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Computed Tomography Imaging Features and Distribution of Metastases in ROS1-rearranged Non-Small-cell Lung Cancer
Subba R Digumarthy1, Dexter P Mendoza1, Jessica J Lin2
1Department of Radiology, Massachusetts General Hospital, Boston, MA.
Background:
ROS proto-oncogene 1 (ROS1) rearrangements are a known molecular target in non-small-cell lung cancer (NSCLC). Our goal was to determine whether ROS1-rearranged NSCLC has imaging features and patterns of metastasis, which differ from those of anaplastic lymphoma kinase (ALK)-rearranged or epidermal growth factor receptor (EGFR)-mutant NSCLC.
Patients And Methods:
We retrospectively identified patients with metastatic ROS1-rearranged, ALK-rearranged, or EGFR-mutant NSCLC from January 2014 to June 2018 and included those with pretreatment imaging studies available. We assessed the imaging features of the primary tumor and the distribution of metastases in these patients. The Wilcoxon rank-sum test and Fisher exact test were used to compare the imaging features.
Results:
We identified 257 patients (167 women and 90 men; median age, 56 years; range, 19-90 years) with metastatic NSCLC (ROS1, 53; ALK, 87; EGFR, 117). Compared with ALK-rearranged or EGFR-mutant NSCLC, ROS1-rearranged NSCLC was less likely to present with extrathoracic metastases (ROS1, 49%; ALK, 75%; EGFR, 72%; P < .01), including brain metastases (ROS1, 9%; ALK, 25%; EGFR, 40%; P < .04). Compared with EGFR-mutant NSCLC, ROS1-rearranged tumors were more likely to exhibit imaging features of lymphangitic carcinomatosis (ROS1, 42%; EGFR, 12%; P < .01) and less likely to have air bronchograms in the primary tumor (ROS1, 2%; EGFR, 28%; P < .01). ROS1-rearranged tumors were also more likely to present with distant nodal metastases (ROS1, 15%; EGFR, 2%; P < .01) and sclerotic-type bone metastases (ROS1, 17%; EGFR, 6%; P < .01).
Conclusion:
Although considerable overlap exists in the imaging features of ROS1-rearranged, ALK-rearranged, and EGFR-mutant NSCLC, we found that ROS1-rearranged NSCLC has certain distinct imaging features and patterns of spread.
Insights
ROS1-rearranged non-small-cell lung cancer (NSCLC) shows distinct imaging features and metastasis patterns compared to ALK-rearranged or EGFR-mutant NSCLC. This research aids in differentiating these NSCLC subtypes through imaging analysis.
Area of Science:
- Oncology
- Radiology
- Molecular Diagnostics
Background:
- ROS proto-oncogene 1 (ROS1) rearrangements are a recognized molecular target in non-small-cell lung cancer (NSCLC).
- Understanding the distinct imaging characteristics and metastatic patterns of ROS1-rearranged NSCLC is crucial for diagnosis and treatment planning.
Purpose of the Study:
- To investigate and compare the imaging features and metastatic patterns of ROS1-rearranged NSCLC.
- To differentiate ROS1-rearranged NSCLC from anaplastic lymphoma kinase (ALK)-rearranged and epidermal growth factor receptor (EGFR)-mutant NSCLC based on imaging findings.
Main Methods:
- Retrospective analysis of pretreatment imaging studies from patients with metastatic NSCLC.
- Inclusion of patients with ROS1, ALK, or EGFR-mutant NSCLC diagnosed between January 2014 and June 2018.
- Statistical comparison of imaging features and metastasis distribution using Wilcoxon rank-sum and Fisher exact tests.
Main Results:
- ROS1-rearranged NSCLC showed significantly less extrathoracic metastasis (49%) compared to ALK (75%) and EGFR (72%) subtypes.
- Brain metastasis was less frequent in ROS1-rearranged NSCLC (9%) versus ALK (25%) and EGFR (40%).
- ROS1-rearranged tumors were more likely to present with lymphangitic carcinomatosis (42%), distant nodal metastases (15%), and sclerotic bone metastases (17%) compared to EGFR-mutant NSCLC.
Conclusions:
- While overlap exists, ROS1-rearranged NSCLC exhibits unique imaging features and metastatic patterns.
- Distinct imaging findings can aid in differentiating ROS1-rearranged NSCLC from ALK-rearranged and EGFR-mutant NSCLC.
- These findings contribute to improved diagnostic accuracy and personalized treatment strategies for NSCLC.
