Correlation between image characteristics and pathologic findings in non small cell lung cancer patients after anatomic resection

Introduction
Tumor characteristics in computed tomography (CT) are correlated to pathologic presentation and survival. However, most studies have been based on thin slice thickness CT while lymph node metastatic pattern has remained unclear. The aim of this study was to analyze the correlation between image characteristics under 5 mm slice thickness and pathology findings in non small lung cancer patients who have received curative resection.
Materials and methods
From January 2010 to May 2014, 440 patients who underwent curative resection were included and medical records were reviewed retrospectively. The tumor size and consolidation tumor ratio were simultaneously evaluated and measured by a physician, a thoracic surgeon, and a radiologist. The correlation between image and pathology characteristics and its survival impact was analyzed.
Results
Tumor sizes, as measured by CT and by pathologic measurement were highly coincident. (p < 0.001) GGO predominant lesions were correlated to well-differentiated adenocarcinoma, (p< 0.001), and less tumor necrosis (p<0.0001), lymphocyte infiltration (p = 0.0042) and tumor purity (p <0.0001). In addition, less risk of visceral pleura (p < 0.0001) and angiolymphatic invasion, and fewer metastases to N1 lymph node (p = 0.004) involvement were identified. No lymph node metastasis (0/12) was identified in sub-centimeter pure GGO lesion. The consolidation tumor ratio could be used to differentiate patients’ survival and excellent 5-year overall survival was identified in pure GGO lesion cases.
Conclusion
No lymph node metastasis was identified in sub-centimeter pure GGO lesion. The consolidation tumor ratio could be used to differentiate patients’ disease status and overall survival, while excellent 5-year overall survival was identified in cases with pure GGO lesion.

引言
计算机断层扫描（CT）下的肿瘤特征与病理表现及患者生存情况密切相关。然而，现有多数研究均基于薄层CT开展，淋巴结转移模式仍未明确。本研究旨在分析5mm层厚CT影像特征与接受根治性切除术的非小细胞肺癌患者病理结果之间的相关性。

材料与方法
本研究纳入2010年1月至2014年5月期间接受根治性切除术的440例患者，并对其病历资料进行回顾性分析。由内科医师、胸外科医师及放射科医师共同对肿瘤大小及肿瘤实性占比进行同步评估与测量。随后分析影像与病理特征的相关性及其对患者生存的影响。

结果
CT测量与病理测量的肿瘤大小具有高度一致性（p < 0.001）。磨玻璃影（ground-glass opacity, GGO）为主型病变与高分化腺癌显著相关（p < 0.001），同时伴随较低的肿瘤坏死率（p < 0.0001）、淋巴细胞浸润程度（p = 0.0042）及肿瘤纯度（p < 0.0001）。此外，该类病变患者发生脏层胸膜侵犯（p < 0.0001）、淋巴血管侵犯的风险更低，且出现N1淋巴结转移的概率显著降低（p = 0.004）。在亚厘米纯磨玻璃影病灶中未发现淋巴结转移（0/12）。肿瘤实性占比可用于区分患者的生存情况，纯磨玻璃影病灶患者的5年总生存期表现优异。

结论
亚厘米纯磨玻璃影病灶未发现淋巴结转移。肿瘤实性占比可用于区分患者的疾病状态与总生存期，而纯磨玻璃影病灶患者的5年总生存期表现优异。