CT signs and clinicopathological features of peripheral cavitary lung adenocarcinoma with the largest diameter less than or equal to 3 cm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Zhan ¹ , ZHANG Zhenrong ¹ , SUN Hongliang ² ,  LIU Deruo ¹

1. Department of Thoracic Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, P.R. China;
2. Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, P.R. China;

Corresponding author：

LIU Deruo, Email: deruoliu@vip.sina.com

Keywords：

Lung adenocarcinoma; cavity; computed tomography; pathology

DOI：

10.7507/1007-4848.201907015

Video：

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Objective To investigate the CT signs and clinicopathological features of peripheral cavitary lung adenocarcinoma with the largest diameter less than or equal to 3 cm.Methods From January 2015 to December 2017, the CT signs and clinicopathological fertures of 51 patients with ≤3 cm peripheral cavitary lung adenocarcinoma diagnosed by chest CT and surgical pathology were retrospectively analyzed. Furthermore, CT signs and clinicopathological features of thick-walled cavitary lung adenocarcinoma and thin-walled cavitary lung adenocarcinoma were compared. There were 29 males and 22 females at age of 62 (56, 67) years.Results There were 27 thick-walled cavitary lung adenocarcinoma and 24 thin-walled cavitary lung adenocarcinoma. Thick-walled cavitary adenocarcinoma had greater SUVmax [6.5 (3.7, 9.7) vs. 2.2 (1.4, 3.8), P=0.019], larger cavity wall thickness (11.8±4.6 mm vs. 7.6±3.7 mm, P=0.001), larger tumor tissue size [2.1 (1.7, 2.8) cm vs. 1.6 (1.2, 2.0) cm, P=0.006], and more solid nodules (17 patients vs. 8 patients, P=0.035). Thin-walled cavitary adenocarcinoma had more smoking history (12 patients vs. 6 patients, P=0.038), larger cavity size [12.3 (9.2, 16.6) mm vs. 4.4 (2.8, 7.1) mm, P=0.000], and larger proportion of cavities [0.30 (0.19, 0.37) vs. 0.03 (0.01, 0.09), P=0.000]. On CT signs, there were more features of irregular inner wall (19 patients vs. 6 patients, P=0.000), intra-cystic separation (16 patients vs. 6 patients, P=0.001) and vessels through the cystic cavity (10 patients vs. 1 patient, P=0.001) in thin-walled caviraty lung adenocarcinoma.Conclusion Peripheral cavitary lung adenocarcinoma of ≤3 cm on chest CT has characteristic manifestations in clinical, imaging and pathology, and there is a statistical difference between thick-walled cavitary lung adenocarcinoma and thin-walled cavitary lung adenocarcinoma.

