Top

Cancer Imaging

Published in:

Open Access 01-12-2016 | Research article

Evaluation of locoregional invasiveness of small-sized non-small cell lung cancers by enhanced dual-energy computed tomography

Authors: Hironori Shimamoto, Shingo Iwano, Hiroyasu Umakoshi, Koji Kawaguchi, Shinji Naganawa

Published in: Cancer Imaging | Issue 1/2016

Abstract

Background

To investigate the correlation between iodine-related attenuation of dual-energy computed tomography (DE-CT) and the histopathological invasiveness of surgically resected primary non-small cell lung cancers (NSCLCs) ≤ 3 cm in diameter.

Methods

We selected 63 consecutive NSCLC lesions from 60 patients (32 males, 28 females; age range, 39–85 years; mean age, 68 years). After injection of iodinated contrast media, arterial phases were scanned using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation (3D-IRA) of primary tumors at the arterial phase was computed using “lung nodule” application software. The corrected 3D-IRA normalized to the patient’s body weight and contrast medium concentration was then calculated. Single-factor analysis of variance (ANOVA) was used for comparison among tumor differentiation grade groups. Univariate and multivariate logistic regression analysis was used for the correlation between locoregional invasive tumor and clinical factors.

Results

Resected tumors were histopathologically classified into well-differentiated (G1; n = 24), moderately-differentiated (G2; n = 28), and poorly-differentiated (G3; n = 11) groups by degree of tumor differentiation. The mean ± standard deviation of the 3D-IRA was 56.1 ± 22.6 HU in G1 tumours, 48.5 ± 23.9 HU in G2 tumours, and 28.4 ± 15.8 HU in G3 tumours; significant differences were observed between groups by ANOVA. (p = 0.005). Univariate logistic analysis showed that the 3D-IRA and corrected 3D-IRAs were significantly correlated with locoregional invasive tumors (p = 0.002 and p < 0.001, respectively). Multivariate logistic analysis revealed that only the corrected 3D-IRA was significantly correlated with tumor invasiveness (p = 0.003), while gender, clinical size, and solid/subsolid type were not (p = 0.950, p = 0.057 and p = 0.456, respectively).

Conclusions

The 3D-IRA of small-sized NSCLCs was significantly associated with and invasiveness. Low 3D-IRA tumors tended to have greater invasiveness than high 3D-IRA tumors.

Chung CK, Zaino R, Stryker JA, O’Neill Jr M, DeMuth Jr WE. Carcinoma of the lung: evaluation of histological grade and factors influencing prognosis. Ann Thorac Surg. 1982;33(6):599–604.CrossRefPubMed

Kozu Y, Maniwa T, Takahashi S, Isaka M, Ohde Y, Nakajima T. Risk factors for both recurrence and survival in patients with pathological stage I non-small-cell lung cancer. Eur J Cardiothorac Surg. 2013;44(1):e53–8.CrossRefPubMed

Kishimoto M, Iwano S, Ito S, Kato K, Ito R, Naganawa S. Prognostic evaluations of small size lung cancers by 18 F-FDG PET/CT and thin-section CT. Lung Cancer. 2014;86(2):180–4.CrossRefPubMed

Iwano S, Yokoi K, Taniguchi T, Kawaguchi K, Fukui T, Naganawa S. Planning of segmentectomy using three-dimensional computed tomography angiography with a virtual safety margin: Technique and initial experience. Lung Cancer. 2013;81(3):410–5.CrossRefPubMed

Billé A, Pelosi E, Skanjeti A, Arena V, Errico L, Borasio P, et al. Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography. Eur J Cardiothorac Surg. 2009;36(3):440–5.CrossRefPubMed

Iwano S, Koike W, Matsuo K, Okada T, Shimoyama Y, Naganawa S. Correlation between dual-phase dynamic multi-detector CT findings and fibrosis within lung adenocarcinoma tumors. Eur J Radiol. 2011;80(3):e470–5.CrossRefPubMed

Spira D, Neumeister H, Spira SM, Hetzel J, Spengler W, von Weyhern CH, et al. Assessment of tumor vascularity in lung cancer using volume perfusion CT (VPCT) with histopathologic comparison: a further step toward an individualized tumor characterization. J Comput Assist Tomogr. 2013;37(1):15–21.CrossRefPubMed

Wang Y, Wang J-a, Liang K-r, Liang M-z, X-g L. Correlations between tumor stroma characters and dynamic enhanced MDCT findings in nodular pulmonary adenocarcinoma. J Comput Assist Tomogr. 2014;38(1):82–8.CrossRefPubMed

Zhang LJ, Yang GF, Wu SY, Xu J, Lu GM, Schoepf UJ. Dual-energy CT imaging of thoracic malignancies. Cancer Imaging. 2013;13:81–91.CrossRefPubMed

10.

