Ishizawa Hisato, Matsuda Yasushi, Ohno Yoshiharu, Sakurai Eiko, Ota Atsuhiko, Hattori Hidekazu, Tsukamoto Tetsuya, Matsunaga Masaaki, Kawai Hiroshi, Suzuki Yamato, Nagano Hiromitsu, Negi Takahiro, Tochii Daisuke, Tochii Sachiko, Suda Takashi, Hoshikawa Yasushi
Department of Thoracic Surgery, Fujita Health University, Toyoake, Japan.
Department of Radiology, Fujita Health University, Toyoake, Japan.
J Thorac Dis. 2023 Feb 28;15(2):516-528. doi: 10.21037/jtd-22-1115. Epub 2023 Feb 21.
Lung cancer frequently occurs in lungs with background idiopathic interstitial pneumonias (IIPs). Limited resection is often selected to treat lung cancer in patients with IIPs in whom respiratory function is already compromised. However, accurate surgical margins are essential for curative resection; underestimating these margins is a risk for residual lung cancer after surgery. We aimed to investigate the findings of lung fields adjacent to cancer segments affect the estimation of tumor size on computed tomography compared with the pathological specimen.
This analytical observational study retrospectively investigated 896 patients with lung cancer operated on at Fujita Health University from January 2015 to June 2020. The definition of underestimation was a ≥10 mm difference between the radiological and pathological maximum sizes of the tumor.
The lung tumors were in 15 honeycomb, 30 reticulated, 207 emphysematous, and 628 normal lungs. The ratio of underestimation in honeycomb lungs was 33.3% compared to 7.4% without honeycombing (P=0.004). Multivariate analysis showed that honeycombing was a significant risk factor for tumor size underestimation. A Bland-Altman plot represented wide 95% limits of agreement, -40.8 to 70.2 mm, between the pathological and radiological maximum tumor sizes in honeycomb lungs.
肺癌常发生于伴有特发性间质性肺炎（IIP）的肺脏。对于呼吸功能已受损的IIP患者，常选择有限切除来治疗肺癌。然而，准确的手术切缘对于根治性切除至关重要；低估这些切缘会增加术后残留肺癌的风险。我们旨在研究与病理标本相比，癌灶周围肺野的表现对计算机断层扫描上肿瘤大小估计的影响。
这项分析性观察研究回顾性调查了2015年1月至2020年6月在藤田保健大学接受手术的896例肺癌患者。低估的定义为肿瘤的放射学最大尺寸与病理学最大尺寸之间相差≥10 mm。
肺肿瘤位于15个蜂窝状肺、30个网状肺、207个气肿性肺和628个正常肺中。蜂窝状肺中的低估比例为33.3%，无蜂窝状改变的肺中为7.4%（P = 0.004）。多因素分析表明，蜂窝状改变是肿瘤大小低估的一个重要危险因素。Bland-Altman图显示，蜂窝状肺中病理和放射学最大肿瘤大小之间的一致性界限较宽，为-40.8至70.2 mm。
