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Published on: August 18, 2016
Visceral Pleural Invasion in Pulmonary Adenocarcinoma: Differences in CT Patterns between Solid and Subsolid Cancers.
Benedikt H Heidinger1, Ursula Schwarz-Nemec1, Kevin R Anderson1
1Departments of Radiology (B.H.H., U.S.N., C.d.M.M., A.C.M.F., A.A.B.) and Pathology (K.R.A., Y.C., P.A.V.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215; Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Austria (B.H.H., U.S.N., M.E.M.); and Seacoast Pathology/Aurora Diagnostics, Exeter, NH (K.R.A.).
Visceral pleural invasion (VPI) is more common in solid lung adenocarcinomas than subsolid ones. CT imaging patterns also differ between solid and subsolid nodules, aiding in VPI assessment.
Area of Science:
- Pulmonary Medicine
- Thoracic Oncology
- Radiology
Background:
- Lung adenocarcinoma is a common malignancy.
- Accurate staging, including assessment of visceral pleural invasion (VPI), is crucial for treatment planning.
- CT imaging is a primary tool for evaluating lung nodules.
Purpose of the Study:
- To determine the incidence of VPI in lung adenocarcinomas.
- To analyze CT imaging patterns associated with VPI.
- To compare VPI incidence and CT patterns between solid and subsolid adenocarcinomas.
Main Methods:
- Retrospective analysis of 286 lung adenocarcinomas resected between 2005 and 2016.
- Measurement of CT size, pleural contact length, and calculation of their ratios.
- Evaluation of CT features including pleural deviation, thickening, spiculations, pleural tags, effusion, and transgression/infiltration patterns.
Main Results:
- VPI was present in 17.1% of nodules, significantly higher in solid (24.6%) than subsolid (4.7%) adenocarcinomas.
- In solid nodules, VPI correlated with higher contact length-to-size ratio and multiple pleural tag types.
- In subsolid nodules, VPI correlated with longer pleural contact of the solid component and transgression/infiltration patterns.
Conclusions:
- The solid or subsolid nature of an adenocarcinoma impacts VPI likelihood.
- CT patterns associated with VPI are distinct for solid and subsolid nodules.
- Considering nodule type and CT patterns improves preoperative VPI assessment in lung adenocarcinomas.
