Lung cancers associated with cystic airspaces: CT features and pathologic correlation

Area of Science:

• Thoracic oncology
• Radiology
• Pathology

Background:

• Lung cancer associated with cystic airspaces (LCCA) is a rare condition.
• Delayed diagnosis and treatment are common due to a lack of understanding of LCCA.
• Elucidating LCCA's characteristics is crucial for improving patient outcomes.

Purpose of the Study:

• To define the clinicopathological characteristics of LCCA.
• To identify imaging features that correlate with pathological invasiveness in LCCA.
• To improve the diagnostic accuracy and management of LCCA.

Main Methods:

• Retrospective review of preoperative computed tomographic (CT) scans from 10,835 patients with non-small cell lung cancer (NSCLC).
• Identification of 123 LCCA cases and classification into four morphologic patterns (thin-walled, thick-walled, cystic airspace with mural nodule, mixed).
• Analysis of clinicopathological and radiological features, including correlation with histological invasiveness and EGFR mutations.

Main Results:

• Four morphologic patterns of LCCA were identified: thin-walled (18.7%), thick-walled (27.6%), cystic airspace with mural nodule (CWN) (35.0%), and mixed (18.7%).
• A solid component in the cyst wall predicted histological invasiveness across all patterns.
• Type III (CWN) pattern, part-solid/solid components, and irregular inner cyst surface were independent risk factors for moderately/poorly differentiated subtypes.

Conclusions:

• Morphological patterns and cyst wall components are key predictors of pathological invasiveness in LCCA.
• Imaging features can help differentiate between invasive and non-invasive LCCA subtypes.
• Further research into LCCA's specific imaging-pathology correlations can enhance clinical management.