Associations among bronchioloalveolar carcinoma components, positron emission tomographic and computed tomographic findings, and malignant behavior in small lung adenocarcinomas
JTCS_133-6_1448.pdf 193 KB
Objective: The aggressiveness of small adenocarcinomas has not been fully evaluated using integrated positron emission tomography/computed tomography (PET/CT). We investigated malignant aggressiveness according to PET/CT, high-resolution computed tomography (HR-CT) findings and the proportions of pathologically defined bronchioloalveolar carcinomas (BACs) in cT1N0M0 lung adenocarcinoma. Methods: Sixty consecutive patients with cT1N0M0 lung adenocarcinomas of 3 cm or less in diameter, underwent fluorodeoxyglucose (FDG)-PET/CT and HR-CT followed by complete tumor resection. Correlations between the proportion of BAC and maximum standardized uptake value (SUV) on PET/CT, ground-glass opacity (GGO) and tumor shadow disappearance rate (TDR) were investigated and the findings were compared with clinicopathological features. Results: Lymphatic and vascular invasion occurred in 18 (30%) and 13 (22%) patients, respectively, whereas hilar or mediastinal lymph nodes were involved in 8 patients (13%). Maximum SUV generally seemed the most valuable predictor of lymphatic invasion, vascular invasion and nodal metastasis, compared with GGO, TDR and BAC ratios. Although the association was significant between the BAC ratio versus maximum SUV, GGO ratio and TDR (all p<0.0001), maximum SUV (R2 = 0.245) was less correlated with the BAC ratio than the GGO ratio (R2 = 0.554) and TDR (R2 = 0.671). Conclusions: The malignant behavior of small adenocarcinomas with a lower maximum SUV and a greater proportion of GGO, TDR and BAC was less aggressive. Maximum SUV was a more powerful clinical predictor of biological tumor performance, independently of pathological BAC proportion. Preoperative assessment of maximum SUV on PET/CT in addition to the GGO ratio and TDR on HR-CT might be useful to guide treatment strategies for small adenocarcinomas.
The Journal of Thoracic and Cardiovascular Surgery
Copyright (c) 2007 The American Association for Thoracic Surgery.