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Küçük Akciğer Adenokanserlerinin Çok Kesitli Bilgisayarlı Tomografi Bulguları ile Histopatolojik Bulgularının Karşılaştırılması

Yıl 2019, Cilt: 72 Sayı: 3, 284 - 290, 23.01.2020

Melahat Kul

Öz

Amaç: Bu çalışmada küçük akciğer adenokanserlerinin bilgisayarlı tomografi (BT) bulguları ile histopatolojik bulguları, Uluslararası Akciğer Kanserini
Araştırma Derneği, Amerikan Toraks Derneği ve Avrupa Solunum Derneği’nin sınıflaması esas alınarak karşılaştırılmıştır.
Gereç ve Yöntem: Akciğer adenokanser tanısı alan 34 nodül (≤2 cm) retrospektif olarak tarandı. Attenüasyon tiplerinin (solid, mikst, saf buzlu cam)
yanı sıra, kaybolma oranları ≥%50 olan tümörler hava-içerikli tip, kaybolma oranları <%50 olan tümörler ise solid-dansite tip olarak kategorize edildi.
BT bulguları (boyut, hava bronkogramı, intranodüler lüsensi, spikülasyon, lobülasyon, çentiklenme, plevral çekinti ve kalınlaşma, bronkovasküler
demet kalınlaşması) ile patolojik sonuçlar arasındaki korelasyon araştırıldı. Bu amaçla, adenokanser in situ (AİS) ile minimal invazif adenokanser
(MİA) non-/minimal invazif adenokanser (NMİA) grubunda ele alındı.

Bulgular: Otuz dört nodülün 23’ü (%67,7) invazif adenokanser, dokuzu (%26,4) AİS ve ikisi (%5,9) MİA idi. İnvazif adenokanser tanılı lezyonların
çoğu solid-dansite tip (19, %82,6) ve solid (13, %56,5) veya mikst nodül (10, %43,5) iken NMİA grubu lezyonlar daha sık olarak hava içerikli tip (9,
%81,8) ve saf buzlu cam dansitesinde (3, %27,3) veya mikst nodül (7, %63,6) şeklinde izlendi. Bu fark istatistiksel olarak anlamlıydı (p≤0,05). Ayrıca
invazif adenokanserlerin maksimum çapı (15,09±3,32 mm) NMİA grubu nodüllerin maksimum çapından (12,28±3,23 mm) daha büyüktü (p=0,031).
Bu bulgulara ek olarak bronkovasküler demet kalınlaşması istatistiksel olarak anlamlı şekilde invazif adenokanserde daha sık izlendi (p=0,024).
İntranodüler lüsensi hariç diğer BT bulguları da invazif adenokanserde daha sık izlenmekle birlikte bu bulgularda izlenen farklar istatistiksel olarak
anlamlı değildi (p>0,05).

Sonuç: Çalışmamızda BT bulguları ile invazif adenokanserlerin NMİA grubu lezyonlardan ayrılabileceği görülmüştür. Ancak bu sonuçların daha geniş
hasta popülasyonunu kapsayan çalışmalar ile teyit edilmesi gerekmektedir.

Anahtar Kelimeler

Akciğer Adenokanseri IASLC/ATS/ERS Sınıflaması Bilgisayarlı Tomografi

Etik Beyan

Etik Kurul Onayı: Ankara Üniversitesi Tıp Fakültesi’nden etik kurul onayı alınmıştır (karar no: 08-339-15, 11.05.2015).

