin demarcation was smooth in 37.1%, blurred in 27.6% or irregular in 35.3% and spiculae were present in 26.3% of the lesions. The microscopic and radiologic description of the metastasis surface correlated well [correlation coefficient (CC) =0.75, P<0.001]. A smooth surface on CT scan corresponded with a smooth microscopic surface in 72/86 (83.7%) of the lesions. The radiomorphologic feature of an irregular or cloudy surface was highly associated with the presence of at least one aggressive pattern of local dissemination (P<0.001). The presence of spiculae on CT scan was well associated with the presence of aggressive local spread (P<0.001) and the microscopic features corresponding with spiculae were interstitial growth, STAS and L1.
Radiomorphologic characteristics of lung metastases correspond well with the microscopic appearance of the resected lesion. Therefore it seems possible to adjust safety margins based on the radiologic appearance of the metastasis.
肺转移瘤局部侵袭性生长的组织学表现与摘除术或楔形切除术后肺内局部复发风险增加相关。当基于术前CT扫描能够识别侵袭性生长的形态学模式时，可为患者量身定制切除计划。
前瞻性比较87例患者232个肺转移瘤的放射形态学和微观生长特征，以确定是否存在肺内局部播散的侵袭性模式。
发现微观侵袭性局部生长情况如下：胸膜受累（18.5%）、淋巴管浸润（6.9%）、血管浸润（7.3%）、间质生长（38.4%）、微卫星结节（24.5%）、气腔播散（STAS）（13.4%），以及表面光滑、轻度模糊或不规则的情况分别占34.1%、43.1%和22.8%。放射学边缘分界光滑的占37.1%，模糊的占27.6%，不规则的占35.3%，26.3%的病灶有毛刺。转移瘤表面的微观和放射学描述相关性良好[相关系数（CC）=0.75，P<0.001]。CT扫描显示的光滑表面与72/86（83.7%）的病灶微观表面光滑相对应。不规则或模糊表面的放射形态学特征与至少一种局部播散侵袭性模式的存在高度相关（P<0.001）。CT扫描上毛刺的存在与侵袭性局部扩散的存在密切相关（P<0.001），与毛刺相对应的微观特征是间质生长、STAS和L1。
肺转移瘤的放射形态学特征与切除病灶的微观表现密切相关。因此，似乎可以根据转移瘤的放射学表现调整安全切缘。
