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HRCT Features of Small Peripheral Lung Carcinomas Detected in a Low-dose CT Screening Program

Posted Dec 31, 2009 Updated Apr 7, 2023
By Shusuke Sone MD , Toru Matsumoto BS PhD , Takayuki Honda MD , Kenji Tsushima MD , Fumiyoshi Takayama MD , Takaomi Hanaoka MD , Ryoichi Kondo MD , Masayuki Haniuda MD
11 min read

Rationale and Objectives

To define high-resolution computed tomography (HRCT) features of lung cancers detected by computed tomography (CT) screening according to histopathology and prognosis.

Methods and Materials

Tumor size, CT value, morphology, and tumor volume doubling time (TVDT) were determined for 10 atypical adenomatous hyperplasias (AAH) and 50 lung cancers followed between 1996 and 1998 to 2007.

Results

For the 10 AAHs, the density less than −500 HU in all lesions (mean, −654 HU) and the size was up to 14 mm (mean, 9 mm); all patients remain alive. Focal bronchioloalveolar cell carcinomas (BAC) were denser (mean, −537 HU) than AAH and mostly less dense than −350 HU; all patients remain alive. All 22 adenocarcinomas (ADC) were denser than −450 HU (mean, −186 HU); 6 were problematic and measured >−150HU and >10 mm or had >10 mm of central denser zone (CDZ) (partly solid tumors) or tumor size (solid tumor). Two of four squamous cell carcinomas (SCC) measuring 15 and 10 mm, respectively, were problematic. Two patients with small-cell lung carcinomas (SCLC) measuring 15 and 23 mm, respectively, remain alive. AAH, BAC, ADC, and SCC lesions were in general polygonal in shape. SCLC lesions appeared as round nodules with excrescence. The mean TVDT for AAH, BAC, ADC, SCC, and SCLC was 1278, 557, 466, 212, and 103 days, respectively.

Conclusion

The CT features reflected tumor aggressiveness. Non-SCLC lesions of >−150HU and >10 mm (or >−100HU and >10 mm for the solid portion of the tumor) are associated with unfavorable prognosis. Timely interventions should be undertaken before problematic increase in number of cases.

Lung cancer is currently the leading cause of cancer death in the United States; 215,020 cases of lung cancer are expected to be newly diagnosed and 161,840 patients will die from it in 2008 . This poor prognosis appears to reflect a small number of patients who are detected and treated at an early, curable stage . Low-dose computed tomography (CT) screening is effective in detecting peripheral small lung nodules . To translate early detection of lesions into true improvement of treatment outcome and prognosis, we need to establish an effective management strategy for small nodules by enhancing our understanding and interpretation of high-resolution CT (HRCT) findings. The aim of any such strategy should include the avoidance of both unnecessary invasive diagnostic procedures and treatment of indolent lesions and avoidance of underdiagnosis or delay in initiating treatment for genuine lung cancer .

We conducted a trial of low-dose CT screening for lung cancer between 1996 and 1998 . We report in this article the HRCT features of lung cancer found in the program, according to histopathology and prognosis of patients. This information would help radiologists in making meaningful workup examinations of HRCT scans.

Background of the study

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Subjects and study methods

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Statistical Methods

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Results

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Table 1

Demographic and Pathological Features of 10 Cases of AAH and 50 Lung Cancer Lesions (58 Patients)

n/lesion Sex (F/M) Smoking status (NS/S) Age (y), mean (min–max) Pathologic stage Outcome (Alive/survived with disease/dead) CT pattern AAH 10 6/4 7/3 64 (49–73) IA:10 10/0 none/part/solid: 6/4/0 BAC 21/22 12/9 15/6 65 (50–73) IA: 22 21/0 6/16/0 ADC 21/22 10/11 10/11 63 (46–74) IA:14, IB:1, IIA:1, IIIA:1, IIIB:1, IV:3 (including 2 cases with one each of small satellite lesion) 17/1/3 1/21/0 SCC 4 0/4 0/4 64 (47–73) IA:2, IIA:1, IIIB:1 3/0/1 0/0/4 SCLC 2 0/2 0/2 70 (67–73) IA:2 2/0/0 0/0/2 Total 58/60 28/30 32/28 64 (46–74) IA(52), IB(1), IIA(2), IIIA(1), IIIB(2), VI(1) 53/1/4 13/41/6

AAH, atypical adenomatous hyperplasia; BAC, bronchioloalveolar cell carcinoma; ADC, adenocarcinoma; SCC, squamous cell carcinoma; SCLC, small-cell lung carcinomas; NS, nonsmoker; S, smoker.

