Impact of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of stage IA adenocarcinoma of the lung: Correlation between computed tomography images and EGFR and KRAS gene mutations

Abstract

Abstract. The aim of the present study was to compare pathological diagnoses, as determined by the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification, with conventional radiological features. In addition, the present study aimed to evaluate the correlation among clinical characteristics, computed tomography (CT) images and gene mutation status in patients with stage IA adenocarcinoma of the lung. A total of 212 patients with stage IA lung adenocarcinoma were included in the study. The patients were classified into pure ground-glass opacity (pGGO), mixed GGO (mGGO) and solid GGO (sGGO) by CT imaging. Histological subtype was classified according to the IASLC/ATS/ERS classification of lung adenocarcinoma. In addition, epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma (KRAS) mutation assays were performed, and 36.8% of patients (78/212) were determined to have an EGFR mutation, while 8.5% of patients (18/212) were found to have a KRAS mutation. According to the IASLC/ATS/ERS classification, 44 cases were diagnosed as adenocarcinoma in situ (AIS; 20.8%), 62 cases were diagnosed as minimally invasive adenocarcinoma (MIA; 29.2%) and 106 cases were classified as invasive adenocarcinoma (IAC; 50.0%). pGGO image patterns were observed in 39.2% of patients (n=83), while mGGO and sGGO patterns were observed in 28.8% (n=61) and 32.0% (n=68) of patients, respectively. From pGGO to sGGO, cases of AIS and MIA were shown to have a decreasing trend, while IAC cases exhibited an increasing trend (P=0.036). Analysis of the correlation between CT image patterns and gene mutations demonstrated that L858R point mutations, exon 19 deletions and KRAS mutations were more common in lesions with a lower GGO proportion (P=0.029, 0.027 and 0.018, respectively). Therefore, according to the IASLC/ATS/ERS classification, GGO imaging patterns were shown to correlate with subtypes of adenocarcinomas. In addition, EGFR and KRAS mutations were found to be associated with lesions with a low GGO proportion. Therefore, analysis of GGO lesions may offer useful indications of the histological subtype of an adenocarcinoma in patients with stage IA lung adenocarcinoma, and predictive value for EGFR and KRAS mutations.

Lung Adenocarcinoma: Predictive Value ofKRASMutation Status in Assessing Local Recurrence in Patients Undergoing Image-guided Ablation

“…Mery CM, Pappas AN, Bueno R, et al Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the Interestingly, we also saw a trend toward an association between groundglass appearance and mutation status-KRAS mutant tumors were less likely to have a ground-glass component (P = .06). This finding is supported by recent work correlating CT imaging features with mutation status (35,36). This may also explain why the presence of a ground-glass appearance in the nodule was significant in the univariate analysis but not in the multivariate analysis.…”

“…Patient and tumor characteristics are summarized in Table 1. There were 54 patients, with a median age of 72 years (range, 54-87 years) and a median number of pack-years of smoking of (27) 2 (11) 13 (35) .061…”

Survivin knockdown induces senescence in TTF‑1-expressing, KRAS-mutant lung adenocarcinomas

“…More than half of the KRAS -mutated lung adenocarcinomas analyzed in the present study were of the TRU-type, and one fourth of them were classified as AIS or MIA. Although these pathological findings may seem unexpected in that quite a few KRAS -mutant lung adenocarcinomas are less aggressive than might be expected, we would like to stress that the findings mentioned above are consistent with those of previous reports ( 27 , 52 ). This suggests that KRAS -mutant lung adenocarcinomas, at least operable ones, appear more differentiated and less aggressive than might be thought.…”

Associations between epidermal growth factor receptor mutations and histological subtypes of lung adenocarcinoma according to the IASLC/ATS/ERS classification in Chinese patients

“…Formalin‐fixed paraffin‐embedded lung cancer tissues were obtained during surgery. Tumor specimens were procured for EGFR gene mutational analysis using previously documented methods . Briefly, DNA was extracted from the samples using a QIAamp DNA FFPE tissue kit (Qiagen, Hilden, Germany).…”