Skip to main content

Advertisement

SpringerLink
Log in

Pulmonary adenocarcinomas appearing as part-solid ground-glass nodules: Is measuring solid component size a better prognostic indicator?

  • Chest
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To assess whether measuring the solid portion of adenocarcinomas appearing as part-solid ground-glass nodules (GGNs) can predict a patient’s prognosis accurately and how the prognosis corresponds to that of solid nodules.

Methods

501 patients (solid nodule group, 304; part-solid GGN group, 197) underwent curative surgery for stage I adenocarcinomas. Maximal diameters of the whole lesion including ground-glass opacities (D whole ) and solid components only (D solid ) were measured on CT. Disease-free survival (DFS) and overall survival (OS) were calculated from the date of surgery.

Results

D solid was a significant prognostic factor in the part-solid GGN group, while D whole was not. Part-solid GGNs with D solid ≤2 cm showed significantly better DFS (P = 0.016) and OS (P = 0.004) than solid nodules; however, those with D solid >2 cm did not show a significant difference. Hazard ratio (HR) for increase in D solid was significantly greater in part-solid GGNs than in solid nodules (P = 0.009). For OS, HR for increase in D solid was greater in part-solid GGNs than in solid nodule, which was marginally not significant (P = 0.060).

Conclusion

D solid was better than D whole for prognosis prediction of adenocarcinomas appearing as part-solid GGNs. In addition, the influence of D solid on prognosis in the part-solid GGN group was greater than in the solid nodule group.

Key points

• Dsolid is a better prognosis indicator than Dsolid in part-solid GGN adenocarcinomas

• Part-solid GGN adenocarcinoma show better prognosis than solid adenocarcinomas when Dsolid ≤2 cm

• Dsolid has greater prognostic influence in part-solid GGN adenocarcinomas than solid adenocarcinomas

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

GGN:

Ground-glass nodule

D whole :

Maximal diameter of the whole lesion including ground-glass opacity

D solid :

Maximal diameter of solid component only

DFS:

Disease-free survival

OS:

Overall survival

HR:

Hazard ratio

References

  1. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30

    Article  PubMed  Google Scholar 

  2. de Groot P, Munden RF (2012) Lung cancer epidemiology, risk factors, and prevention. Radiol Clin North Am 50:863–876

    Article  PubMed  Google Scholar 

  3. Sone S, Li F, Yang ZG et al (2001) Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner. Br J Radiol 84:25–32

    CAS  Google Scholar 

  4. Aoki T, Tomoda Y, Watanabe H et al (2001) Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology 220:803–809

    Article  CAS  PubMed  Google Scholar 

  5. Godoy MC, Naidich DP (2009) Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended im guidelines for assessment and management. Radiology 253:606–622

    Article  PubMed  Google Scholar 

  6. Henschke CI, Yankelevitz DF, Mirtcheva R et al (2002) CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 178:1053–1057

    Article  PubMed  Google Scholar 

  7. Austin JH, Garg K, Aberle D et al (2013) Radiologic implications of the 2011 classification of adenocarcinoma of the lung. Radiology 266:62–71

    Article  PubMed  Google Scholar 

  8. Travis WD, Brambilla E, Noguchi M et al (2011) national association for the study of lung cancer/american thoracic society/european respiratory society national multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 6:244–285

    Article  PubMed  Google Scholar 

  9. Saito H, Kameda Y, Masui K et al (2011) Correlations between thin-section CT findings, histopathological and clinical findings of small pulmonary adenocarcinomas. Lung Cancer 71:137–143

    Article  PubMed  Google Scholar 

  10. Goo JM, Park CM, Lee HJ (2011) Ground-glass nodules on chest CT as imaging biomarkers in the management of lung adenocarcinoma. AJR Am J Roentgenol 196:533–543

    Article  PubMed  Google Scholar 

  11. Park CM, Goo JM, Lee HJ, Lee CH, Chun EJ, Im JG (2007) Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics 27:391–408

    Article  PubMed  Google Scholar 

  12. Kim H, Park CM, Koh JM, Lee SM, Goo JM (2013) Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy. Diagn v Radiol 20:47–57

    Google Scholar 

  13. Rami-Porta R, Ball D, Crowley J et al (2007) The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2:593–602

    Article  PubMed  Google Scholar 

  14. Edge SB, American Joint Committee on Cancer (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  15. Tsutani Y, Miyata Y, Mimae T et al (2013) The prognostic role of pathologic invasive component size, excluding lepidic growth, in stage I lung adenocarcinoma. J Thorac Cardiovasc Surg 146:580–585

    Article  PubMed  Google Scholar 

  16. Borczuk AC, Qian F, Kazeros A et al (2009) Invasive size is an independent predictor of survival in pulmonary adenocarcinoma. Am J Surg Pathol 33:462–469

    Article  PubMed Central  PubMed  Google Scholar 

  17. Tsutani Y, Miyata Y, Nakayama H et al (2012) Prognostic significance of using solid versus whole tumor size on high-resolution computed tomography for predicting pathologic malignant grade of tumors in clinical stage IA lung adenocarcinoma: a multicenter study. J Thorac Cardiovasc Surg 143:607–612

