Correlation between computed tomographic findings, bronchioloalveolar carcinoma component, and biologic behavior of small-sized lung adenocarcinomas

Okada, Morihito; Nishio, Wataru; Sakurai, Toshihiko; Uchino, Kenji; Hanioka, Keisuke; Ohbayashi, Chiho; Tsubota, Noriaki

doi:10.1016/j.jtcvs.2003.08.048

Cited by 98 publications

(68 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Okada showed that both TDR and GGO were well associated with BAC ratios (i.e., the fraction of the tumor that is GGO), which are determined postoperatively. The TDR also had a stronger impact as a predictor of the BAC component (26). The authors recommended calculating TDR because it is more objective than qualitatively evaluating the ratio of GGO, which can have high interobserver variability (27).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Differentiation of Bronchioloalveolar Carcinoma from Adenocarcinoma with Bronchioloalveolar Components with Metabolic and Anatomic Characteristics Using PET/CT

Goudarzi

Jacene²,

Wahl³

2008

J Nucl Med

View full text Add to dashboard Cite

18 F-FDG PET has been reported to have reduced sensitivity in detecting bronchioloalveolar carcinoma (BAC) versus lung cancers with other histologies. However, there are CT characteristics that are suggestive of BAC, and potentially these could be useful to refine diagnostic criteria so PET/CT can be more accurate in the diagnosis of BAC. We correlated tumor size and density obtained with CT and glucose metabolism obtained with 18 F-FDG PET in patients with BAC and adenocarcinoma with BAC components (Adeno1BAC) to determine the roles of both the anatomic and the functional components of the PET/CT examination in diagnosing this disease. Also, the correlation between tumor size and 18 F-FDG uptake or Hounsfield unit (HU) value was determined in these 2 groups. Methods: This was a retrospective study on a consecutive series of 53 patients with 57 pathology-proven lesions (26 BAC, 31 Adeno1BAC) who underwent 18 F-FDG PET/CT scans. The standardized uptake value (SUV) and average HUs reported were obtained for the tumors. The tumor size, 18 F-FDG uptake, and HU values in both groups were compared. The correlation between metabolic (SUV) and CT (HU) characteristics for the lesions and tumor size was assessed using the Pearson correlation coefficient. Results: A total of 26 lesions with pure BAC had a median SUVmax of 1.48 (range, 0.63-4.54). A total of 81% of patients with BAC (21/26 lesions) had SUVmax values of less than 2.5. Thirty-one lesions diagnosed as Adeno1BAC had a median SUVmax of 6.03 (range, 2.45-24) (P , 0.0001 vs. BAC). The mean SUVmax (1.77 6 0.99) of BAC was much lower than that of Adeno1BAC (6.55 6 4.33) (P , 0.0001). Maximum HU in BAC lesions (2111.96 6 123.92) was substantially lower than that in Adeno1BAC (82.03 6 33.77) lesions (P , 0.0001). The average maximum tumor dimension in the lung window was much smaller for BACs (17.63 6 5.5) than for Adeno1BACs (49.38 6 27.5) (P , 0.0001). A strong positive correlation between tumor size and HU was observed in the Adeno1BAC group (P 5 0.0002). Conclusion: PET/CT can help differentiate between BAC and Adeno1BAC by using tumor size, CT density, and metabolic activity. Pure BAC exhibits smaller size, lower 18 F-FDG uptake, and lower tumor density than does Adeno1BAC. Many BACs have low SUVs (,2.0), but their low HU on CT aids in their proper identification.

show abstract

Section: Discussionmentioning

confidence: 99%

Diagnosis and Differentiation of Bronchioloalveolar Carcinoma from Adenocarcinoma with Bronchioloalveolar Components with Metabolic and Anatomic Characteristics Using PET/CT

Goudarzi

Jacene²,

Wahl³

2008

J Nucl Med

View full text Add to dashboard Cite

show abstract

“…Interestingly, some recent investigators have begun to address the possibility of lung parenchymal sublobar limited resection for this specific subgroup of small lung cancers with GGO appearance [1][2][3][4][5][6][7]. Although operative procedures are generally dependent on size, number, and location of lesions, limited resection procedures, such as wedge resection, are a well-recognized form of operative procedure for small-sized pure GGO.…”

