Prognostic value of ground-glass opacity found in small lung adenocarcinoma on high-resolution CT scanning
Introduction
Recently, low-dose X-ray spiral computed tomography (CT) scanning of the lung has improved the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage [1], [2]. When the small nodules include a component of so-called ground-glass opacity (GGO) on high-resolution CT (HRCT) scanning, adenocarcinoma is suspected [3], [4].
In April 1999, the newly revised third edition of WHO concerning histological typing of lung tumors was published [5]. According to the new classification, lung adenocarcinoma was divided into five categories. Among them, bronchioloalveolar carcinoma (BAC) is classified as non-invasive carcinoma, and tumors with both non-invasive and invasive components are classified as adenocarcinoma with mixed subtype. Lymph node and hematogenous metastases are quite rare among such non-invasive or slightly-invasive carcinomas of the lung.
In our previous study [6], we concluded that the proportion of BAC components involving small peripheral lung adenocarcinoma may reflect clinicopathological and prognostic characteristics, and the semiquantitative assessment of the BAC area may prove valuable when planning therapeutic strategies, particularly surgical treatment. We hypothesized that the histological BAC area must be reflected as GGO on HRCT.
The purpose of this study was to elucidate the correlation between the histological BAC area and GGO area on HRCT in small peripheral adenocarcinoma, and to determine the value of semiquantitative assessment of the GGO area within a tumor, as a preoperative indicator for the planning of surgical procedure.
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Patients and methods
From February 1995 to October 1999, 519 non-small-cell lung cancer (NSCLC) patients underwent operations in our institute. Of these, 104 patients with peripheral small-sized adenocarcinoma 20 mm or less in diameter on HRCT were retrospectively analyzed in the present study (Table 1). Of the 104 patients, 55 were male, and 49 were female. The mean age was 60 years (range, 34–78 years). The maximal tumor diameter measured on HRCT was 10 mm or less in 33 patients, 11–15 mm in 41 patients, and more
Results
Table 2 shows the correlation between the histological BAC component and GGO component on HRCT. Fifty patients were included in the category with both BAC and GGO greater than 50% (sensitivity=76%). Conversely, 36 patients were included into the category with both BAC and GGO less than 50% (specificity=95%). There were 16 patients with BAC greater than 50% and GGO less than 50%. Only two patients were included in the category with BAC less than 50% and GGO greater than 50%. Good agreement was
Discussion
Besides the TNM staging, a number of prognostic indicators have been proposed [8], [9], [10], [11], [12]. They included not only conventional clinico–pathological indicators such as tumor differentiation [8], pleural involvement [8], status of vascular and lymphatic invasion [10] and mitotic index [9], but also molecular indicators such as K-ras [10], p53 [11], factor Viii [11], erB-b2 [11], CD44 [11] and telomerase activity [12]. However, the details of these results are only available after
Conclusion
Although the follow-up period was relatively short, this novel classification based on semiquantitative analysis of the GGO area may reflect the tumor character and become an useful independent preoperative indicator in deciding the operative procedure in patients with small adenocarcinoma of the lung.
Acknowledgments
This study was partially funded by a Grant-in-Aid for Cancer Research (9–18) from the Ministry of Health and Welfare, Japan.
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