    Article  PubMed  Google Scholar 

  18. Sakao Y, Nakazono T, Tomimitsu S et al (2004) Lung adenocarcinoma can be subtyped according to tumor dimension by computed tomography mediastinal-window setting. Additional size criteria for clinical T1 adenocarcinoma. Eur J Cardiothorac Surg 26:1211–1215

    Article  PubMed  Google Scholar 

  19. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722

    Article  PubMed  Google Scholar 

  20. Durrleman S, Simon R (1989) Flexible regression models with cubic splines. Stat Med 8:551–561

    Article  CAS  PubMed  Google Scholar 

  21. Hess KR (1994) Assessing time-by-covariate actions in proportional hazards regression models using cubic spline functions. Stat Med 13:1045–1062

    Article  CAS  PubMed  Google Scholar 

  22. Heinzl H, Kaider A (1997) Gaining more flexibility in Cox proportional hazards regression models with cubic spline functions. Comput Methods Programs Biomed 54:201–208

    Article  CAS  PubMed  Google Scholar 

  23. Lee SM, Park CM, Goo JM, Lee HJ, Wi JY, Kang CH (2013) Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features. Radiology 268:265–273

    Article  PubMed  Google Scholar 

  24. Yanagawa N, Shiono S, Abiko M, Ogata SY, Sato T, Tamura G (2013) New IASLC/ATS/ERS classification and invasive tumor size are predictive of disease recurrence in stage I lung adenocarcinoma. J Thorac Oncol 8:612–618

    Article  PubMed  Google Scholar 

  25. Yoshizawa A, Motoi N, Riely GJ et al (2011) Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases. Mod Pathol 24:653–664

    Article  CAS  PubMed  Google Scholar 

  26. Ikehara M, Saito H, Yamada K et al (2008) Prognosis of small adenocarcinoma of the lung based on thin-section computed tomography and pathological preparations. J Comput Assist Tomogr 32:426–431

    Article  PubMed  Google Scholar 

  27. Suzuki K, Koike T, Asakawa T et al (2011) A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol 6:751–756

    Article  PubMed  Google Scholar 

  28. Matsuguma H, Oki I, Nakahara R et al (2013) Comparison of three measurements on computed tomography for the prediction of less invasiveness in patients with clinical stage I non-small cell lung cancer. Ann Thorac Surg 95:1878–1884

    Article  PubMed  Google Scholar 

  29. Ohde Y, Nagai K, Yoshida J et al (2003) The proportion of consolidation to ground-glass opacity on high resolution CT is a good predictor for distinguishing the population of non-invasive peripheral adenocarcinoma. Lung Cancer 42:303–310

    Article  PubMed  Google Scholar 

  30. Tsutani Y, Miyata Y, Yamanaka T et al (2013) Solid tumors versus mixed tumors with a ground-glass opacity component in patients with clinical stage IA lung adenocarcinoma: Prognostic comparison using high-resolution computed tomography findings. J Thorac Cardiovasc Surg 146:17–23

    Article  PubMed  Google Scholar 

  31. Revel MP, Bissery A, Bienyenu M, Aycard L, Lefort C, Frija G (2004) Are two-dimensional CT measurements of small noncalcified pulmonary nodule reliable? Radiology 231:453–458

    Article  PubMed  Google Scholar 

  32. Kakimura R, Ashizawa K, Kuriyama K et al (2012) Measurement of focal groun glass opacity diameters on CT images: observer agreement in regard to identifying increaseases in the size of ground-glass opacities. Acad Radiol 19:389–394

    Article  Google Scholar 

  33. Goo JM (2011) A computer-aided diagnosis for evaluating lung nodules on chest CT: the current status and perspective. Korean J Radiol 12:145–155

    Article  PubMed Central  PubMed  Google Scholar 

  34. Kim H, Park CM, Woo S et al (2013) Pure and part-solid pulmonary ground-glass nodules: measurement variability of volume and mass in nodules with a solid portion less than or equal to 5 mm. Radiology 269:585–593

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The scientific guarantor of this publication is Chang Min Park, MD, PhD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study received funding from the Research Grant of the Korean Foundation for Cancer Research (grant number: CB-2011-02-01). The Medical Research Collaborating Center in Seoul National University Hospital kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in Lee SM, Park CM, Goo JM, Lee HJ, Wi JY, Kang CH (2013) Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features. Radiology 268:265-273. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehangno, , Jongno-gu,, Seoul, 110-744, Korea

    Eui Jin Hwang, Chang Min Park, Youngjin Ryu, Sang Min Lee & Jin Mo Goo

  2. Cancer Research Institute, Seoul National University, Seoul, Korea

    Chang Min Park, Young Tae Kim & Jin Mo Goo

  3. Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea

    Young Tae Kim

  4. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea

    Young Whan Kim

Authors
  1. Eui Jin Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang Min Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Youngjin Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sang Min Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Young Tae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Young Whan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jin Mo Goo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chang Min Park.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hwang, E.J., Park, C.M., Ryu, Y. et al. Pulmonary adenocarcinomas appearing as part-solid ground-glass nodules: Is measuring solid component size a better prognostic indicator?. Eur Radiol 25, 558–567 (2015). https://doi.org/10.1007/s00330-014-3441-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3441-1

Keywords

Search

Navigation