Heidinger Benedikt H, Schwarz-Nemec Ursula, Anderson Kevin R, de Margerie-Mellon Constance, Monteiro Filho Antonio C, Chen Yigu, Mayerhoefer Marius E, VanderLaan Paul A, Bankier Alexander A
Departments of Radiology (B.H.H., U.S.N., C.d.M.M., A.C.M.F., A.A.B.) and Pathology (K.R.A., Y.C., P.A.V.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215; Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Austria (B.H.H., U.S.N., M.E.M.); and Seacoast Pathology/Aurora Diagnostics, Exeter, NH (K.R.A.).
Radiol Cardiothorac Imaging. 2019 Aug 29;1(3):e190071. doi: 10.1148/ryct.2019190071. eCollection 2019 Aug.
To analyze the incidence and CT patterns of visceral pleural invasion (VPI) in adenocarcinomas on the basis of their CT presentation as solid or subsolid nodules.
A total of 286 adenocarcinomas in direct contact with a pleural surface, resected at an institution between 2005 and 2016, were included in this retrospective, institutional review board-approved study. CT size and longest contact length with a pleural surface were measured and their ratios computed. Pleural deviation, pleural thickening, spiculations, different pleural tag types, pleural effusion, and the CT appearance of transgression into an adjacent lobe or infiltration of surrounding tissue were evaluated. Fisher exact tests and simple and multiple logistic regression models were used.
Of the 286 nodules, 179 of 286 (62.6%) were solid and 107 of 286 (37.4%) were subsolid. VPI was present in 49 of 286 (17.1%) nodules and was significantly more frequent in solid (44 of 179; 24.6%) than in subsolid nodules (five of 107; 4.7%; < .001). In solid nodules, multiple regression analysis showed an association of higher contact length-to-size ratio (adjusted odds ratio [OR], 1.02; = .007) and the presence of multiple pleural tag types (adjusted OR, 5.88; = .002) with VPI. In subsolid nodules, longer pleural contact length of the solid nodular component (adjusted OR, 1.27; = .017) and the CT appearance of transgression or infiltration (adjusted OR, 10.75; = .037) were associated with VPI.
During preoperative evaluation of adenocarcinomas for the likelihood of VPI, whether a tumor manifests as a solid or a subsolid nodule is important to consider because the incidence of VPI is significantly higher in solid than in subsolid nodules. In addition, this study showed that the CT patterns associated with VPI differ between solid and subsolid nodules.© RSNA, 2019See also the commentary by Elicker in this issue.
根据腺癌在CT上表现为实性或亚实性结节，分析其脏层胸膜侵犯（VPI）的发生率及CT表现。
本回顾性研究经机构审查委员会批准，纳入了2005年至2016年间在某机构切除的286例与胸膜表面直接接触的腺癌。测量CT上肿瘤大小及与胸膜表面的最长接触长度，并计算其比值。评估胸膜凹陷、胸膜增厚、毛刺征、不同类型的胸膜结节、胸腔积液以及侵犯相邻肺叶或周围组织的CT表现。采用Fisher精确检验以及单因素和多因素逻辑回归模型。
286个结节中，179个（62.6%）为实性，107个（37.4%）为亚实性。286个结节中有49个（17.1%）存在VPI，实性结节中VPI的发生率（179个中有44个，24.6%）显著高于亚实性结节（107个中有5个，4.7%；P<0.001）。在实性结节中，多因素回归分析显示接触长度与大小比值较高（校正比值比[OR]，1.02；P = 0.007）以及存在多种胸膜结节类型（校正OR，5.88；P = 0.002）与VPI相关。在亚实性结节中，实性结节成分的胸膜接触长度较长（校正OR，1.27；P = 0.017）以及侵犯或浸润的CT表现（校正OR，10.75；P = 0.037）与VPI相关。
在术前评估腺癌发生VPI的可能性时，考虑肿瘤表现为实性还是亚实性结节很重要，因为实性结节中VPI的发生率显著高于亚实性结节。此外，本研究表明实性和亚实性结节中与VPI相关的CT表现不同。©RSNA，2019另见本期Elicker的评论。
