Ambrosi Francesca, Lissenberg-Witte Birgit, Comans Emile, Sprengers Ralf, Dickhoff Chris, Bahce Idris, Radonic Teodora, Thunnissen Erik
Experimental, Diagnostic, and Specialty Medicine Department, University of Bologna Medical Center, Bologna, Italy.
Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.
JTO Clin Res Rep. 2020 Feb 27;1(2):100018. doi: 10.1016/j.jtocrr.2020.100018. eCollection 2020 Jun.
Ground-glass opacities in a high-resolution computed tomography (HR-CT) scan correlate, if malignant, with adenocarcinoma in situ. The solid appearance in the HR-CT is often considered indicative of an invasive component. This study aims to compare the radiologic features revealed in the HR-CT and the histologic features of primary adenocarcinomas in resection specimens to find the presence of tumor atelectasis in ground-glass nodules (GGNs) and part-solid and solid nodules.
HR-CT imaging was evaluated, and lung nodules were classified as GGNs, part-solid nodules, and solid nodules, whereas adenocarcinomas were classified according to WHO classification. Lepidic growth pattern with collapse was considered if there was reduction of air in the histologic section with maintained pulmonary architecture (without signs of pleural or vascular invasion).
Radiologic and histologic features were compared in 47 lesions of 41 patients. The number of GGN, part-solid, and solid nodules were two, eight, and 37, respectively. Lepidic growth pattern with collapse was observed in both GGN, seven of the eight part-solid (88%) and 24 of the 37 solid (65%) lesions. Remarkably, more than 50% of the adenocarcinomas with a solid appearance in HR-CT imaging had a preexisting pulmonary architecture with adenocarcinoma with a predominant lepidic growth pattern. In these cases, the solid component can be explained by tumor-related collapse in vivo (tumor atelectasis on radiologic examination).
Tumor atelectasis is a frequent finding in pulmonary adenocarcinomas and may beside a ground glass opacity also result in a solid appearance in HR-CT imaging. A solid appearance on HR-CT cannot be attributed to invasion alone, as has been the assumption until now.
高分辨率计算机断层扫描（HR-CT）中的磨玻璃影若为恶性，则与原位腺癌相关。HR-CT中的实性表现通常被认为提示存在浸润成分。本研究旨在比较HR-CT显示的影像学特征与切除标本中原发性腺癌的组织学特征，以发现磨玻璃结节（GGN）、部分实性结节和实性结节中肿瘤肺不张的存在情况。
对HR-CT影像进行评估，将肺结节分为GGN、部分实性结节和实性结节，而腺癌则根据世界卫生组织分类进行分类。如果组织学切片中空气减少但肺结构保持完整（无胸膜或血管侵犯迹象），则考虑为伴有萎陷的鳞屑样生长模式。
对41例患者的47个病灶进行了影像学和组织学特征比较。GGN、部分实性结节和实性结节的数量分别为2个、8个和37个。在GGN、8个部分实性结节中的7个（88%）和37个实性结节中的24个（65%）中均观察到伴有萎陷的鳞屑样生长模式。值得注意的是，HR-CT影像中表现为实性的腺癌中，超过50%存在预先存在的肺结构，腺癌以鳞屑样生长模式为主。在这些病例中，实性成分可通过体内肿瘤相关萎陷来解释（影像学检查中的肿瘤肺不张）。
肿瘤肺不张在肺腺癌中很常见，除磨玻璃影外，还可能导致HR-CT影像中出现实性表现。HR-CT上的实性表现不能像迄今为止所假设的那样仅归因于浸润。