Table 2

CT Features of 10 Cases of AAH and 50 Lung Cancer Lesions (58 Patients)

Measurements on last HRCT, mean (min–max) CDZ TVDT Shape Size (mm) CT value Size CT value Screen CT HRCT Polygonal Miscellaneous AAH 9 (6– 14) -654 (-765, -512) 3 (3, 5, n = 4) -305 (-463, -130) 1254 (457, 3730, n = 7) 1336 (649, 2607, n = 3) 9 1 (epicycloid) BAC 10 (5–19) -537 (-763, -291) 5 (2, 9, n = 16) -278 (-470, -34) 571 (73, 2166, n = 9) 536 (113, 1799, n = 6) 21 1 (hypocycloid) ADC 14 (7–27) -186 (-640, 22) 11 (3, 18, n = 20) -96 (-461, 22) 503 (59, 2865, n = 15) 227 (185, 258, n = 4) 20 1 (epicycloid), 1 (irregularly infiltrative) SCC 14 (10–18) -15 (-97, 43) 212 (73, 350, n = 2) 4 (including 2 with round margins) SCLC 19 (15–23) 14 (10, 16) 103 (64, 142, n = 2) 2 (lobulated mass) Total 12 (5–27) -377 (-765, 43) 631 (59, 3730, n = 35) 527 (113, 2607, n = 12) 54 6

Abbreviations as in Table 1 . TVDT, tumor volume doubling time; CDZ, central denser zone.

Figure 1, (a) High-resolution computed tomography (HRCT) of a 71-year-old female nonsmoker with adenocarcinoma (ADC)/with BAC features (WBF) (Noguchi type A) showing 7-mm square nonsolid nodule, with fairly straight margin, in the subpleural zone of the right lower lobe. (b) Three-dimensional reformatted sagittal image of the same patient showing a 5 × 8 mm hexagonal nodule with somewhat rounded corners. The tumor volume doubling time (TVDT) was 210 days, which was calculated on HRCT scans.

Figure 2, (a) High-resolution computed tomography (HRCT) of a 69-year-old male smoker with bronchioloalveolar cell carcinomas (BAC) (type B) showing an 11-mm partly solid nodule, with a central denser zone (CDZ) of 5 mm, in the mid-zone of the right upper lobe. The lesion is slightly deformed pentagon in shape with rounded angles. (b) Three-dimensional reformatted coronal image of the same patient showing a 10 × 20 mm hexagonal tumor, with partly solid density with somewhat concave margin. The tumor volume doubling time (TVDT) was 189 days, which was calculated on screening computed tomography scans.

Figure 3, (a) High-resolution computed tomography (HRCT) of a 58-year-old female nonsmoker with bronchioloalveolar cell carcinomas (BAC) (type B) lesion in the right upper lung showing an 11-mm partly solid nodule, with a central denser zone (CDZ) of 7 mm. The lesion is pentagon in shape, but appears as rounded because of a slightly convex margin. (b) Three-dimensional reformatted sagittal image of the same patient showing a 10-mm pentagonal tumor, with partly rugged margin. The tumor volume doubling time (TVDT) for this patient was not available.

Figure 4, High-resolution computed tomography (HRCT) of a 67-year-old male smoker with atypical adenomatous hyperplasias (AAH) lesion in the periphery of the right upper lung showing a 14-mm nonsolid lesion of epicycloid in shape, probably from multiple secondary lobular involvement by the lesion; in fact, the lesion appeared polygonal in the most transverse HRCT images at other 25 levels and three-dimensional reformatted images. The tumor volume doubling time (TVDT) was 1529 days, which was calculated on screening computed tomography scans.

Figure 5, High-resolution computed tomography (HRCT) of a 63-year-old male smoker with adenocarcinomas (ADC)/with BAC features (WBF) lesion (Noguchi type C, T4N2M1) in the subpleural zone of right upper lung showing an irregularly shaped 15 × 31 mm solid lesion with fine spiculations accompanied by chest wall invasion. The tumor volume doubling time (TVDT) for this lesion was 182 days, which was calculated on the screening computed tomography scans. Another lesion (ADC, poorly differentiated) was shown in the subpleural zone of the right basal lung.

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Figure 6, High-resolution computed tomography (HRCT) of a 68-year-old male smoker with squamous cell carcinomas (SCC) showing a pentagon-shaped 12-mm solid nodule (p-T1N1) in the perihilar zone of the left lower lobe, just posterior to the left descending pulmonary artery. Tumor margin is slightly convex, showing a rounded appearance. The tumor volume doubling time (TVDT) was 350 days, which was calculated on screening computed tomography scans. The patient remains alive after surgery and adjuvant chemotherapy.

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Figure 7, High-resolution computed tomography (HRCT) of a 67-year-old male smoker with SCLC showing a 15-mm solid nodule in the subpleural zone of the right lower lobe. The lesion is a rounded nodule with excrescence posteriorly. The tumor volume doubling time (TVDT) was 64 days, which was calculated on the screening computed tomography scans. The patient remains alive after surgery and adjuvant chemotherapy.

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Figure 8, Scatter diagram of the density and size of 60 tumors (58 patients) according to histopathology and outcome. Plots for problematic cases (with more advanced p-stage than IA, postsurgery recurrence or mortality from lung cancer) are marked by red.

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Figure 9, Scatter diagram of the density and size of 43 solid tumors and partly solid tumors with central denser zone (41 patients) according 50 to histopathology and outcome. Plots for problematic cases are marked by red.

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Discussion

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Acknowledgment

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Academic Radiology, Volume 17, Issue 1
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