Schmid-Bindert G, Henzler T, Chu TQ, Meyer M, Nance Jr JW, Schoepf UJ, et al. Functional imaging of lung cancer using dual energy CT: how does iodine related attenuation correlate with standardized uptake value of 18FDG-PET-CT? Eur Radiol. 2012;22(1):93–103.CrossRefPubMed

11.

Baxa J, Vondrakova A, Matouskova T, Ruzickova O, Schmidt B, Flohr T, et al. Dual-phase dual-energy CT in patients with lung cancer: assessment of the additional value of iodine quantification in lymph node therapy response. Eur Radiol. 2014;24(8):1981–8.CrossRefPubMed

12.

Sudarski S, Hagelstein C, Weis M, Schoenberg SO, Apfaltrer P. Dual-energy snap-shot perfusion CT in suspect pulmonary nodules and masses and for lung cancer staging. Euro J Radiol. 2015;84(12):2393–400.CrossRef

13.

Baxa J, Matouskova T, Krakorova G, Schmidt B, Flohr T, Sedlmair M, Bejcek J, Ferda J. Dual-Phase Dual-Energy CT in Patients Treated with Erlotinib for Advanced Non-Small Cell Lung Cancer: Possible Benefits of Iodine Quantification in Response Assessment. Eur Radiol. 2015. doi:10.1007/s00330-015-4092-6.

14.

Aoki M, Hirose K, Sato M, Akimoto H, Kawaguchi H, Hatayama Y, Fujioka I, Tanaka M, Ono S, Takai Y. Prognostic impact of average iodine density assessed by dual-energy spectral imaging for predicting lung tumor recurrence after stereotactic body radiotherapy. J Radiat Res. 2016. doi:10.1093/jrr/rrv100.

15.

Iwano S, Ito R, Umakoshi H, Ito S, Naganawa S. Evaluation of lung cancer by enhanced dual-energy CT: association between three-dimensional iodine concentration and tumour differentiation. Br J Radiol. 2015;88(1055):20150224.CrossRefPubMed

16.

Al-Alao BS, Gately K, Nicholson S, McGovern E, Young VK, O’Byrne KJ. Prognostic impact of vascular and lymphovascular invasion in early lung cancer. Asian Cardiovasc Thorac Ann. 2014;22(1):55–64.CrossRefPubMed

17.

Pechet TT, Carr SR, Collins JE, Cohn HE, Farber JL. Arterial invasion predicts early mortality in stage I non-small cell lung cancer. Ann Thorac Surg. 2004;78:1748–53.CrossRefPubMed

18.

Poncelet AJ, Cornet J, Coulon C, Collard P, Noirhomme P, Weynand B. Intra-tumoral vascular or perineural invasion as prognostic factors for long-term survival in early stage non-small cell lung carcinoma. Eur J Cardiothorac Surg. 2008;33:799–804.CrossRefPubMed

19.

Iwano S, Kishimoto M, Ito S, Kato K, Ito R, Naganawa S. Prediction of pathologic prognostic factors in patients with lung adenocarcinomas: comparison of thin-section computed tomography and positron emission tomography/computed tomography. Cancer Imaging. 2014;14:3. doi:10.1186/1470-7330-14-3.PubMedPubMedCentral

20.

Ito R, Iwano S, Kishimoto M, Ito S, Kato K, Naganawa S. Correlation between FDG-PET/CT findings and solid type non-small cell cancer prognostic factors: are there differences between adenocarcinoma and squamous cell carcinoma? Ann Nucl Med. 2015;29(10):897–905.CrossRefPubMed

21.

Chae EJ, Song JW, Krauss B, Song KS, Lee CW, Lee HJ, Seo JB. Dual-energy computed tomography characterization of solitary pulmonary nodules. J Thorac Imaging. 2010;25(4):301–10. doi:10.1097/RTI.0b013e3181e16232.CrossRefPubMed

22.

