Original article
General thoracic
Mean Computed Tomography Value to Predict the Tumor Invasiveness in Clinical Stage IA Lung Cancer

https://doi.org/10.1016/j.athoracsur.2017.01.060Get rights and content

Background

The purpose of this study was to validate the ability of the mean computed tomography (m-CT) value to predict tumor invasiveness and recurrence, and further, to compare with other measurements such as consolidation/tumor ratio and solid tumor size.

Methods

A retrospective study was conducted of 494 patients with clinical stage IA lung cancer who had peripherally located lung adenocarcinoma. Receiver operating characteristic curve analysis was used to compare the ability to predict tumor invasiveness and recurrence between m-CT value, consolidation/tumor ratio, and tumor size. Multiple logistic regression analyses were performed to determine the independent variables for the prediction of pathologic, less invasive lung cancer. Disease-free survival was measured from the date of the operation until any recurrence.

Results

The m-CT values were 643.6 ± 9.4 Hounsfield units in the noninvasive cancer group and 365.9 ± 11.4 Hounsfield units in the invasive cancer group (p < 0.0001). The invasive cancer group was strongly associated with a high CT attenuation value, high consolidation/tumor ratio, large solid tumor size, large tumor size, and high standardized uptake value. Multiple logistic analyses, including the preoperatively determined variables, revealed that standardized uptake value and m-CT are independent predictive factors of less invasive lung cancer. In addition, the hazard ratio of the m-CT value was higher than that of the standardized uptake value value.

Conclusions

The evaluation of m-CT value is useful in predicting less invasive lung cancer. The m-CT value can potentially determine operative procedure, particularly limited resection for peripheral lung adenocarcinoma.

Section snippets

Patients

This study was approved by the Kanazawa University Internal Review Board. Between October 2006 and October 2012, 873 consecutive patients underwent pulmonary resection for lung cancer. The study excluded patients who received preoperative treatment, such as radiotherapy or chemotherapy, or had multiple lung cancers. Included were 494 patients (220 men and 274 women) diagnosed with clinical stage IA lung cancer with peripherally located adenocarcinoma of the lung. The reason for focusing on

Results

Clinical and pathologic characteristics are reported in Table 1. Forty-two (8.5%) patients were upstaged of T status, and 32 (6.5%) were upstaged of N status. A total of 140 patients (28.3%) were classified as NINVC, and 354 were classified as INVC.

The CT findings of typical GGO lesions are presented in Figure 1. In the lesion in Figure 1A, the proportion of the solid portion was 35%, and the m-CT value was 586 Hounsfield units (HU). Figure 1B shows a typical pure GGO lesion. The tumors in

Comment

The present study aimed to evaluate the ability of the m-CT value to predict tumor invasiveness and to compare with other measurements. Evaluation of various CT features, such as the m-CT values, C/T ratio, solid tumor size, whole tumor size, m-CT value, and SUV, can be helpful in predicting tumor invasiveness. In particular, we initially demonstrated that the m-CT value of the GGO lesion is a sensitive marker for predicting tumor invasiveness.

Although the lymphatic or blood vessel invasion is

References (21)

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