Lung cancers associated with cystic airspaces: CT features and pathologic correlation
Lung cancers associated with cystic airspaces: CT features and pathologic correlation
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DOI：
10.1016/j.lungcan.2019.05.012
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发表时间：
2019-09-01
期刊：
影响因子：
5.3
通讯作者：
Jiang, Gening
中科院分区：
文献类型：
--
作者：
Shen, Yingran;Xu, Xinnan;Jiang, Gening
目的：肺癌合并囊性气腔是一种罕见的疾病。由于对本病认识不足，往往延误诊断和治疗。我们的目的是阐明LCCA的临床病理特征，并探讨与病理invasiveness.Method相关的影像学特征：2015年1月至2016年12月期间诊断为NSCLC的10，835例患者的术前计算机断层扫描（CT）扫描由两名胸部放射科医生进行了审查，以确定与囊性空域的相关性。结果123例LCCA的临床病理及影像学表现可分为四种类型：I、薄壁型（n = 23，18.7%）; II，厚壁型III型为囊腔伴壁结节（CWN）型（n = 43，35.0%），IV型为混合型（n = 23，18.7%）。在所有四种类型的LCCA中，囊壁中的固体成分预测组织学侵袭性。Ⅲ型中/低分化亚型所占比例（85.0%）高于其他三型（分别为50.0%、50.0%和69.6%）。多因素分析显示，III型糖尿病（比值比[OR]，6.5; 95%置信区间[CI]，1.1-36.4; P = 0.035），壁内部分固体/固体成分（部分实性：OR = 27.2; 95%CI = 5.6-3131.6; P < 0.001;实性：OR = 614.6; 95%CI = 36.4-10,368.6; P < 0.001），囊肿内表面不规则（OR 7.0; 95%CI 1.9-26.2; P = 0.004）是M/P分化亚型的独立危险因素。EGFR突变是各型LCCA的主要遗传学改变，但各型间差异无统计学意义。结论：LCCA的形态学类型和管壁成分是决定病理侵袭性的两个重要预测因子。
Objective: Lung cancer associated with cystic airspaces (LCCA) is a rare entity. The diagnosis and treatment is often delayed due to lack of comprehension of this disease. We aimed to elucidate LCCA's clinicopathological characteristics and investigate imaging features correlated with pathological invasiveness.Method: The preoperative computed tomographic (CT) scans of 10,835 patients diagnosed with NSCLC between January 2015 and December 2016 were reviewed by two thoracic radiologists for association with a cystic airspace. A clinicopathological and radiological feature analysis was done.Result A total number of 123 LCCA patients were identified and four morphologic patterns were recognized: I, thin-walled type (n = 23, 18.7%); II, thick-walled type (n = 34, 27.6%); III, a cystic airspace with a mural nodule (CWN) type (n = 43, 35.0%); and IV, mixed type (n = 23, 18.7%). A solid component in the cyst wall predicted histological invasiveness in all four types of LCCA. The proportion of moderately/poorly (M/P)-differentiated subtype in type III (85.0%) was higher than in other three patterns (which were 50.0%, 50.0%, and 69.6%, respectively). Multivariate analysis revealed that type III pattern (odds ratio [OR], 6.5; 95% confidence interval [CI], 1.1-36.4; P = 0.035), part-solid/solid component in wall (part-solid: OR, 27.2; 95% CI, 5.6-3131.6; P < 0.001; solid: OR 614.6; 95% CI, 36.4-10,368.6; P < 0.001), and irregular inner surface of cyst (OR 7.0; 95% CI 1.9-26.2; P = 0.004) were independent risk factors for the M/P-differentiated subtype. EGFR mutations were the predominant genetic alterations in each type of LCCAs, but no significant difference was found among them.Conclusions: In LCCA, morphological patterns and wall components were two important predictors for determining pathological invasiveness.