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Correlation between pleural tags on CT and visceral pleural invasion of peripheral lung cancer that does not appear touching the pleural surface

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Abstract

Objectives

To evaluate the association between a sign and visceral pleural invasion (VPI) of peripheral non–small-cell lung cancer (NSCLC) that does not appear touching the pleural surface.

Methods

A total of 221 consecutive patients with NSCLC that did not appear touching the pleural surface, ≤ 3 cm in solid tumor diameter, and was surgically resected between January 2009 and December 2015 were included. We focused on the flat distortion of the tumor caused by an arch-shaped linear tag between the tumor and the pleura on CT and named it a bridge tag sign. We evaluated the associations between the clinicopathological features of the tumor, including the bridge tag sign, and VPI. We also evaluated the associations between histopathological findings and the bridge tag sign. The utility of the bridge tag sign in the diagnosis of VPI was statistically assessed.

Results

The bridge tag sign was observed in 48 (20.8%) patients. VPI was positive in 9 (4.1%) patients; among these, the bridge tag sign was positive in 8 patients. In multivariate analysis, a bridge tag sign was significantly associated with VPI. The bridge tag sign was associated with longer contact length of the pleura with the tumor and trapezoid type pleural retraction. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the bridge tag sign in the diagnosis of VPI were 88.9%, 83.5%, 83.7%, 18.6%, and 99.4%, respectively.

Conclusions

A bridge tag sign on CT might improve the accuracy of the prediction of VPI.

Key Points

• We present the bridge tag sign which is defined as a flat distortion of an NSCLC tumor by an arch-shaped linear tag between the tumor and chest wall or interlobar fissure.

• The bridge tag sign was an independent predictive factor for visceral pleural invasion.

• The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the bridge tag sign in the diagnosis of visceral pleural invasion were 88.9%, 83.5%, 83.7%, 18.6%, and 99.4%, respectively.

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Abbreviations

CT:

Computed tomography

GGN:

Ground-glass nodule

HE:

Hematoxylin and eosin

NPV:

Negative predictive value

NSCLC:

Non–small-cell lung cancer

PPV:

Positive predictive value

ROC curve:

Receiver operating characteristic curve

TNM:

Tumor-node-metastasis

VPI:

Visceral pleural invasion

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Acknowledgements

We thank Miss. Hinata Fukusako, Mai Nitta, and Masami Murakami for their assistance in performing pathological tissue. We are grateful to Dr. Eiji Ikeda and Dr. Katsuyoshi Ito for their helpful comments on the manuscript.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, 755-8505, Japan

    Hideko Onoda, Mayumi Higashi, Yoshie Kunihiro & Masahiro Tanabe

  2. Department of Pathology, National Hospital Organization Kanmon Medical Center, Shimonoseki, Japan

    Tomoyuki Murakami

  3. Department of Thoracic Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Japan

    Hiroyuki Tao

  4. Department of Surgery, Kurume University School of Medicine, Kurume, Japan

    Shintaro Yokoyama

  5. Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan

    Reo Kawano

  6. Department of Radiology, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan

    Nobuyuki Tanaka & Tsuneo Matsumoto

Authors
  1. Hideko Onoda
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  2. Mayumi Higashi
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  3. Tomoyuki Murakami
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  4. Hiroyuki Tao
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  5. Shintaro Yokoyama
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  6. Yoshie Kunihiro
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  7. Reo Kawano
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  8. Masahiro Tanabe
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  9. Nobuyuki Tanaka
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  10. Tsuneo Matsumoto
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Corresponding author

Correspondence to Hideko Onoda.

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Guarantor

The scientific guarantor of this publication is Dr. Katsuyoshi Ito.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Mr. Reo Kawano kindly provided statistical advice for this manuscript.

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study / diagnostic or prognostic study / performed at one institution

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Onoda, H., Higashi, M., Murakami, T. et al. Correlation between pleural tags on CT and visceral pleural invasion of peripheral lung cancer that does not appear touching the pleural surface. Eur Radiol 31, 9022–9029 (2021). https://doi.org/10.1007/s00330-021-07869-y

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  • DOI: https://doi.org/10.1007/s00330-021-07869-y

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