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Kaynakça

  • 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J CLIN. 2015;65:5-29.
  • 2. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer /American Thoracic Society/European Respiratory Society of Lung Adenocarcinoma. J Thoracic Oncol. 2011;6:244-285.
  • 3. Travis WD, Brambilla E, Müller-Hermelink HK, et al. World Health Organization Classification of Tumours. Pathology and Genetics ofTumours of the Lung, Pleura, Thymus and Heart. Lyon: IARC Press. 2004:11-127.
  • 4. Yoshino I, Nakanishi R, Kodate M, et al. Pleural retraction and intratumoral air-bronchogram as prognostic factors for stage I pulmonary adenocarcinoma following complete resection. Int Surg. 2000;85:105-112.
  • 5. Colby TV, Koss M, Travis WD. Tumors of the Lower Respiratory Tract. Washington, DC. Armed Forces Institute of Pathology 3rd ed., 1995.
  • 6. Suzuki K, Asamura H, Kusumoto M et al. “Early” peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan. Ann Thorac Surg. 2002;74:1635-1639.
  • 7. Aoki T, Tomoda Y, Watanabe H, et al. Peripheral lung adenocarcinoma: Correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology. 2001;220:803-809.
  • 8. Akira M, Atagi S, Kawahara M, et al. High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients. Am J Roentgenol. 1999;173:1623-1629.
  • 9. Saito H, Yamada K, Hamanaka N, et al. Initial findings and progression of lung adenocarcinoma on serial computed tomography scans. J Comput Assist Tomogr. 2009;33:42-48.
  • 10. Ishikawa H, Koizumi N, Morita T, et al. Ultrasmall pulmonary opacities on multidetector-row high-resolution computed tomography: a prospective radiologic-pathologic examination. J Comput Assist Tomogr. 2005;29:621- 625.
  • 11. Ikeda K, Awai K, Mori T, et al. Differential diagnosis of ground-glass opacity nodules: CT number analysis by three-dimensional computerized quantification. Chest. 2007;132:984-990.
  • 12. Choi JA, Kim JH, Hong KT, et al. CT bronchus sign in malignant solitar pulmonary lesions: value in the prediction of cell type. Eur Radiol. 2000;10:1304-1309.
  • 13. Takashima S, Maruyama Y, Hasegawa M, et al. CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern. AJR Am J Roentgenol. 2003;180:817-826.
  • 14. Gould MK, Fletcher J, Iannettoni MD, et al. American College of Chest Physicians. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:108S–130S.
  • 15. Dong B, Sato M, Sagawa M, et al. Computed tomographic image comparison between mediastinal and lung windows provides possible prognostic information in patients with small peripheral lung adenocarcinoma. J Thorac Cardiovasc Surg. 2002;124:1014-1020.
  • 16. Nakazono T, Sakao Y, Yamaguchi K, et al. Subtypes of peripheral adenocarcinoma of the lung: differentiation by thin-section CT. Eur Radiol. 2005;15:1563-1568.
  • 17. Yabuuchi H, Murayama S, Murakami J, et al. High-resolution CT characteristics of poorly differentiated adenocarcinoma of the peripheral lung: comparison with well differentiated adenocarcinoma. Radiat Med. 2000;18:343-347.
  • 18. Ikehara M, Saito H, Kondo T, et al.Comparison of thin-section CT and pathological findings in small solid-density type pulmonary adenocarcinoma: prognostic factors from CT findings. Eur J Radiol. 2012;81:189-194.

Correlation of Computed Tomography Findings with Histopathology in Small Lung Adenocancer

Yıl 2019, Cilt: 72 Sayı: 3, 284 - 290, 23.01.2020

Melahat Kul

Öz

Objectives: To analyse the correlation between computed tomography (CT) features and histopathological findings of small lung adenocancers
using the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification of Lung
Adenocancer.

Materials and Methods: A retrospective review of 34 nodules (size ≤2 cm) representing lung adenocancer was performed. Besides their attenuation
type (solid, mixed, pure ground glass), tumours were defined as air-containing type if their vanishing ratio was ≥%50 and as solid-density type
if the vanishing ratio was <%50. The correlation between CT findings (size, air bronchogram, intranodular lucencies, spiculation, lobulation,
notches, pleural retraction and thickening, thickening of bronchovascular bundle) and pathological results was investigated. Tumours representing
adenocancer in situ (AIS) and minimally invasive adenocancer (MIA) were investigated in one group as non-/minimally invasive adenocancer (NMIA).

Results: Of the 34 nodules 23 (67.7%) were invasive adenocancer, nine (26.4%) were AIS, and two (5.9%) were MIA. Lesions diagnosed as invasive
adenocancer were more often of solid-density type (19, 82.6%), and solid (13, 56.5%) or mixed nodules (10, 43.5%) whereas NMIA group lesions
were more often of air-containing type (9, %81.8), and pure ground-glass (3, 27.3%) or mixed nodules (7, 63.6%) with a statistically difference between invasive adenocancer and NMIA group (p≤0.05). Furthermore, invasive adenocancer nodules had a larger maximum diameter
(15.09±3.32 mm) than NMIA nodules (12.28±3.23 mm) (p=0.031).
Thickening of bronchovascular bundle was another CT finding that was significantly more common in invasive adenocancer (p=0.024). The other CT
findings showed also a higher frequency in invasive adenocancer compared to NMIA group except for intranodular lucency which was observed in
both pathological groups equally. But this difference in frequency was not statistically significant (p>0.05).

Conclusion: Invasive adenocancer and NMIA lesions can be differentiated by their CT features. But greater study populations are needed for further
confirmation.

