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Original Research |

Predictive Factors of Pathologically Proven Noninvasive Tumor Characteristics in T1aN0M0 Peripheral Non-small Cell Lung CancerPathologic Noninvasiveness Factors in Lung Cancer

Yoshihisa Shimada, MD; Junji Yoshida, MD, PhD; Tomoyuki Hishida, MD, PhD; Mitsuyo Nishimura, MD; Genichiro Ishii, MD, PhD; Kanji Nagai, MD, PhD
Author and Funding Information

From the Division of Thoracic Surgery (Drs Shimada, Yoshida, Hishida, Nishimura, and Nagai), and the Pathology Division, Research Center for Innovative Oncology (Dr Ishii), National Cancer Center Hospital East, Kashiwa, Chiba, Japan.

Correspondence to: Junji Yoshida, MD, PhD, Division of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; e-mail: jyoshida@east.ncc.go.jp


Funding/Support: This study was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour, and Welfare, Japan.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):1003-1009. doi:10.1378/chest.11-0017
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Background:  We retrospectively analyzed preoperative factors that may predict pathologically invasive tumor characteristics, including lymph node involvement, and pleural and vessel invasion in patients with cT1aN0M0 peripheral non-small cell lung cancer (NSCLC), in an attempt to identify candidates for pulmonary resection less than lobectomy.

Methods:  We reviewed the charts of 363 patients in whom cT1aN0M0 lung cancer in the lung periphery had been diagnosed or was suspected, based on high-resolution CT scan of 1- or 2-mm-slice intervals, within 1 month of surgical resection, and examined the relationships between preoperative clinical information and pathologic invasive tumor characteristics, corresponding to lymph node involvement and pleural and vessel invasion.

Results:  Multivariate analysis showed that a tumor disappearance ratio (TDR) < 0.5, the presence of spiculation, and an absence of air bronchograms were statistically significant independent predictors of pathologic invasiveness. Most TDR ≥ 0.5 tumors were noninvasive (98.7%), and only one patient had a recurrence within 5 years after surgical resection. Of the tumors with a TDR ≥ 0.5 without spiculation, 98.3% were noninvasive, and all those patients remained recurrence-free for 5 years after surgery.

Conclusion:  The combination of a TDR ≥ 0.5 and the absence of spiculation was highly predictive of noninvasive or minimally invasive NSCLC. Future studies should evaluate whether limited resection of these tumors provides acceptable outcomes.

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