Correlations between thin-section CT findings, histopathological and clinical findings of small pulmonary adenocarcinomas.

STUDY OBJECTIVES: Previously, we reported that small pulmonary adenocarcinomas (tumor diameter 20 mm or less) could be classified according to attenuation on thin-section CT (TS-CT) images as either 'air-containing type' or 'solid-density type' (Lung Cancer 2002;36:49-57). Air-containing type was defined as having areas where TOM (tumor opacity on mediastinal window images) was half or less than half the size of those noted on lung window images. Solid-density type was defined as having areas where TOM was greater than half the size of those noted on lung window images. Our findings indicated that there was no microscopic evidence of metastasis with air-type nor any relapses nor deaths, after resection. By contrast, patients with solid-density types demonstrated a poor prognosis. At this time, the histopathological characteristics of areas of TOM have not been fully investigated. The purpose of this study is to define the correlations between TOM and histopathological findings of small lung adenocarcinomas. METHOD: We retrospectively reviewed the records and CT scans of 134 patients, who had undergone surgical resection of peripheral adenocarcninomas. All tumor diameters were 20 mm or less in size. All 134 patients had undergone TS-CT prior to surgery. TS-CT Images were acquired by a model X-Vigor/Real or an Aquillion CT scanner (Toshiba Medical Systems). Thin-section images of tumors were obtained at 135 kVp at 250 mAs with 1-2 mm section thicknesses. All images were photographed using mediastinal (level, 40 HU; width, 400 HU) and lung (level, -600 HU; width, 1600 HU) window settings. We researched the histopathological components corresponding to the areas of TOM. RESULTS: Areas of TOM demonstrated five possible histopathological findings; (1) collapse (C), (2) collapse with bronchioloalveolarcell carcinoma (CwB), (3) adenocarcinoma cells (Cells), (4) fibroblasts (F), and (5) mucus (M). Areas of TOM in air-containing type adenocarcinomas (52 cases) demonstrated predominantly C and/or CwB (C/CwB type, 44 cases). Areas of TOM in solid-density type adenocarcinomas (82 cases), in comparison, demonstrated predominantly Cells and/or Cells/F (Cell/F type, 67 cases). We noted a statistically significant difference between the histopathological findings of the areas of TOM of air-containing type and solid-density type tumors. The 39 cases of Cell/F type adenocarcinomas revealed microscopic evidence of metastasis (pleural involvement, vascular invasion, lymphatic permeation, or lymphnode metastasis). Whereas, no C/CwB type adenocarcinomas cases revealed any microscopic metastasis. The prognosis of C/CwB type after resection is better than for Cell/F type. CONCLUSION: We found that air-containing type adenocarcinomas demonstrated C/CwB type, and that solid-density type adenocarcinomas demonstrated Cell/F type. The histopathological findings of small pulmonary adenocarcinomas could be classified into three groups: C/CwB type, Cell/F type and M type. The prognosis of C/CwB type is better than for Cell/F type. Our results indicate that there are clear correlations between the areas of TOM and the histopathological components of small pulmonary adenocarcinomas. Therefore TS-CT findings are a useful aid in determining the best surgical methods.

[Video-assisted thoracic surgery for pulmonary metastasis of colorectal cancer].

The effect of surgical procedures for survival of cases with pulmonary metastasis from colorectal cancer was examined retrospectively. In the literature, some factors such as timing of surgery, numbers of metastases, site of laterality, lesion in lymph nodes, extra-pulmonary metastases and serum CEA level have been considered to exert influence on surgical treatment for pulmonary metastasis of colorectal cancer. On the other hand, no significant differences have been in the literature and our hospital found between open thoracotomy and thoracoscopic surgery, lobectomy and limited resection, and with and without lymph node dissection. Therefore, less invasive and limited resection using thoracoscopy should be attempted in surgical treatment of pulmonary metastasis of colorectal cancer.

Clinical significance of pleural lavage cytology for non-small cell lung cancer: is surgical resection valid for patients with positive pleural lavage cytology?

The purpose of the present study was to retrospectively analyze the clinicopathological characteristics and clarify the validity of surgical resection for patients with positive pleural lavage cytology (PLC). Between 1993 and 2006, 563 patients who underwent complete surgical resection for primary non-small cell lung cancer and who were examined with regard to PLC were retrospectively analyzed. Forty-two patients (7.2%) showed positive PLC. The 5-year survival rates were 65.0% and 33.5% for patients with negative and positive PLC, respectively. The 5-year survival rates for patients with positive PLC were 57.1%, 50.8%, 40.0%, and 0% for pathological stage I, II, IIIA, and IIIB, respectively. Multivariate analysis revealed that preoperative carcinoembryonic antigen (CEA) level, PLC, vascular invasion, lymphatic permeation, and pathological stage were independent prognostic factors. The 5-year survival rate for the patients with a high CEA level and positive PLC was 0%. Intrathoracic recurrence was observed more frequently in patients with positive PLC. PLC was an independent prognostic factor. While positive PLC alone may not be a contraindication for surgical resection, patients who are complicated with a high CEA level preoperatively should receive special attention since no long-term survivors were observed.

Prognosis of small adenocarcinoma of the lung based on thin-section computed tomography and pathological preparations.

OBJECTIVE: We investigated the relationship between findings from tumor opacity in the mediastinal window image and solid lesions in pathological preparations and related the results to tumor recurrence. METHODS: The subjects were 115 patients with a lung adenocarcinoma of 20 mm or smaller who underwent surgical resection. The proportion of the reduction in the tumor opacity in the mediastinal window image maximum diameter to the maximum diameter of the tumor opacity was calculated as the reduction percentage, and the proportion of the maximum solid lesions in pathological preparation diameter to the maximum tumor diameter was calculated as the pathological ratio. RESULTS: The incidence of relapse was significantly higher in patients with a reduction percentage of less than 50% and in patients with a pathological ratio of less than 50%. CONCLUSIONS: Measurement of the reduction percentage and the pathological ratio may allow prediction of prognosis of small adenocarcinoma of the lung.

Long-term survival after a surgical resection of pulmonary metastases from gastric cancer: report of a case.

We describe a patient who survived for a prolonged period after repeated resections of pulmonary metastases from gastric cancer. A 59-year-old man underwent a distal gastrectomy for gastric cancer. A right middle lobectomy and a left lower lobectomy were performed for metastases from gastric cancer at 34 months and 82 months after the initial gastric resection, respectively. The patient died of cerebral infarction 65 months after the first lung resection, with no further relapse. To our knowledge, long-term survival after resection of pulmonary metastases from gastric cancer has only been reported in 3 patients previously. We herein review the literature and discuss the role of surgery in such patients.