Central and peripheral pulmonary sclerosing pneumocytomas: multi-phase CT study and comparison with Ki-67

Abstract

Background This study aimed to evaluate the multi-phase CT findings of central and peripheral pulmonary sclerosing pneumocytomas (PSPs) and compared them with Ki-67 to reveal their neoplastic nature. Patients and methods Multi-phase CT and clinical data of 33 PSPs (15 central PSPs and 18 peripheral PSPs) were retrospectively analyzed and compared their multi-phase CT features and Ki-67 levels. Results For quantitative indicators, central PSPs were larger than peripheral PSPs (10.39 ± 3.25 cm3 vs. 4.65 ± 2.61 cm3, P = 0.013), and tumor size was negatively correlated with acceleration index (r = −0.845, P < 0.001). The peak enhancement of central PSPs appeared in the delayed phase, with a longer time to peak enhancement (TTP, 100.81 ± 19.01 s), lower acceleration index (0.63 ± 0.17), progressive enhancement, and higher Ki-67 level. The peak enhancement of peripheral PSPs appeared in the venous phase, with the shorter TTP (62.67 ± 20.96 s, P < 0.001), higher acceleration index (0.99 ± 0.25, P < 0.001), enhancement washout, and lower Ki-67 level. For qualitative indicators, the overlying vessel sign (86.67% vs. 44.44%, P = 0.027), prominent pulmonary artery sign (73.33% vs. 27.78%, P = 0.015), and obstructive inflammation/atelectasis (26.67% vs. 0%, P = 0.033) were more common in central PSPs, while peripheral PSPs were more common with halo sign (38.89% vs. 6.67%, P = 0.046). Conclusions The location of PSP is a possible contributing factor to its diverse imaging-pathological findings. The tumor size, multi-phase enhancement, qualitative signs, and Ki-67 were different between central and peripheral PSPs. Combined tumor size, multi-phase findings, and Ki-67 level are helpful to reveal the nature of the borderline tumor.

Multiple pulmonary sclerosing pneumocytoma, based on a study of 36 cases worldwide

“…This classification method can better guide the clinical treatment strategy of multiple PSP. An analysis of the imaging findings of multiple PSP revealed 8.33% of patients to have lymph node metastasis or even extrapulmonary metastasis 15 , which was significantly higher than the lymph node metastasis rate of solitary PSP 17 – 20 .

Figure 2 The site of multiple PSP.

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Revisiting Pulmonary Sclerosing Pneumocytoma

“…PSP affects most frequently women in Eastern countries. Series from China [ 3 , 4 , 5 , 18 , 26 , 27 ], Taiwan [ 8 ], Japan [ 15 ], Korea [ 28 ], and the USA [ 2 ] confirm female predominance, the wide age range of patients, no clear relationship with smoking, more frequent involvement of lower lobes, and a predominant clinical presentation as a solitary nodule. Cases with multiple nodules, however, even bilateral, have also been reported [ 10 , 11 , 12 , 13 ].…”

“…Location within the lung seems to matter. For example, Zhang et al [ 27 ] have detected significant differences in multiphase CT scans between central- vs. peripheral-located tumors within the lung in 33 patients (all female), serving as helpful tools in distinguishing the nature of borderline tumors.…”