High-resolution computed tomographic findings of small peripherally located squamous cell carcinoma

With the spread of high-resolution computed tomography (HRCT) screening for lung cancer, we are increasingly faced with the need to determine whether certain small lesions are benign or malignant. The features of small adenocarcinomas have been clarified but not those of squamous cell carcinoma. The objective of our study was therefore to clarify the HRCT findings of peripherally located squamous cell carcinomas less than 2 cm in maximum dimension. Subjects consisted of 27 consecutive pathologically proven cases of peripherally located squamous cell carcinoma that were less than 2 cm in maximum dimension. HRCT findings of all 27 cases were analyzed retrospectively and independently by three radiologists who were unaware of the pathological diagnosis, and decisions were reached by consensus with special attention to 10 review points. Internal characteristic features included calcification, cavity formation, and air bronchogram. Tumor margin features included spiculation, notching, irregularity, and ground-glass opacity. Surrounding structural features consisted of pleural indentation, pulmonary emphysema, and satellite lesions. The presence of irregularity (70.4%), surrounding pulmonary emphysema (70.4%), and pleural indentation (51.9%) was observed frequently. No mass was accompanied by calcification. HRCT images of peripherally located squamous cell carcinoma suggested that the demonstration of irregularity, surrounding pulmonary emphysema, pleural indentation, and absence of calcification may contribute to the accurate CT diagnosis of small peripheral squamous cell carcinoma.