Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
Department of Cardiothoracic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
AJR Am J Roentgenol. 2021 Oct;217(4):871-881. doi: 10.2214/AJR.21.25618. Epub 2021 May 12.
Prognostic factors on preoperative CT in stage IA non-small cell lung cancer (NSCLC) may help select patients for sublobar resection or lobectomy. The purpose of this study was to identify CT features predictive of pathologic lymphovascular invasion (LVI) in stage IA NSCLC and to evaluate the features' prognostic value in patients who undergo sublobar resection. This retrospective study included 904 patients (mean age, 62.0 years; 453 men, 451 women) who underwent lobectomy ( = 574) or sublobar resection ( = 330) for stage IA NSCLC. Two thoracic radiologists independently evaluated findings on pre-operative chest CT and then resolved discrepancies. Recurrences were identified from medical record review. Multivariable logistic regression was used to identify independent predictors of pathologic LVI. Multivariable Cox proportional hazards models were used to identify prognostic features. Interreader agreement was assessed. Pathologic LVI was present in 10.2% (92/904) of patients. It was present only in solid-dominant part-solid nodules (PSNs) and solid nodules and only in nodules with a solid portion diameter over 10 mm. Among solid-dominant PSNs and solid nodules with a solid portion diameter over 10 mm, independent ( < .05) predictors of pathologic LVI were peritumoral interstitial thickening (odds ratio [OR], 13.22) and pleural contact (defined as pleural contact measuring over one-quarter of the circumference of the nodule's solid portion) (OR, 2.45). Also among such nodules, peritumoral interstitial thickening achieved 80.4% sensitivity, 76.7% specificity, and 77.4% accuracy; pleural contact achieved 35.9% sensitivity, 82.5% specificity, and 74.3% accuracy; and presence of either feature achieved 90.2% sensitivity, 64.3% specificity, and 68.9% accuracy for predicting pathologic LVI. In patients undergoing sublobar resection, after adjusting for T category and operative type, recurrence-free survival (RFS) was independently ( < .05) predicted by solid-dominant PSN or solid nodule with a solid portion diameter over 10 mm also showing peritumoral interstitial thickening (hazard ratio [HR], 5.37) or also showing either peritumoral interstitial thickening or pleural contact (HR, 6.05). The interreader agreement kappa values were 0.67 for peritumoral interstitial thickening and 0.77 for pleural contact. Pathologic LVI occurred only in solid-dominant PSNs and solid nodules with solid portion over 10 mm. Among such nodules, peritumoral interstitial thickening and pleural contact independently predicted pathologic LVI and RFS. CT features may help select patients with stage IA NSCLC for sublobar resection rather than more extensive surgery.
术前 CT 对 IA 期非小细胞肺癌（NSCLC）的预后因素有助于选择行亚肺叶切除术或肺叶切除术的患者。本研究旨在确定 IA 期 NSCLC 中预测病理性血管淋巴管侵犯（LVI）的 CT 特征，并评估这些特征在接受亚肺叶切除术的患者中的预后价值。本回顾性研究纳入了 904 例（平均年龄 62.0 岁；453 名男性，451 名女性）因 IA 期 NSCLC 行肺叶切除术（=574 例）或亚肺叶切除术（=330 例）的患者。两名胸部放射科医生独立评估术前胸部 CT 的结果，然后解决差异。通过病历回顾确定复发情况。采用多变量逻辑回归确定病理性 LVI 的独立预测因素。采用多变量 Cox 比例风险模型确定预后特征。评估了两位读者的一致性。904 例患者中有 10.2%（92/904）存在病理性 LVI。仅在实性为主的部分实性结节（PSN）和实性结节中发现 LVI，且仅在实性部分直径大于 10mm 的结节中发现 LVI。在实性为主的 PSN 和实性部分直径大于 10mm 的结节中，病理性 LVI 的独立（<0.05）预测因子为肿瘤周围间质增厚（比值比[OR]，13.22）和胸膜接触（定义为胸膜接触测量超过结节实性部分周长的四分之一）（OR，2.45）。同样在这些结节中，肿瘤周围间质增厚的敏感性为 80.4%，特异性为 76.7%，准确性为 77.4%；胸膜接触的敏感性为 35.9%，特异性为 82.5%，准确性为 74.3%；两种特征的存在预测病理性 LVI 的敏感性为 90.2%，特异性为 64.3%，准确性为 68.9%。在接受亚肺叶切除术的患者中，在调整 T 分期和手术类型后，无复发生存率（RFS）独立（<0.05）由实性为主的 PSN 或实性部分直径大于 10mm 的实性结节预测，也显示肿瘤周围间质增厚（风险比[HR]，5.37）或也显示肿瘤周围间质增厚或胸膜接触（HR，6.05）。两位读者的一致性kappa 值分别为肿瘤周围间质增厚 0.67，胸膜接触 0.77。病理性 LVI 仅发生在实性为主的 PSN 和实性部分直径大于 10mm 的实性结节中。在这些结节中，肿瘤周围间质增厚和胸膜接触独立预测病理性 LVI 和 RFS。CT 特征可能有助于选择 IA 期 NSCLC 患者行亚肺叶切除术，而不是更广泛的手术。
