Lung Cancer: Lung Cancer: Imaging |

Crab Claw Sign as Indication of Malignancy for Small GGO (1 cm) to Receive Surgery FREE TO VIEW

Jun Zhang, MD; Ning Chen; Xueshan Qiu, MD
Author and Funding Information

The First Hospital of China Medical University, Shenyang, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A283. doi:10.1016/j.chest.2016.02.295
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SESSION TITLE: Lung Cancer: Imaging

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: CT scan image was reviewed to explore the characteristics of small ground glass opacity (GGO) pulmonary lesions.

METHODS: Twenty asymptomatic small pulmonary GGO (1cm) were CT detected, fifteen remained no increase or shrank; five showed no change after anti-inflammation treatment and three months’ follow-up, then surgical resection conducted. Atypical adenomatous hyperplasia (AAH) was diagnosed frozen pathologically in two cases, adenocarcinoma in situ (AIS) was frozen diagnosed in three cases; the postoperative diagnosis was AIS for three cases and minimally invasive adenocarcinoma (MIA) for two cases. CT image was reviewed.

RESULTS: About 1cm small round GGO nodule was found in CT image. Location: right upper lobe 2 cases, right middle lobe 1, left upper lobe 2. HRCT or 3DCT showed detailed information. Density: three cases showed heterogeneous density, mixed GGO (mGGO); the other two pure GGO (pGGO). Shape and margin: three mGGO showed lobulated margin. Spiculation: in three mGGO. Pleural indentation: in two mGGO and one pGGO. Vascular convergence: crab claw sign, or called crab claw like vascular convergence, which is usually showed in CT image of peripheral lung adenocarcinoma, now showed in HRCT image of GGO, including crab chela sign: in the CT image, two small blood vessels converge to the tumor from two sides, just like a crab is stretching its chelipeds using its chela clamping the tumor, showed in the five cases; crab foot sign: in the CT image, one small blood vessel converge to the tumor from one side, just like a crab is stretching one of its walking legs reaching and hooking the tumor, showed in five cases. One pGGO was diagnosed MIA, the other one AIS; the two mGGO were diagnosed AIS, and the other one MIA.

CONCLUSIONS: HRCT or 3DCT could help show sign of malignancy such as crab claw sign, or called crab claw like vascular convergence: crab chela sign and crab foot sign, in both pGGO and mGGO. pGGO may have pleural indentation and be diagnosed MIA; mGGO with lobulated margin, spiculation, pleural indentation and heterogeneous consolidation may be diagnosed AIS.

CLINICAL IMPLICATIONS: Crab claw sign: crab chela sign and crab foot sign, may serve as indication of malignancy for small GGO (1cm) to receive surgery. (Supported by grants from the Education Department of Liaoning Province, No. 20060991; the Nature Science Foundation of Liaoning Province, China, No.20102285; and the Fund for Scientific Research of The First Hospital of China Medical University, No. FSFH1210).

DISCLOSURE: The following authors have nothing to disclose: Jun Zhang, Ning Chen, Xueshan Qiu

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