Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 11/2019

01-11-2019 | Lung Cancer | Chest

Clinical T categorization in stage IA lung adenocarcinomas: prognostic implications of CT display window settings for solid portion measurement

Authors: Hyungjin Kim, Jin Mo Goo, Young Tae Kim, Chang Min Park

Published in: European Radiology | Issue 11/2019

Login to get access

Abstract

Objectives

Our study aimed at evaluating the prognostic implications of lung and mediastinal CT display window settings for solid portion measurements on the eighth-edition lung cancer staging system’s clinical T (cT) categorization.

Methods

We retrospectively analyzed 691 surgically treated patients from 2009 to 2015 for clinical stage IA lung adenocarcinomas. Solid portions were measured at the lung and mediastinal window settings, respectively, and cT categories were determined for each measurement (cTlung and cTmediastinum). The prognostic power of the two cT factors for disease-free survival (DFS) was assessed using Cox regression, and concordance indices (C-indices) were compared using the Student t test. Subsequently, the patients were split into training and validation cohorts to calculate optimal cutoffs for the cT categorization of mediastinal window–based solid portions (cToptimal) and validate its prognostic performance.

Results

Both cTlung ((cT1b: adjusted HR, 3.547; p = 0.017), (cT1c: adjusted HR, 9.439; p < 0.001)) and cTmediastinum ((cT1b: adjusted HR, 4.635; p < 0.001), (cT1c: adjusted HR, 11.235; p < 0.001)) were significantly associated with DFS for each multivariable Cox model. The C-indices were 0.772 (95% CI, 0.702–0.842) for cTlung and 0.787 (95% CI, 0.726–0.848) for cTmediastinum (p = 0.789). The optimal cutoffs for cT categorization of the mediastinal window–based solid portions were 0.9 cm and 1.8 cm. However, there were no significant differences in the C-indices among cTlung, cTmediastinum, and cToptimal (p > 0.05).

Conclusions

The prognostic performances of the cT categorizations at the lung and mediastinal windows were not significantly different. The current cT categorization based on the lung window measurement is appropriate as it stands.