Yoshida J, Ishii G, Hishida T, Aokage K, Tsuboi M, Ito H, et al. Limited resection trial for pulmonary ground-glass opacity nodules: case selection based on high-resolution computed tomography-interim results. Jpn J Clin Oncol. 2015;45(7):677–81.CrossRefPubMed

23.

Ozeki N, Iwano S, Taniguchi T, Kawaguchi K, Fukui T, Ishiguro F, et al. Therapeutic surgery without a definitive diagnosis can be an option in selected patients with suspected lung cancer. Interact Cardiovasc Thorac Surg. 2014;19(5):830–7.CrossRefPubMed

24.

Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidrich DP, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e93S–120.CrossRefPubMedPubMedCentral

25.

Wiener RS, Schwartz LM, Woloshin S, Welch HG. Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Ann Intern Med. 2011;155:137–44.CrossRefPubMedPubMedCentral

26.

Iwano S, Ito S, Tsuchiya K, Kato K, Naganawa S. What causes false-negative PET findings for solid-type lung cancer? Lung Cancer. 2013;79(2):132–6.CrossRefPubMed

27.

Suzawa N, Ito M, Qiao S, Uchida K, Takao M, Yamada T, et al. Assessment of factors influencing FDG uptake in non-small cell lung cancer on PET/CT by investigating histological differences in expression of glucose transporters 1 and 3 and tumour size. Lung Cancer. 2011;72(2):191–8.CrossRefPubMed

28.

Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K. Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. Lung Cancer. 2004;45(1):19–27.CrossRefPubMed

29.

Asamura H, Hishida T, Suzuki K, Koike T, Nakamura K, Kusumoto M, et al. Radiographically determined noninvasive adenocarcinoma of the lung: survival outcomes of Japan Clinical Oncology Group 0201. J Thorac Cardiovasc Surg. 2013;146(1):24–30.CrossRefPubMed

30.

Ohde Y, Nagai K, Yoshida J, Nishimura M, Takahashi K, Suzuki K, et al. The proportion of consolidation to ground-glass opacity on high resolution CT is a good predictor for distinguishing the population of non-invasive peripheral adenocarcinoma. Lung Cancer. 2003;42(3):303–10.CrossRefPubMed

31.

Muto J, Hida Y, Kaga K, Ohtaka K, Okamoto S, Tamaki N, et al. Use of maximum standardized uptake value on fluorodeoxyglucose positron-emission tomography in predicting lymph node involvement in patients with primary non-small cell lung cancer. Anticancer Res. 2014;34(2):805–10.PubMed

32.

Li M, Sun Y, Liu Y, Han A, Zhao S, Ma L, et al. Relationship between primary lesion FDG uptake and clinical stage at PET-CT for non-small cell lung cancer patients: An observation. Lung Cancer. 2010;68(3):394–7.CrossRefPubMed

33.

Uhrig M, Simons D, Kachelrieß M, Pisana F, Kuchenbecker S, Schlemmer HP. Advanced abdominal imaging with dual energy CT is feasible without increasing radiation dose. Cancer Imaging. 2016;16(1):15. doi:10.1186/s40644-016-0073-5.CrossRefPubMedPubMedCentral

Title: Evaluation of locoregional invasiveness of small-sized non-small cell lung cancers by enhanced dual-energy computed tomography
Authors: Hironori Shimamoto
Shingo Iwano
Hiroyasu Umakoshi
Koji Kawaguchi
Shinji Naganawa
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Cancer Imaging / Issue 1/2016
Electronic ISSN: 1470-7330
DOI: https://doi.org/10.1186/s40644-016-0077-1

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

A method to assess image quality for Low-dose PET: analysis of SNR, CNR, bias and image noise

68Ga-PSMA ligand PET/CT in patients with prostate cancer: How we review and report

Erratum to: A method to assess image quality for Low-dose PET: analysis of SNR, CNR, bias and image noise

MRI of endometrium cancer – how we do it

Translational research in diagnosis and management of soft tissue tumours

Single-source chest-abdomen-pelvis cancer staging on a third generation dual-source CT system: comparison of automated tube potential selection to second generation dual-source CT

Keynote webinar | Spotlight on antibody–drug conjugates in cancer