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Clinical Investigations: SURGERY |

Surgically Curable Peripheral Lung Carcinoma*: Correlation of Thin-Section CT Findings With Histologic Prognostic Factors and Survival

Kunihiko Shimizu, MD; Kouzou Yamada, MD; Haruhiro Saito, MD; Kazumasa Noda, MD; Haruhiko Nakayama, MD; Youichi Kameda, MD; Koichiro Nakata, MD
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*From the Division of Respiratory Medicine (Drs. Shimizu and Nakata), Department of Internal Medicine, Toho University School of Medicine, Tokyo; and Departments of Thoracic Oncology (Drs. Yamada, Saito, and Noda), Thoracic Surgery (Dr. Nakayama), and Pathology (Dr. Kameda), Kanagawa Cancer Center, Yokohama, Japan.

Correspondence to: Kunihiko Shimizu, MD, Toho University School of Medicine, Department of Internal Medicine, Division of Respiratory Medicine, Omorinishi 6–11-1, Otaku, Tokyo, Japan; e-mail: kshimizu@med.toho-u.ac.jp



Chest. 2005;127(3):871-878. doi:10.1378/chest.127.3.871
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Study objectives: To define characteristics of surgically curable, early cancers of the lung, we retrospectively studied relationships between thin-section CT (TS-CT) scans, pathologic features, and outcome data in 287 patients with resected small-diameter (< 20 mm) peripheral lung carcinoma. Cases included 260 adenocarcinomas, 16 squamous cell carcinomas, 6 small cell carcinomas, 3 large cell carcinomas, and 2 others.

Measurements and results: All tumors were classified by tumor shadow disappearance rate (TDR) on TS-CT as having either an “air-containing” or “solid-density” pattern. Adenocarcinomas are typically classified into these patterns. Air-containing patterns (n = 136) showed 1% pleural involvement and 2% vascular invasion, with no lymphatic permeation by pathology. Solid-density patterns (n = 124) showed 34% pleural involvement, 42% vascular invasion, and 29% lymphatic permeation. No cases of relapse or death were observed in cases with the air-containing pattern, in contrast to the high relapse and death rate in solid-density cases (p < 0.0001). All non-adenocarcinoma cases (n = 25) had a solid-density pattern, with 4% pleural involvement, 52% vascular invasion, and 44% lymphatic permeation. The overall 5-year survival rate for non-adenocarcinoma was 60%, similar to that for solid-density adenocarcinoma.

Conclusions: When peripheral lung cancers < 20 mm in diameter show air-containing patterns on TS-CT images, surgical outcomes may be favorable with curable disease.

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