Department of Surgery, Teikyo University Hospital, Tokyo, Japan.
Department of Thoracic surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
Ann Thorac Cardiovasc Surg. 2021 Aug 20;27(4):230-236. doi: 10.5761/atcs.oa.20-00240. Epub 2020 Dec 18.
We would like to clarify the imaging findings of the main tumor that may omit the requirement for lymph node dissection in clinical IA (cIA) lung adenocarcinoma.
A total of 336 patients with cIA lung adenocarcinomas with normal preoperative carcinoembryonic antigen (CEA) who underwent surgical resection were analyzed. We investigated the association between various computed tomography (CT) imaging findings or the maximum standardized uptake value (SUVmax) of fluorodeoxyglucose-position emission tomography (FDG-PET) and lymph node metastasis. The maximum tumor diameter was calculated from the CT images using both the lung window setting (LD) and mediastinal window setting (MD). The diameter of the solid component (CD) was defined as consolidation diameter in lung window setting. The solid component ratio (C/T) was defined as CD/LD.
SUVmax, MD, and C/T were independent factors related to lymph node metastasis, but CD was not (p = 0.38). The conditions required for the positive predictive value (PPV) to reach 100% were 10.6 mm for MD, 12.5 mm for CD, and 0.55 for C/T. SUVmax did not reach 100%.
In cIA lung adenocarcinoma with CEA in the normal range, we found that it may be possible for lymph node dissection to be omitted by MD, CD, and C/T.
我们希望阐明主要肿瘤的影像学表现，这些表现可能使临床 IA（cIA）肺腺癌患者免除淋巴结清扫的要求。
分析了 336 例术前癌胚抗原（CEA）正常的 cIA 肺腺癌患者的资料。我们研究了各种 CT 成像表现或氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）的最大标准化摄取值（SUVmax）与淋巴结转移之间的关系。使用肺窗（LD）和纵隔窗（MD）从 CT 图像计算最大肿瘤直径。在 LD 中定义实性成分的直径为实变直径。实性成分比（C/T）定义为 CD/LD。
SUVmax、MD 和 C/T 是与淋巴结转移相关的独立因素，但 CD 不是（p=0.38）。达到 100%阳性预测值（PPV）的条件分别为 MD 为 10.6mm、CD 为 12.5mm 和 C/T 为 0.55。SUVmax 未达到 100%。
在 CEA 正常范围的 cIA 肺腺癌中，我们发现 MD、CD 和 C/T 可能使淋巴结清扫成为可能。
