To evaluate correlations between proportion and distribution of tumor stroma and MDCT early phase enhancement character in solid lung adenocarcinoma, and compare with microvessel density and histological subtypes.
Thirty-one patients with lung adenocarcinoma shown as solid solitary pulmonary nodules underwent routine contrast-enhanced MDCT followed by surgical resections. CT character included net enhancement and distribution of enhancement. The largest cut surface of tumor specimens were stained by hematoxylin and eosin. About 25 fields of view of each specimen were scanned as digitized pictures at low magnification. Semi-auto segmentation software was used to calculate mean stroma proportion. Pearson correlation coefficient was used to represent the relationships between extent of tumor enhancement, proportion of tumor stroma and MVD respectively. Fisher’s exact test was used to analyze statistical differences in degree of CT enhancement among groups of different histological subtypes.
Proportion of invasive tumor stroma (13.2%–54.5%, mean 26.2 ± 8.8%) was correlated positively with net enhancement (8–60.8 HU, mean 31.2 ± 13.6 HU; r = 0.483, P = 0.006) which was more than MVD. 58.1% cases showed homogenous enhancement, 32.3% cases showed peripheral inhomogenous enhancement, 3.2% cases showed central inhomogeneous enhancement, 3.2% cases showed asymmetrical inhomogenous enhancement, and 3.2% cases showed no enhancement. 58.1% cases’ stroma showed mixed distribution, 35.5% cases showed peripheral distribution, 3.2% cases showed central distribution, and 3.2% cases showed asymmetrical distribution. Significantly more adenocarcinomas classified with ‘net enhancement > 20 HU” were found in the acinar group than in the solid with mucin subtype (P = 0.005).
Extent of CT enhancement reflects underlying not only the tumor angiogenesis but also stroma proliferation in solid small lung adenocarcinoma. Tumor stroma proportion could reflect the histopathologic basis of small lung adenocarcinoma’s CT enhancement substantially than MVD. Distribution between enhancement and tumor stroma have good correspondence. Most of acinar adenocarcinomas have higher degree of CT net enhancement than solid with mucin adenocarcinomas.
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multi-detector row computed tomography
World Health Organization
invasive tumor stroma proportion
total tumor stroma proportion
noninvasive tumor stroma proportion
Henschke CI, McCauley DI, Yankelevitz DF, et al. Early lung cancer action project: overall design and findings from baseline screening. Lancet, 1999, 354: 99–105.
Altorki N, Kent M, Pasmantier M. Detection of early-stage lung cancer: computed tomographic scan or chest radiograph? J Thorac Cardiovasc Surg, 2001, 121: 1053–1057.
Henschke CI, Yankelevitz DF, Libby DM, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med, 2006, 355: 1763–1771.
Travis WD, Brambilla E, Muller-Hermelink HK, et al. Pathology and genetics: tumours of the lung, pleura, thymus and heart. Lyon: IARC, 2004. 344.
Sakurai H, Maeshima A, Watanabe S, et al. Grade of stroma invasion in small adenocarcinoma of the lung: histopathological minimal invasion and prognosis. Am J Surg Pathol, 2004, 28: 198–206.
Shimosato Y, Suzuki A, Hashimoto T, et al. Prognostic implications of fibrotic focus (scar) in small peripheral lung cancers. Am J Surg Pathol, 1980, 4: 365–373.
Yamashiro K, Yasuda S, Nagase A, et al. Prognostic significance of an interface pattern of central fibrosis and tumor cells in peripheral adenocarcinoma of the lung. Hum Pathol, 1995, 26: 67–73.
Yokose T, Suzuki K, Nagai K, et al. Favorable and unfavorable morphological prognostic factors in peripheral adenocarcinoma of the lung 3 cm or less in diameter. Lung Cancer, 2000, 29: 179–188.
Suzuki K, Yokose T, Yoshida J, et al. Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung. Ann Thorac Surg, 2000, 69: 893–897.
Underwood JCE. General and systematic pathology. 2nd ed. Science Press, Harcourt Asia, Churchill Livingstone, 1999. 247–248.
Yi CA, Lee KS, Kim EA, et al. Solitary pulmonary nodules: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density. Radiology, 2004, 233: 191–199.
Tateishi U, Nishihara H, Watanabe S, et al. Tumor angiogenesis and dynamic CT in lung adenocarcinoma: radiologic-pathologic correlation. J Comput Assist Tomogr, 2001, 25: 23–27.
Weidner N, Semple JP, Welch WR, et al. Tumor angiogenesis and metastasis — correlation in invasive breast carcinoma. N Engl J Med, 1991, 324: 1–8.
Colby TV, Koss MN, Travis WD. Bronchioloalveolar carcinoma. In: Rosai J, Sobin LH, eds. Atlas of tumor pathology. 3rd series, vol. 13 (Tumors of the lower respiratory tract). Washington, DC: Armed Forces Institute of Pathology, 1995. 203–234.
Travis WD, Colby TV, Corrin B, et al. Histological typing of lung and pleural tumors: World Health Organization International Histological Classification of Tumors. 3rd ed. Berlin: Springer, 1999.
Maeshima AM, Niki T, Maeshima A, et al. Modified scar grade: a prognostic indicator in small peripheral lung adenocarcinoma. Cancer, 2002, 95: 2546–2554.
Eto T, Suzuki H, Honda A, et al. The changes of the stromal elastotic framework in the growth of peripheral lung adenocarcinomas. Cancer, 1996, 77: 646–656.
Terasaki H, Niki T, Matsuno Y, et al. Lung adenocarcinoma with mixed bronchioloalveolar and invasive components: clinicopathological features, subclassification by extent of invasive foci, and immunohistochemical characterization. Am J Surg Pathol, 2003, 27: 937–951.
Kurokawa T, Matsuno Y, Noguchi M, et al. Surgical curable “early” adenocarcinoma in the periphery of the lung. Am J Surg Pathol, 1994, 18: 431–438.
Noguchi M, Morikawa A, Kawasaki M, et al. Small adenocarcinoma of the lung: histologic characteristics and prognosis. Cancer, 1995, 75: 2844–2852.
Jeong YJ, Lee KS, Jeong SY, et al. Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi-detector row CT. Radiology, 2005, 237: 675–683.
Swensen SJ, Viggiano RW, Midthun DE, et al. Lung nodule enhancement at CT: multicenter study. Radiology, 2000, 214: 73–80.
Yamashita K, Matsunobe S, Tsuda T, et al. Solitary pulmonary nodule: preliminary study of evaluation with incremental dynamic CT. Radiology, 1995, 194: 399–405.
Zhang M, Kono M. Solitary pulmonary nodules: evaluation of blood flow patterns with dynamic CT. Radiology, 1997, 205: 471–478.
Miyake H, Matsumoto A, Terada A, et al. Mucin-producing tumor of the lung: CT findings. J Thorac Imaging, 1995, 10: 96–98.
Kuriyama K, Seto M, Kasugai T, et al. Ground-glass opacity on thin-section CT: value in differentiating subtypes of adenocarcinoma of the lung. AJR Am J Roentgenol, 1999, 173: 465–469.
Yang ZG, Sone S, Takashima S, et al. High-resolution CT analysis of small peripheral lung adenocarcinomas revealed on screening helical CT. AJR Am J Roentgenol, 2001, 176: 1399–1407.
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Wang, Y., Liu, X., Lin, Y. et al. The correlation between stroma analysis and MDCT early phase contrast enhancement in small solid lung adenocarcinoma. Chinese German J Clin Oncol 6, 419–424 (2007). https://doi.org/10.1007/s10330-007-0061-0
- extracellular matrix