Radiologic and Nuclear Medicine Predictors of Tumor Invasiveness in Patients with Clinical Stage IA Lung Adenocarcinoma

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2011 Jun 3

PMID 21633846

Authors

Masaya Tamura

Makoto Oda

Isao Matsumoto

Yosuke Shimizu

Ryuichi Waseda

Go Watanabe

Affiliations

Soon will be listed here.

Abstract

Background: The aim of this study was to analyze parameters to predict tumor invasiveness according to high-resolution computed tomography and positron emission tomography in patients with clinical stage IA lung adenocarcinoma.

Methods: A total of 122 patients with clinical stage IA lung adenocarcinoma were enrolled in the study. Receiver operating characteristic (ROC) curves were constructed for three factors--the degree of solid tumor component (solid%), maximum standard uptake value (SUVmax) and tumor size--and cutoff values were determined to reveal the highest sensitivity and specificity to diagnose tumor invasiveness. We created an algorithm for detecting tumor invasiveness (model 1). The data for the three factors were combined and their ROC curves constructed (model 2). A prospective study was conducted to validate the utility of these models.

Results: Multivariate analysis identified solid%, SUVmax, and tumor size as potentially important predictors of tumor invasiveness. In the ROC curve analysis, solid% (area under the curve was 0.882) had the largest area under the curve, followed by the SUV (0.867) and tumor size (0.747). The combination assay using all three factors had the highest sensitivity and specificity for prediction (0.902). Models 1 and 2 were applied to the prospectively enrolled cases, and their utility was reviewed. Both models showed 100% sensitivity, with model 2 showing a slightly higher diagnostic value than model 1.

Conclusions: The solid portion ratio was a more powerful clinical predictor for lymphovascular invasion than the SUVmax. Our novel scoring model for tumor invasiveness can be employed for preoperative assessment of tumor invasiveness.

References

Okada M, Nishio W, Sakamoto T, Uchino K, Hanioka K, Ohbayashi C . Correlation between computed tomographic findings, bronchioloalveolar carcinoma component, and biologic behavior of small-sized lung adenocarcinomas. J Thorac Cardiovasc Surg. 2004; 127(3):857-61. DOI: 10.1016/j.jtcvs.2003.08.048. View

Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A . Effect of tumor size on prognosis in patients with non-small cell lung cancer: the role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg. 2005; 129(1):87-93. DOI: 10.1016/j.jtcvs.2004.04.030. View

Ichinose Y, Yano T, Yokoyama H, Inoue T, Asoh H, Katsuda Y . The correlation between tumor size and lymphatic vessel invasion in resected peripheral stage I non-small-cell lung cancer. A potential risk of limited resection. J Thorac Cardiovasc Surg. 1994; 108(4):684-6. View

Noguchi M, Morikawa A, Kawasaki M, Matsuno Y, Yamada T, Hirohashi S . Small adenocarcinoma of the lung. Histologic characteristics and prognosis. Cancer. 1995; 75(12):2844-52. DOI: 10.1002/1097-0142(19950615)75:12<2844::aid-cncr2820751209>3.0.co;2-#. View

Takamochi K, Nagai K, Yoshida J, Suzuki K, Ohde Y, Nishimura M . Pathologic N0 status in pulmonary adenocarcinoma is predictable by combining serum carcinoembryonic antigen level and computed tomographic findings. J Thorac Cardiovasc Surg. 2001; 122(2):325-30. DOI: 10.1067/mtc.2001.114355. View

Ginsberg R, Rubinstein L . Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995; 60(3):615-22; discussion 622-3. DOI: 10.1016/0003-4975(95)00537-u. View

Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N . Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006; 132(4):769-75. DOI: 10.1016/j.jtcvs.2006.02.063. View

Kodama K, Doi O, Higashiyama M, Yokouchi H . Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: a single-institution study. J Thorac Cardiovasc Surg. 1997; 114(3):347-53. DOI: 10.1016/S0022-5223(97)70179-X. View

Ogawa J, Tsurumi T, Yamada S, Koide S, Shohtsu A . Blood vessel invasion and expression of sialyl Lewisx and proliferating cell nuclear antigen in stage I non-small cell lung cancer. Relation to postoperative recurrence. Cancer. 1994; 73(4):1177-83. DOI: 10.1002/1097-0142(19940215)73:4<1177::aid-cncr2820730409>3.0.co;2-0. View

10.

Yoshikawa K, Tsubota N, Kodama K, Ayabe H, Taki T, Mori T . Prospective study of extended segmentectomy for small lung tumors: the final report. Ann Thorac Surg. 2002; 73(4):1055-8; discussion 1058-9. DOI: 10.1016/s0003-4975(01)03466-x. View

11.

Nakata M, Sawada S, Yamashita M, Saeki H, Kurita A, Takashima S . Objective radiologic analysis of ground-glass opacity aimed at curative limited resection for small peripheral non-small cell lung cancer. J Thorac Cardiovasc Surg. 2005; 129(6):1226-31. DOI: 10.1016/j.jtcvs.2004.10.032. View

12.

Varlotto J, Recht A, Flickinger J, Medford-Davis L, Dyer A, DeCamp M . Factors associated with local and distant recurrence and survival in patients with resected nonsmall cell lung cancer. Cancer. 2009; 115(5):1059-69. DOI: 10.1002/cncr.24133. View

13.

Matsuguma H, Yokoi K, Anraku M, Kondo T, Kamiyama Y, Mori K . Proportion of ground-glass opacity on high-resolution computed tomography in clinical T1 N0 M0 adenocarcinoma of the lung: A predictor of lymph node metastasis. J Thorac Cardiovasc Surg. 2002; 124(2):278-84. DOI: 10.1067/mtc.2002.122298. View

14.

Tsuchiya T, Hashizume S, Akamine S, Muraoka M, Honda S, Tsuji K . Upstaging by vessel invasion improves the pathology staging system of non-small cell lung cancer. Chest. 2007; 132(1):170-7. DOI: 10.1378/chest.06-1950. View

15.

Yamada S, Kohno T . Video-assisted thoracic surgery for pure ground-glass opacities 2 cm or less in diameter. Ann Thorac Surg. 2004; 77(6):1911-5. DOI: 10.1016/j.athoracsur.2003.12.040. View

16.

Okada M, Tauchi S, Iwanaga K, Mimura T, Kitamura Y, Watanabe H . Associations among bronchioloalveolar carcinoma components, positron emission tomographic and computed tomographic findings, and malignant behavior in small lung adenocarcinomas. J Thorac Cardiovasc Surg. 2007; 133(6):1448-54. DOI: 10.1016/j.jtcvs.2007.02.023. View

17.

Kessler R, Gasser B, Massard G, Roeslin N, Meyer P, Wihlm J . Blood vessel invasion is a major prognostic factor in resected non-small cell lung cancer. Ann Thorac Surg. 1996; 62(5):1489-93. DOI: 10.1016/0003-4975(96)00540-1. View