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Comparative analysis of clinicoradiologic characteristics of lung adenocarcinomas with ALK rearrangements or EGFR mutations

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

Abstract

Objective

To compare the clinicoradiologic features of tumours with echinoderm anaplastic lymphoma kinase (ALK) rearrangements, epidermal growth factor receptor (EGFR) mutations, or wild type (WT) for both genes in a cohort of patients with lung adenocarcinoma to identify useful characteristics of different gene statuses.

Methods

In 346 lung adenocarcinoma patients, ALK rearrangements were confirmed with fluorescence in situ hybridisation, and EGFR mutations were determined by pyrosequencing assay. Patients were divided into three groups: ALK rearrangement (ALK+ group, n = 48), EGFR mutation (EGFR+ group, n = 166), and WT for both genes (WT group, n = 132). Chest computed tomography (CT) examinations were performed in all patients. The percentages of ground-glass opacity volume (pGGO) and tumour shadow disappearance rate (TDR) were measured using semi-automated nodule assessment software.

Results

The pGGO was significantly lower in the ALK+ group (25.1 % ± 24.3) than in the EGFR+ group (37.2 % ± 25.7, p < 0.001) and the WT group (36.1 % ± 24.6, p = 0.001). The TDR in the ALK+ group (17.3 % ± 25.1) was significantly lower than in the EGFR+ group (26.8 % ± 24.9, p = 0.002) and the WT group (25.7 % ± 24.6, p = 0.003).

Conclusions

Solid pattern with lower incidence of lobulated border, finely spiculated margins, pleural retraction, and bubble-like lucency on CT imaging are the main characteristics of ALK rearrangement tumours.

Key Points

• EGFR/ALK testing is recommended for lung adenocarcinoma patients for EGFR/ALK-targeted TKI therapy.

• EGFR /ALK testing is restricted by limited tissue samples and cost pressures.

• Lower pGGO and TDR are the main clinicoradiological characteristics of ALK+ tumours.

• pGGO and TDR are predictive factors for selecting patients for ALK/EGFR testing.

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Abbreviations

ALK:

Anaplastic lymphoma kinase

AUC:

Area under the curve

CEA:

Carcinoembryonic antigen

CT:

Computed tomography

EGFR:

Epidermal growth factor receptor

FISH:

Fluorescence in situ hybridisation

pGGO:

Percentage of ground-glass opacity volume

PFS:

Progression-free survival

ROC:

Receiver operating characteristic

RR:

Relative risk

sD:

Solid portion estimated diameter

sSmax:

Solid portion maximum cross-section area

sV:

Solid portion volume

tD:

Total nodule estimated diameter

TDR:

Tumour shadow disappearance rate

TKI:

Tyrosine kinase inhibitor

tSmax:

Total nodule maximum cross-section area

tV:

Total nodule volume

WT:

Wild type

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Acknowledgements

We thank Ms. Xiaozhen Jing for editing assistance. The scientific guarantor of this publication is Jianying Zhou. 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 has received funding from the National Natural Science Foundation of China (grant number 81101768) and the State Scholarship Fund of China (file number 201308330145). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Respiratory Disease, Thoracic Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Xiacheng District, Hangzhou, China

    J. Y. Zhou, J. Zheng, X. Chen & J. Y. Zhou

  2. Department of Radiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

    Z. F. Yu, W. B. Xiao & L. N. Jiang

  3. Department of Pathology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

    J. Zhao, K. Sun, B. Wang & W. Ding

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  1. J. Y. Zhou
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  2. J. Zheng
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  4. W. B. Xiao
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  7. B. Wang
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  9. L. N. Jiang
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  10. W. Ding
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  11. J. Y. Zhou
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Correspondence to J. Y. Zhou.

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Zhou, J.Y., Zheng, J., Yu, Z.F. et al. Comparative analysis of clinicoradiologic characteristics of lung adenocarcinomas with ALK rearrangements or EGFR mutations. Eur Radiol 25, 1257–1266 (2015). https://doi.org/10.1007/s00330-014-3516-z

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  • DOI: https://doi.org/10.1007/s00330-014-3516-z

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