Section: Introductionmentioning

confidence: 99%

Pathologic and Biological Assessment of Lung Tumors Showing Ground-Glass Opacity

Ohta

Shimizu

Kobayashi

et al. 2006

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…4,5 Components of BAC appear to present as areas of ground-glass opacity (GGO) on HRCT, defined as a hazy increase in lung attenuation without obscuring underlying vascular markings, 6 and they can also be expressed as areas of tumor shadow disappearance rate (TDR), defined as the ratio of tumor area of the mediastinal window to that of the lung window on HRCT. 7 Therefore, the GGO ratio or TDR might be linked to the grade of adenocarcinoma malignancy. 3,[7][8][9] However, a recent large phase 2 study demonstrated that preoperative radiographic findings on HRCT cannot accurately diagnose the pathological invasiveness of small lung adenocarcinoma.…”

mentioning

confidence: 99%

“…7 Therefore, the GGO ratio or TDR might be linked to the grade of adenocarcinoma malignancy. 3,[7][8][9] However, a recent large phase 2 study demonstrated that preoperative radiographic findings on HRCT cannot accurately diagnose the pathological invasiveness of small lung adenocarcinoma. 10 In contrast to anatomic images of CT, positron emission tomography (PET) with F18-fluorodeoxyglucose (FDG) quantitatively images glucose metabolism, which reflects the metabolic activity and proliferative potential of malignant tumors, and it is therefore widely and increasingly used for the diagnosis, staging, and therapeutic assessment of non-small cell lung cancer.…”

mentioning

confidence: 99%

“…3,4,[7][8][9] A large prospective study of 811 patients (Japan Clinical Oncology Group [JCOG] 0201) evaluated the specificity, sensitivity, and accuracy of preoperative radiologic diagnoses based on HRCT findings regarding the invasiveness of clinical T1N0M0 adenocarcinomas. 10 The results demonstrated that predetermined criteria for specificity could not be confirmed, and that candidates for limited surgery could not be adequately determined based on their criteria using HRCT.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Value of integrated positron emission tomography revised using a phantom study to evaluate malignancy grade of lung adenocarcinoma

Nakayama

Okumura

Daisaki³

et al. 2010

Cancer

Self Cite

View full text Add to dashboard Cite

BACKGROUND:The malignant biological behavior of small-sized lung adenocarcinomas remains obscure, although understanding this feature is important for selecting appropriate treatment. In the current study, the authors evaluated malignancy grades of small adenocarcinomas using fluorodeoxyglucose-positron emission tomography/ computed tomography (PET/CT) in addition to high-resolution CT (HRCT) and pathological analysis in a multicenter setting. METHODS: A total of 201 patients with clinical T1N0M0 adenocarcinoma underwent PET/CT and HRCT followed by complete surgical resection. Associations between components of bronchioloalveolar carcinoma (BAC) in specimens and maximum standardized uptake values (maxSUV) on PET/CT and ground-glass opacity (GGO) ratios and tumor disappearance rate (TDR) on HRCT were analyzed, as well as associations between these findings and pathological features of the tumors. Variations in maxSUV among institutions and the underestimations derived from small tumors, which are limitations of PET performed in multicenter studies, were adjusted using a phantom study. RESULTS: The maxSUV, BAC ratio, TDR, and GGO ratio (in that order) reflected the grade of tumor invasiveness and lymph node metastasis. The maxSUV and BAC ratio were found to be significant prognostic predictors derived from disease-free survival curves. Although the BAC ratio was found to be significantly associated with preoperative radiographic parameters, the maxSUV, GGO ratio, and TDR (all P < .0001), the degree of correlation with maxSUV (correlation coefficient [R 2 ] ¼ 0.1699) was much weaker than that reported with the GGO ratio (R 2 ¼ 0.5860) or TDR (R 2 ¼ 0.5082). CONCLUSIONS: Phantom studies can overcome the difficulties of multicenter studies using PET. A higher maxSUV appears to reflect aggressive malignant behavior in clinical T1N0M0 adenocarcinomas, independent of BAC components. Preoperative PET/CT assessment in addition to HRCT could be used to construct hypotheses for a future clinical study of strategies for the treatment of patients with small lung adenocarcinoma. Cancer 2010;116:3170-7.

show abstract

Correlation between computed tomographic findings, bronchioloalveolar carcinoma component, and biologic behavior of small-sized lung adenocarcinomas

Cited by 98 publications

References 20 publications

Diagnosis and Differentiation of Bronchioloalveolar Carcinoma from Adenocarcinoma with Bronchioloalveolar Components with Metabolic and Anatomic Characteristics Using PET/CT

Diagnosis and Differentiation of Bronchioloalveolar Carcinoma from Adenocarcinoma with Bronchioloalveolar Components with Metabolic and Anatomic Characteristics Using PET/CT

Pathologic and Biological Assessment of Lung Tumors Showing Ground-Glass Opacity

Value of integrated positron emission tomography revised using a phantom study to evaluate malignancy grade of lung adenocarcinoma

Contact Info

Product

Resources

About