CT Features Associated with Epidermal Growth Factor Receptor Mutation Status in Patients with Lung Adenocarcinoma

Abstract

).q RSNA, 2016 Purpose:To retrospectively identify the relationship between epidermal growth factor receptor (EGFR) mutation status, predominant histologic subtype, and computed tomographic (CT) characteristics in surgically resected lung adenocarcinomas in a cohort of Asian patients. materials andMethods:This study was approved by the institutional review board, with waiver of informed consent. Preoperative chest CT findings were retrospectively evaluated in 385 surgically resected lung adenocarcinomas. A total of 30 CT descriptors were assessed. EGFR mutations at exons 18-21 were determined by using the amplification refractory mutation system. Multiple logistic regression analyses were performed to identify independent factors of harboring EGFR mutation status. The final model was selected by using the backward elimination method, and two areas under the receiver operating characteristic curve (ROC) were compared with the nonparametric approach of DeLong, DeLong, and Clarke-Pearson. Results:EGFR mutations were found in 168 (43.6%) of 385 patients. Mutations were found more frequently in (a) female patients (P , .001); (b)those who had never smoked (P , .001); (c)those with lepidic predominant adenocarcinomas (P = .001) or intermediate pathologic grade (P , .001); (e) smaller tumors (P , .001); (f) tumors with spiculation (P = .019), ground-glass opacity (GGO) or mixed GGO (P , .001), air bronchogram (P = .006), bubblelike lucency (P , .001), vascular convergence (P = .024), thickened adjacent bronchovascular bundles (P = .027), or pleural retraction (P , .001); and (g) tumors without pleural attachment (P = .004), a well-defined margin (P = .010), marked heterogeneous enhancement (P = .001), severe peripheral emphysema (P = .002), severe peripheral fibrosis (P = .013), or lymphadenopathy (P = .028). The most important and significantly independent prognostic factors of harboring EGFR-activating mutation for the model with both clinical variables and CT features were those who had never smoked and those with smaller tumors, bubblelike lucency, homogeneous enhancement, or pleural retraction when adjusting for histologic subtype, pathologic grade, or thickened adjacent bronchovascular bundles. ROC curve analysis showed that use of clinical variables combined with CT features (area under the ROC curve = 0.778) was superior to use of clinical variables alone (area under the ROC curve = 0.690). Conclusion:CT imaging features of lung adenocarcinomas in combination with clinical variables can be used to prognosticate EGFR mutation status better than use of clinical variables alone.q RSNA, 2016

Clinical and CT characteristics of surgically resected lung adenocarcinomas harboring ALK rearrangements or EGFR mutations

“…In a recent study, we have shown CT features associated with EGFR -mutated lung adenocarcinomas [25]. In this present study, we investigated the abilities of CT findings to discriminate between the two actionable mutations in an independent population.…”

Pulmonary ground-glass opacity: computed tomography features, histopathology and molecular pathology

“…Although no significant association was found between GGO and EGFR mutations (P=0.07), the EGFR mutation occurred more frequently in male patients with GGO than in those without GGO. Furthermore, two studies (41,42) involving 263 and 285 lung adenocarcinoma, reported that the EGFRmutated group had significantly higher frequencies and no higher frequencies of GGO, respectively. Lee et al (6) found that GGO volume percentage in tumors with L858R mutation was significantly higher than that in EGFR wildtype tumors (P=0.0001) and 19 deletion mutated tumors (P=0.0006).…”

Volume doubling time of lung adenocarcinomas considering epidermal growth factor receptor mutation status of exon 19 and 21: three-dimensional volumetric evaluation

“…As mentioned before, previous studies have already revealed that EGFR mutation status is closely related to the manifestation and prognosis of lung adenocarcinomas. Most recently, Liu et al (2) retrospectively evaluated 385 surgically resected lung adenocarcinomas and found that 16 CT features were associated with EGFR mutation status. The most significant and independent prognostic factors of EGFRactivating mutation in their study were non-smokers, smaller tumor size, bubblelike lucency, homogenous enhancement or pleural retraction.…”

“…Previous studies have revealed that EGFR mutation status is closely related to the manifestation and prognosis of lung adenocarcinomas (1)(2)(3). In advanced non-small cell lung cancer (NSCLC) patients, the mutation in exon 19 could provide superior objective response rate (ORR), one-year progression-free survival (PFS), and two-year overall survival (OS) after EGFR-tyrosine kinase inhibitors (EGFR-TKIs) treatment when compared with mutation in exon 21 (4)(5)(6).…”