Uota Fuga, Iwano Shingo, Kamiya Shinichiro, Ito Rintaro, Nakamura Shota, Chen-Yoshikawa Toyofumi Fengshi, Naganawa Shinji
Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Eur Radiol. 2025 Jan 28. doi: 10.1007/s00330-025-11382-x.
Chest wall infiltration in primary lung cancer affects the surgical and therapeutic strategies. This study evaluates the efficacy of the chest wall vessel involvement in subpleural lung cancer (CWVI) on ultra-high-resolution CT (UHR-CT) for detecting chest wall invasion.
A retrospective analysis of lung cancer cases with confirmed pleural and chest wall invasion was conducted from November 2019 to April 2022. Seventy-seven patients (mean ± standard deviation age 70 ± 8 years, 64 males) who underwent preoperative contrast-enhanced UHR-CT were included. They were grouped into 51 non-chest wall infiltration (pl1 and pl2) and 26 chest wall infiltration (pl3). Clinical, histopathological, and UHR-CT findings were reviewed.
Upper lobe tumors exhibited a higher chest wall invasion rate (p < 0.001). Rib destruction was evident in five patients with chest wall invasion but none with pleural invasion (p < 0.001). CWVI was present in 19 of 26 patients with chest wall invasion and 2 of 51 patients with pleural invasion (p < 0.001). The maximum tumor diameter (Dmax), arch distance which means the interface length between the primary tumor and the chest wall (Adist), and the ratio of Dmax to Adist were higher in chest wall invasion cases (all p < 0.001). After excluding patients with rib destruction, in multivariate logistic regression analysis, only CWVI was a significant predictor for chest wall invasion (odds ratio 29.22 (95% confidence interval 9.13-262.90), p < 0.001).
CWVI on UHR-CT can help diagnose lung cancer infiltrating the chest wall, offering a potential tool for clinical decision-making.
Question Chest wall infiltration in primary lung cancer has implications for the treatment plan, but diagnosis is often difficult with conventional CT. Findings Chest wall vessel involvement in subpleural lung cancer on ultra-high-resolution CT is a valuable predictor for diagnosing chest wall infiltration. Clinical relevance The delineation of chest wall vessels with contrast-enhanced ultra-high-resolution CT may improve the diagnosis of chest wall infiltration and allow accurate staging and optimal treatment options for subpleural primary lung cancer.
原发性肺癌的胸壁浸润会影响手术和治疗策略。本研究评估超高分辨率CT（UHR-CT）检测胸膜下肺癌胸壁血管受累（CWVI）对胸壁侵犯的诊断效能。
对2019年11月至2022年4月确诊有胸膜和胸壁侵犯的肺癌病例进行回顾性分析。纳入77例术前行对比增强UHR-CT检查的患者（平均年龄±标准差70±8岁，男性64例）。将其分为51例无胸壁浸润（pl1和pl2）和26例胸壁浸润（pl3）。对临床、组织病理学和UHR-CT检查结果进行回顾。
上叶肿瘤的胸壁侵犯率更高（p<0.001）。5例胸壁侵犯患者可见肋骨破坏，而胸膜侵犯患者均无肋骨破坏（p<0.001）。26例胸壁侵犯患者中有19例存在CWVI，51例胸膜侵犯患者中有2例存在CWVI（p<0.001）。胸壁侵犯病例的最大肿瘤直径（Dmax）、即原发肿瘤与胸壁之间的界面长度的弓状距离（Adist）以及Dmax与Adist的比值更高（均p<0.001）。排除有肋骨破坏的患者后，在多因素逻辑回归分析中，只有CWVI是胸壁侵犯的显著预测因素（比值比29.22（95%置信区间9.13-262.90），p<0.001）。
UHR-CT上的CWVI有助于诊断浸润胸壁的肺癌，为临床决策提供了一种潜在工具。
问题原发性肺癌的胸壁浸润对治疗方案有影响，但传统CT诊断往往困难。发现超高分辨率CT上胸膜下肺癌的胸壁血管受累是诊断胸壁浸润的有价值预测因素。临床意义对比增强超高分辨率CT对胸壁血管的描绘可能改善胸壁浸润的诊断，并为胸膜下原发性肺癌提供准确分期和最佳治疗方案。
