Departments of Cardiothoracic Radiology.
Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland.
J Thorac Imaging. 2021 Nov 1;36(6):373-381. doi: 10.1097/RTI.0000000000000594.
Primary lung cancers associated with cystic airspaces are increasingly being recognized; however, there is a paucity of data on their natural history. We aimed to evaluate the prevalence, pathologic, and imaging characteristics of cystic lung cancer in a regional thoracic surgery center with a focus on the evolution of computed tomography morphology over time.
Consecutive patients referred for potential surgical management of primary lung cancer between January 2016 and December 2018 were included. Clinical, imaging, and pathologic data were collected at the time of diagnosis and at the time of the oldest computed tomography showing the target lesion. Descriptive analysis was carried out.
A total of 441 cancers in 431 patients (185 males, 246 females), median age 69.6 years (interquartile range: 62.6 to 75.3 y), were assessed. Overall, 41/441 (9.3%) primary lung cancers were cystic at the time of diagnosis. The remaining showed solid (67%), part-solid (22%), and ground-glass (2%) morphologies. Histopathology of the cystic lung cancers at diagnosis included 31/41 (76%) adenocarcinomas, 8/41 (20%) squamous cell carcinomas, 1/41 (2%) adenosquamous carcinoma, and 1/41 (2%) unspecified non-small cell lung carcinoma. Overall, 8/34 (24%) cystic cancers at the time of diagnosis developed from different morphologic subtype precursor lesions, while 8/34 (24%) cystic precursor lesions also transitioned into part-solid or solid cancers at the time of diagnosis.
This study demonstrates that cystic airspaces within lung cancers are not uncommon, and may be seen transiently as cancers evolve. Increased awareness of the spectrum of cystic lung cancer morphology is important to improve diagnostic accuracy and lung cancer management.
与囊性气腔相关的原发性肺癌越来越受到关注；然而，关于其自然病史的数据却很少。我们旨在评估一个区域胸外科中心的囊性肺癌的患病率、病理学和影像学特征，重点是随着时间的推移 CT 形态的演变。
连续纳入 2016 年 1 月至 2018 年 12 月期间因原发性肺癌潜在手术治疗而转诊的患者。在诊断时和显示目标病变的最旧 CT 时收集临床、影像学和病理学数据。进行描述性分析。
共评估了 431 名患者的 441 例癌症（男性 185 例，女性 246 例），中位年龄为 69.6 岁（四分位距：62.6 至 75.3 岁）。总体而言，441 例原发性肺癌中有 41 例（9.3%）在诊断时呈囊性。其余的表现为实性（67%）、部分实性（22%）和磨玻璃密度（2%）形态。诊断时囊性肺癌的组织病理学包括 31/41（76%）腺癌、8/41（20%）鳞状细胞癌、1/41（2%）腺鳞癌和 1/41（2%）未指定的非小细胞肺癌。总体而言，诊断时 8/34（24%）的囊性癌是由不同形态亚型的前体病变发展而来，而 8/34（24%）的囊性前体病变在诊断时也转变为部分实性或实性癌。
本研究表明，肺癌中的囊性气腔并不少见，并且可能随着癌症的演变而暂时出现。提高对囊性肺癌形态学谱的认识对于提高诊断准确性和肺癌管理至关重要。