Key Points

• Discriminatory power of the eighth-edition clinical T category was not significantly affected by the CT display window settings.
• Given the facts that the lung window setting enables more sensitive detection of the solid portions and higher correlation with the pathological invasive components, our findings may support adherence to the usage of the lung window setting for the solid portion measurement per the current recommendations.
Appendix
Available only for authorised users
Literature
1.
Cheng TY, Cramb SM, Baade PD, Youlden DR, Nwogu C, Reid ME (2016) The international epidemiology of lung cancer: latest trends, disparities, and tumor characteristics. J Thorac Oncol 11:1653–1671CrossRef
2.
Austin JH, Garg K, Aberle D et al (2013) Radiologic implications of the 2011 classification of adenocarcinoma of the lung. Radiology 266:62–71CrossRef
3.
Lee KH, Goo JM, Park SJ et al (2014) Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thorac Oncol 9:74–82CrossRef
4.
Hwang EJ, Park CM, Ryu Y et al (2015) Pulmonary adenocarcinomas appearing as part-solid ground-glass nodules: is measuring solid component size a better prognostic indicator? Eur Radiol 25:558–567CrossRef
5.
Tsutani Y, Miyata Y, Nakayama H et al (2013) Solid tumor size on high-resolution computed tomography and maximum standardized uptake on positron emission tomography for new clinical T descriptors with T1 lung adenocarcinoma. Ann Oncol 24:2376–2381CrossRef
6.
Burt BM, Leung AN, Yanagawa M et al (2015) Diameter of solid tumor component alone should be used to establish T stage in lung adenocarcinoma. Ann Surg Oncol 22(Suppl 3):S1318–S1323CrossRef
7.
Murakawa T, Konoeda C, Ito T et al (2013) The ground glass opacity component can be eliminated from the T-factor assessment of lung adenocarcinoma. Eur J Cardiothorac Surg 43:925–932CrossRef
8.
Travis WD, Asamura H, Bankier AA et al (2016) The IASLC lung cancer staging project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol 11:1204–1223CrossRef
9.
Bankier AA, MacMahon H, Goo JM, Rubin GD, Schaefer-Prokop CM, Naidich DP (2017) Recommendations for measuring pulmonary nodules at CT: a statement from the Fleischner Society. Radiology 285:584–600CrossRef
10.
Naidich DP, Bankier AA, MacMahon H et al (2013) Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 266:304–317CrossRef
11.
Revel MP, Mannes I, Benzakoun J et al (2018) Subsolid lung nodule classification: a CT criterion for improving interobserver agreement. Radiology 286:316–325CrossRef
12.
Ahn H, Lee KW, Lee KH et al (2018) Effect of computed tomography window settings and reconstruction plane on 8th edition T-stage classification in patients with lung adenocarcinoma manifesting as a subsolid nodule. Eur J Radiol 98:130–135CrossRef
13.
Yoo RE, Goo JM, Hwang EJ et al (2017) Retrospective assessment of interobserver agreement and accuracy in classifications and measurements in subsolid nodules with solid components less than 8mm: which window setting is better? Eur Radiol 27:1369–1376CrossRef
14.
15.
Xie W, Regan MM, Buyse M et al (2017) Metastasis-free survival is a strong surrogate of overall survival in localized prostate cancer. J Clin Oncol 35:3097–3104CrossRef
16.
Travis WD, Brambilla E, Noguchi M et al (2011) International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 6:244–285CrossRef
17.
Hunt KK, Karakas C, Ha MJ et al (2017) Cytoplasmic cyclin E predicts recurrence in patients with breast cancer. Clin Cancer Res 23:2991–3002CrossRef
18.
Harrell FE (2015) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis, 2nd edn. Springer, New YorkCrossRef
19.
Weiss A, Chavez-MacGregor M, Lichtensztajn DY et al (2018) Validation study of the American Joint Committee on Cancer eighth edition prognostic stage compared with the anatomic stage in breast cancer. JAMA Oncol 4:203–209CrossRef
20.
Chang C, Hsieh MK, Chang WY, Chiang AJ, Chen J (2017) Determining the optimal number and location of cutoff points with application to data of cervical cancer. PLoS One 12:e0176231CrossRef
21.
Haraguchi N, Satoh H, Kikuchi N, Kagohashi K, Ishikawa H, Ohtsuka M (2007) Prognostic value of tumor disappearance rate on computed tomography in advanced-stage lung adenocarcinoma. Clin Lung Cancer 8:327–330CrossRef
22.
Kim D, Kim HK, Kim SH et al (2018) Prognostic significance of histologic classification and tumor disappearance rate by computed tomography in lung cancer. J Thorac Dis 10:388–397CrossRef
23.
Okada M, Nishio W, Sakamoto T et al (2004) Correlation between computed tomographic findings, bronchioloalveolar carcinoma component, and biologic behavior of small-sized lung adenocarcinomas. J Thorac Cardiovasc Surg 127:857–861CrossRef
24.
Shimizu K, Yamada K, Saito H et al (2005) Surgically curable peripheral lung carcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival. Chest 127:871–878CrossRef
25.
Yoshida J, Ishii G, Hishida T et al (2015) Limited resection trial for pulmonary ground-glass opacity nodules: case selection based on high-resolution computed tomography-interim results. Jpn J Clin Oncol 45:677–681CrossRef
26.
Chen PA, Huang EP, Shih LY et al (2018) Qualitative CT criterion for subsolid nodule subclassification: improving interobserver agreement and pathologic correlation in the adenocarcinoma spectrum. Acad Radiol 25:1439–1445CrossRef
27.
Arenas-Jimenez J (2013) Measurement of solid component in part-solid lesions with a mediastinal window setting? Radiology 268:305–306CrossRef
28.
MacMahon H, Naidich DP, Goo JM et al (2017) Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017. Radiology 284:228–243CrossRef
Metadata
Title
Clinical T categorization in stage IA lung adenocarcinomas: prognostic implications of CT display window settings for solid portion measurement
Authors
Hyungjin Kim
Jin Mo Goo
Young Tae Kim
Chang Min Park
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06216-6

Other articles of this Issue 11/2019

European Radiology 11/2019 Go to the issue

Imaging Informatics and Artificial Intelligence

Identification of suspicious invasive placentation based on clinical MRI data using textural features and automated machine learning

Cardiac

Density and morphology of coronary artery calcium for the prediction of cardiovascular events: insights from the Framingham Heart Study

Hepatobiliary-Pancreas

Lipiodol deposition in portal vein tumour thrombus predicts treatment outcome in HCC patients after transarterial chemoembolisation

Ultrasound

Intra- and inter-operator reproducibility of US point shear-wave elastography in various organs: evaluation in phantoms and healthy volunteers

Ultrasound

Autosomal dominant polycystic kidney disease: new role for ultrasound

Magnetic Resonance

Cortical morphology of chronic users of codeine-containing cough syrups: association with sulcal depth, gyrification, and cortical thickness