Citation： LIU Zhan, ZHANG Zhenrong, SUN Hongliang, LIU Deruo. CT signs and clinicopathological features of peripheral cavitary lung adenocarcinoma with the largest diameter less than or equal to 3 cm. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 45-51. doi: 10.7507/1007-4848.201907015 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	Chaudhuri MR. Primary pulmonary cavitating carcinomas. Thorax, 1973, 28(3): 354-366.
3.	Koenigkam SM, Muley T, Warth A, et al. Morphological computed tomography features of surgically resectable pulmonary squamous cell carcinomas: impact on prognosis and comparison with adenocarcinomas. Eur J Radiol, 2014, 83(7): 1275-1281.
4.	Onn A, Choe DH, Herbst RS, et al. Tumor cavitation in stageⅠnon-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome. Radiology, 2005, 237(1): 342-347.
5.	Gasinska A, Kolodziejski L, Niemiec J, et al. Clinical significance of biological differences between cavitated and solid form of squamous cell lung cancer. Lung Cancer, 2005, 49(2): 171-179.
6.	Watanabe Y, Kusumoto M, Yoshida A, et al. Surgically resected solitary cavitary lung adenocarcinoma: association between clinical, pathologic, and radiologic findings and prognosis. Ann Thorac Surg, 2015, 99(3): 968-974.
7.	Farooqi AO, Cham M, Zhang L, et al. Lung cancer associated with cystic airspaces. AJR Am J Roentgenol, 2012, 199(4): 781-786.
8.	Fintelmann FJ, Brinkmann JK, Jeck WR, et al. Lung cancers associated with cystic airspaces: natural history, pathologic correlation, and mutational analysis. J Thorac Imaging, 2017, 32(3): 176-188.
9.	Mascalchi M, Attinà D, Bertelli E, et al. Lung cancer associated with cystic airspaces. J Comput Assist Tomogr, 2015, 39(1): 102-108.
10.	Xue X, Wang P, Xue Q, et al. Comparative study of solitary thin-walled cavity lung cancer with computed tomography and pathological findings. Lung Cancer, 2012, 78(1): 45-50.
11.	Xue XY, Liu YX, Wang KF, et al. Computed tomography for the diagnosis of solitary thin-walled cavity lung cancer. Clin Respir J, 2015, 9(4): 392-398.
12.	Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the tnm stage groupings in the forthcoming (Eighth) Edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
13.	Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidiscipli-nary Classification of Lung Adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
14.	Wang M, Zhao J, Pan Y, et al. Do Tumor cavitation and sex in resected stageⅠnon-small-cell lung cancer correlate with prognosis? World J Surg, 2009, 33(3): 497-504.
15.	Nishino M, Cryer SK, Okajima Y, et al. Tumoral cavitation in patients with non-small-cell lung cancer treated with antiangiogenic therapy using bevacizumab. Cancer Imaging, 2012, 29(12): 225-235.
16.	Huang C, Wang X, Wang J, et al. Incidence and clinical implication of tumor cavitation in patients with advanced non-small cell lung cancer induced by Endostar, an angiogenesis inhibitor. Thorac Cancer, 2014, 5(5): 438-446.
17.	Zhang L, Yankelevitz DF, Henschke CI, et al. Variation in vascular distribution in small lung cancers. Lung Cancer, 2010, 68(3): 389-93.
18.	Miura H, Taira O, Hiraguri S, et al. Cavitating adenocarcinoma of the lung. Ann Thorac Cardiovasc Surg, 1998, 4(3): 154-158.
19.	Ryu JH, Swensen SJ. Cystic and cavitary lung diseases: focal and diffuse. Mayo Clin Proc, 2003, 78(6): 744-752.
20.	Woodring JH, Fried AM, Chuang VP. Solitary cavities of the lung: diagnostic implications of cavity wall thickness. Am J Roentgenol, 1980, 135(6): 1269-1271.
21.	Watanabe Y, Kusumoto M, Yoshida A, et al. Cavity wall thickness in solitary cavitary lung adenocarcinomas is a prognostic indicator. Ann Thorac Surg, 2016, 102(6): 1863-1871.
22.	Qi Y, Zhang Q, Huang Y, et al. Manifestations and pathological features of solitary thin walled cavity lung cancer observed by CT and PET/CT imaging. Oncol Lett, 2014, 8(1): 285-290.
23.	Goto T, Maeshima A, Oyamada Y, et al. Cavitary lung cancer lined with normal bronchial epithelium and cancer cells. J Cancer, 2011, 2: 503-506.
24.	Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
25.	Ambrosini V, Nicolini S, Caroli P, et al. PET/CT imaging in different types of lung cancer: an overview. Eur J Radiol, 2012, 81(5): 988-1001.
