Computed tomographic image comparison between mediastinal and lung windows provides possible prognostic information in patients with small peripheral lung adenocarcinoma

Dong, Boming; Sato, Masami; Sagawa, Motoyasu; Endo, Chiaki; Usuda, Katsuo; Sakurada, Akira; Wu, Shulin; Oyaizu, Takeshi; Ishida, Itaru; Handa, Masashi; Kondo, Takashi

doi:10.1067/mtc.2002.125647

Cited by 10 publications

(11 citation statements)

References 15 publications

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“…In patients with adenocarcinoma of the lung, particularly those with BAC components, this conventional T staging might be inappropriate. Our results confirm the Japanese studies which found that size measured on CT using an MW setting had better discrimination between absence or presence of nodal spread and prognostic value than size measured on an LW setting [9,25,26]. This can be explained by the fact that the LW incorporates both benign and aggressive elements of mixed adenocarcinomas.…”

Section: Discussionsupporting

confidence: 88%

“…Alternative approaches using simpler radiological measurements of tumour size based on lung and softtissue windows [9], particularly the two-dimensional TDR [16][17][18][19] from which the mTDR in the current study is derived, correlate well with quantitative measurement of the degree of ground-glass appearance. These measurements are at least as good a prognostic indicator as the GGO-based methods [19].…”

Section: Ct-derived Tumour Size In Lung Cancermentioning

confidence: 69%

“…PET data were not used for further evaluation in this study. Although the CT slice thickness was constrained by the PET-CT protocol, it compares favourably with slice thicknesses used in many studies measuring TDR or its variants [9,16,18,19].…”

Section: Ct Imaging Informationmentioning

confidence: 99%

“…However, BAC and solid adenocarcinoma of the lung have different attenuation characteristics on CT; thus, it matters which window should be used to define the T stage of the tumour. There is already evidence from Asian centres, particularly in Japan, to suggest that measurement of tumour dimensions using the mediastinal window (MW) is the better prognostic indicator [9,10].…”

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confidence: 99%

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Accuracy of CT parameters for assessment of tumour size and aggressiveness in lung adenocarcinoma with bronchoalveolar elements

Lardinois

Kalff

Hany

et al. 2010

BJR

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Accurate determination of tumour size in lung adenocarcinoma with bronchoalveolar features (BAC) is important for the determination of TNM (tumour, nodes, metastasis) scores used in staging, prognosis and therapy response assessment. However, tumour sizes derived using lung window (LW) CT or soft-tissue/mediastinal window (MW) CT often give different results. This study examines which measurement correlates best with actual tumour size and which best identifies advanced disease. This retrospective study included 43 BAC patients who underwent surgical resection with mediastinal lymphadenectomy <4 weeks post CT scan. The largest unidimensional tumour diameter on each CT window was compared with actual histopathological tumour size (HP). LW, MW and HP size measurements and a recently described CT parameter - the modified tumour shadow disappearance rate (mTDR) = (1 - [MW/LW]) - were then used to determine which parameter best discriminated between the presence or absence of advanced disease. There was no difference between HP and LW sizes, but MW significantly underestimated HP size (p<0.0001). Unlike MW (p = 0.01) and mTDR (p = 0.001), neither HP (p = 0.14) nor LW (p = 0.10) distinguished between patients with or without advanced disease. On receiver operating characteristic (ROC) analysis at a cut-off of ≤0.13, the sensitivity and specificity of mTDR for detecting advanced disease were 69% and 89%, respectively. In patients with tumours ≤3 cm, only mTDR remained a significant predictor of advanced disease (p = 0.017), with best cut-off at ≤0.20, giving a sensitivity and specificity of 71% and 94%, respectively. MW better predicts advanced disease than LW and might also need to be recorded for RECIST (response evaluation criteria in solid tumours) assessment for T staging of BAC; however, mTDR appears to be an even better predictor and should also be used.

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Section: Discussionsupporting

confidence: 88%

Section: Ct-derived Tumour Size In Lung Cancermentioning

confidence: 69%

Section: Ct Imaging Informationmentioning

confidence: 99%

mentioning

confidence: 99%

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Accuracy of CT parameters for assessment of tumour size and aggressiveness in lung adenocarcinoma with bronchoalveolar elements

Lardinois

Kalff

Hany

et al. 2010

BJR

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“…Two articles measured PSNs, one time using lung window settings only and the other time using both mediastinal and lung window settings [80, 81]; these two articles are included. Another four articles used only the approach using mediastinal and lung window settings and these four articles were excluded [46, 82–84] because the mediastinal settings were not standardised and varied widely. In summary, 4 of the 31 studies were excluded, leaving 27 studies.…”

Section: Resultsmentioning

confidence: 99%

Controversies on lung cancers manifesting as part-solid nodules

Yip

Liu

et al. 2017

Eur Radiol

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Purpose Summarise survival of patients with resected lung cancers manifesting as part-solid nodules (PSNs). Methods PubMed/MEDLINE and EMBASE databases were searched for all studies/clinical trials on CT-detected lung cancer in English before 21 December 2015 to identify surgically resected lung cancers manifesting as PSNs. Outcome measures were lung cancer-specific survival (LCS), overall survival (OS), or disease-free survival (DFS). All PSNs were classified by the percentage of solid component to the entire nodule diameter into category PSNs <80% or category PSNs ≥80%. Results Twenty studies reported on PSNs <80%: 7 reported DFS and 2 OS of 100%, 6 DFS 96.3-98.7%, and 11 OS 94.7-98.9% (median DFS 100% and OS 97.5%). Twenty-seven studies reported on PSNs ≥80%: 1 DFS and 2 OS of 100%, 19 DFS 48.0%-98.0% (median 82.6%), and 16 reported OS 43.0%-98.0% (median DFS 82.6%, OS 85.5%). Both DFS and OS were always higher for PSNs <80%. Conclusion A clear definition of the upper limit of solid component of a PSN is needed to avoid misclassification because cell-types and outcomes are different for PSN and solid nodules. The workup should be based on the size of the solid component.

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Computed tomographic images reflect the biologic behavior of small lung adenocarcinoma: They correlate with cell proliferation, microvascularization, cell adhesion, degradation of extracellular matrix, and K-ras mutation

Dong

Sato

Sakurada

et al. 2005

The Journal of Thoracic and Cardiovascular Surgery

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Computed tomographic image comparison between mediastinal and lung windows provides possible prognostic information in patients with small peripheral lung adenocarcinoma

Abstract: It is suggested that the ratio of the area of the mediastinal computed tomographic image to that of the lung computed tomographic image can be a prognostic factor in patients with small peripheral lung adenocarcinoma.

Cited by 10 publications

References 15 publications

Accuracy of CT parameters for assessment of tumour size and aggressiveness in lung adenocarcinoma with bronchoalveolar elements

Accuracy of CT parameters for assessment of tumour size and aggressiveness in lung adenocarcinoma with bronchoalveolar elements

Controversies on lung cancers manifesting as part-solid nodules

Computed tomographic images reflect the biologic behavior of small lung adenocarcinoma: They correlate with cell proliferation, microvascularization, cell adhesion, degradation of extracellular matrix, and K-ras mutation

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