Anahtar Kelimeler

Lung Adenocancer IASLC/ATS/ERS Classification Computed Tomography

Proje Numarası

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Kaynakça

  • 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J CLIN. 2015;65:5-29.
  • 2. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer /American Thoracic Society/European Respiratory Society of Lung Adenocarcinoma. J Thoracic Oncol. 2011;6:244-285.
  • 3. Travis WD, Brambilla E, Müller-Hermelink HK, et al. World Health Organization Classification of Tumours. Pathology and Genetics ofTumours of the Lung, Pleura, Thymus and Heart. Lyon: IARC Press. 2004:11-127.
  • 4. Yoshino I, Nakanishi R, Kodate M, et al. Pleural retraction and intratumoral air-bronchogram as prognostic factors for stage I pulmonary adenocarcinoma following complete resection. Int Surg. 2000;85:105-112.
  • 5. Colby TV, Koss M, Travis WD. Tumors of the Lower Respiratory Tract. Washington, DC. Armed Forces Institute of Pathology 3rd ed., 1995.
  • 6. Suzuki K, Asamura H, Kusumoto M et al. “Early” peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan. Ann Thorac Surg. 2002;74:1635-1639.
  • 7. Aoki T, Tomoda Y, Watanabe H, et al. Peripheral lung adenocarcinoma: Correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology. 2001;220:803-809.
  • 8. Akira M, Atagi S, Kawahara M, et al. High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients. Am J Roentgenol. 1999;173:1623-1629.
  • 9. Saito H, Yamada K, Hamanaka N, et al. Initial findings and progression of lung adenocarcinoma on serial computed tomography scans. J Comput Assist Tomogr. 2009;33:42-48.
  • 10. Ishikawa H, Koizumi N, Morita T, et al. Ultrasmall pulmonary opacities on multidetector-row high-resolution computed tomography: a prospective radiologic-pathologic examination. J Comput Assist Tomogr. 2005;29:621- 625.
  • 11. Ikeda K, Awai K, Mori T, et al. Differential diagnosis of ground-glass opacity nodules: CT number analysis by three-dimensional computerized quantification. Chest. 2007;132:984-990.
  • 12. Choi JA, Kim JH, Hong KT, et al. CT bronchus sign in malignant solitar pulmonary lesions: value in the prediction of cell type. Eur Radiol. 2000;10:1304-1309.
  • 13. Takashima S, Maruyama Y, Hasegawa M, et al. CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern. AJR Am J Roentgenol. 2003;180:817-826.
  • 14. Gould MK, Fletcher J, Iannettoni MD, et al. American College of Chest Physicians. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:108S–130S.
  • 15. Dong B, Sato M, Sagawa M, et al. Computed tomographic image comparison between mediastinal and lung windows provides possible prognostic information in patients with small peripheral lung adenocarcinoma. J Thorac Cardiovasc Surg. 2002;124:1014-1020.
  • 16. Nakazono T, Sakao Y, Yamaguchi K, et al. Subtypes of peripheral adenocarcinoma of the lung: differentiation by thin-section CT. Eur Radiol. 2005;15:1563-1568.
  • 17. Yabuuchi H, Murayama S, Murakami J, et al. High-resolution CT characteristics of poorly differentiated adenocarcinoma of the peripheral lung: comparison with well differentiated adenocarcinoma. Radiat Med. 2000;18:343-347.
  • 18. Ikehara M, Saito H, Kondo T, et al.Comparison of thin-section CT and pathological findings in small solid-density type pulmonary adenocarcinoma: prognostic factors from CT findings. Eur J Radiol. 2012;81:189-194.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Radyoloji ve Organ Görüntüleme
Bölüm Makaleler
Yazarlar

Melahat Kul 0000-0001-9843-5114

Proje Numarası -
Yayımlanma Tarihi 23 Ocak 2020
Yayımlandığı Sayı Yıl 2019 Cilt: 72 Sayı: 3

Kaynak Göster

APA Kul, M. (2020). Correlation of Computed Tomography Findings with Histopathology in Small Lung Adenocancer. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 72(3), 284-290. https://doi.org/10.4274/atfm.galenos.2019.40427
AMA Kul M. Correlation of Computed Tomography Findings with Histopathology in Small Lung Adenocancer. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ocak 2020;72(3):284-290. doi:10.4274/atfm.galenos.2019.40427
Chicago Kul, Melahat. “Correlation of Computed Tomography Findings With Histopathology in Small Lung Adenocancer”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72, sy. 3 (Ocak 2020): 284-90. https://doi.org/10.4274/atfm.galenos.2019.40427.
EndNote Kul M (01 Ocak 2020) Correlation of Computed Tomography Findings with Histopathology in Small Lung Adenocancer. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72 3 284–290.
IEEE M. Kul, “Correlation of Computed Tomography Findings with Histopathology in Small Lung Adenocancer”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 3, ss. 284–290, 2020, doi: 10.4274/atfm.galenos.2019.40427.
ISNAD Kul, Melahat. “Correlation of Computed Tomography Findings With Histopathology in Small Lung Adenocancer”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72/3 (Ocak 2020), 284-290. https://doi.org/10.4274/atfm.galenos.2019.40427.
JAMA Kul M. Correlation of Computed Tomography Findings with Histopathology in Small Lung Adenocancer. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;72:284–290.
MLA Kul, Melahat. “Correlation of Computed Tomography Findings With Histopathology in Small Lung Adenocancer”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 3, 2020, ss. 284-90, doi:10.4274/atfm.galenos.2019.40427.
Vancouver Kul M. Correlation of Computed Tomography Findings with Histopathology in Small Lung Adenocancer. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;72(3):284-90.
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