26.	Tomizawa K, Shimizu S, Ohara SC, et al. linical significance of tumor cavitation in surgically resected early-stage primary lung cancer. Lung Cancer, 2017, 112: 57-61.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Chaudhuri MR. Primary pulmonary cavitating carcinomas. Thorax, 1973, 28(3): 354-366.
3. Koenigkam SM, Muley T, Warth A, et al. Morphological computed tomography features of surgically resectable pulmonary squamous cell carcinomas: impact on prognosis and comparison with adenocarcinomas. Eur J Radiol, 2014, 83(7): 1275-1281.
4. Onn A, Choe DH, Herbst RS, et al. Tumor cavitation in stageⅠnon-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome. Radiology, 2005, 237(1): 342-347.
5. Gasinska A, Kolodziejski L, Niemiec J, et al. Clinical significance of biological differences between cavitated and solid form of squamous cell lung cancer. Lung Cancer, 2005, 49(2): 171-179.
6. Watanabe Y, Kusumoto M, Yoshida A, et al. Surgically resected solitary cavitary lung adenocarcinoma: association between clinical, pathologic, and radiologic findings and prognosis. Ann Thorac Surg, 2015, 99(3): 968-974.
7. Farooqi AO, Cham M, Zhang L, et al. Lung cancer associated with cystic airspaces. AJR Am J Roentgenol, 2012, 199(4): 781-786.
8. Fintelmann FJ, Brinkmann JK, Jeck WR, et al. Lung cancers associated with cystic airspaces: natural history, pathologic correlation, and mutational analysis. J Thorac Imaging, 2017, 32(3): 176-188.
9. Mascalchi M, Attinà D, Bertelli E, et al. Lung cancer associated with cystic airspaces. J Comput Assist Tomogr, 2015, 39(1): 102-108.
10. Xue X, Wang P, Xue Q, et al. Comparative study of solitary thin-walled cavity lung cancer with computed tomography and pathological findings. Lung Cancer, 2012, 78(1): 45-50.
11. Xue XY, Liu YX, Wang KF, et al. Computed tomography for the diagnosis of solitary thin-walled cavity lung cancer. Clin Respir J, 2015, 9(4): 392-398.
12. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the tnm stage groupings in the forthcoming (Eighth) Edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
13. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidiscipli-nary Classification of Lung Adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
14. Wang M, Zhao J, Pan Y, et al. Do Tumor cavitation and sex in resected stageⅠnon-small-cell lung cancer correlate with prognosis? World J Surg, 2009, 33(3): 497-504.
15. Nishino M, Cryer SK, Okajima Y, et al. Tumoral cavitation in patients with non-small-cell lung cancer treated with antiangiogenic therapy using bevacizumab. Cancer Imaging, 2012, 29(12): 225-235.
16. Huang C, Wang X, Wang J, et al. Incidence and clinical implication of tumor cavitation in patients with advanced non-small cell lung cancer induced by Endostar, an angiogenesis inhibitor. Thorac Cancer, 2014, 5(5): 438-446.
17. Zhang L, Yankelevitz DF, Henschke CI, et al. Variation in vascular distribution in small lung cancers. Lung Cancer, 2010, 68(3): 389-93.
18. Miura H, Taira O, Hiraguri S, et al. Cavitating adenocarcinoma of the lung. Ann Thorac Cardiovasc Surg, 1998, 4(3): 154-158.
19. Ryu JH, Swensen SJ. Cystic and cavitary lung diseases: focal and diffuse. Mayo Clin Proc, 2003, 78(6): 744-752.
20. Woodring JH, Fried AM, Chuang VP. Solitary cavities of the lung: diagnostic implications of cavity wall thickness. Am J Roentgenol, 1980, 135(6): 1269-1271.
21. Watanabe Y, Kusumoto M, Yoshida A, et al. Cavity wall thickness in solitary cavitary lung adenocarcinomas is a prognostic indicator. Ann Thorac Surg, 2016, 102(6): 1863-1871.
22. Qi Y, Zhang Q, Huang Y, et al. Manifestations and pathological features of solitary thin walled cavity lung cancer observed by CT and PET/CT imaging. Oncol Lett, 2014, 8(1): 285-290.
23. Goto T, Maeshima A, Oyamada Y, et al. Cavitary lung cancer lined with normal bronchial epithelium and cancer cells. J Cancer, 2011, 2: 503-506.
24. Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
25. Ambrosini V, Nicolini S, Caroli P, et al. PET/CT imaging in different types of lung cancer: an overview. Eur J Radiol, 2012, 81(5): 988-1001.
26. Tomizawa K, Shimizu S, Ohara SC, et al. linical significance of tumor cavitation in surgically resected early-stage primary lung cancer. Lung Cancer, 2017, 112: 57-61.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

CT signs and clinicopathological features of peripheral cavitary lung adenocarcinoma with the largest diameter less than or equal to 3 cm

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