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J Thorac Cardiovasc Surg 2007;133:1448-1454
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Associations among bronchioloalveolar carcinoma components, positron emission tomographic and computed tomographic findings, and malignant behavior in small lung adenocarcinomas

Morihito Okada, MD, PhDa,*, Shunsuke Tauchi, MDa, Koichiro Iwanaga, MDa, Takeshi Mimura, MDa, Yoshitaka Kitamura, MDa, Hirokazu Watanabe, MD, PhDb, Shuji Adachi, MD, PhDb, Toshiko Sakuma, MD, PhDc, Chiho Ohbayashi, MD, PhDc

a Department of Thoracic Surgery, Hyogo Medical Center for Adults, Akashi City, Hyogo, Japan
b Department of Radiology, Hyogo Medical Center for Adults, Akashi City, Hyogo, Japan
c Department of Pathology, Hyogo Medical Center for Adults, Akashi City, Hyogo, Japan.

Received for publication December 12, 2006; revisions received February 2, 2007; accepted for publication February 19, 2007.

* Address for reprints: Morihito Okada, MD, PhD, Department of Surgical Oncology, Hiroshima University, 1-2-3 Kasumi Minami-Ku, Hiroshima City 734-8551, Japan. (Email: morihito1217jp{at}aol.com).

Objective: The aggressiveness of small adenocarcinomas has not been fully evaluated using integrated positron emission tomography/computed tomography. We investigated malignant aggressiveness according to positron emission tomography/computed tomography, high-resolution computed tomographic findings, and the proportions of pathologically defined bronchioloalveolar carcinomas in cT1N0M0 lung adenocarcinoma.

Methods: Sixty consecutive patients with cT1N0M0 lung adenocarcinomas of 3 cm or less in diameter underwent fluorodeoxyglucose–positron emission tomograph/computed tomography, and high-resolution computed tomography, followed by complete tumor resection. Correlations between the proportion of bronchioloalveolar carcinoma and maximum standardized uptake value on positron emission tomographic scan/computed tomographic scan, ground-glass opacity, and tumor shadow disappearance rate were investigated and the findings were compared with clinicopathologic features.

Results: Lymphatic and vascular invasion occurred in 18 (30%) and 13 (22%) patients, respectively, whereas hilar or mediastinal lymph nodes occurred in 8 patients (13%). Maximum standardized uptake value generally seemed the most valuable predictor of lymphatic invasion, vascular invasion, and nodal metastasis compared with ground-glass opacity, tumor shadow disappearance rate, and bronchioloalveolar carcinoma ratios. Although the association was significant between the bronchioloalveolar carcinoma ratio versus maximum standardized uptake value, ground-glass opacity ratio, and tumor shadow disappearance rate (all P < .0001), maximum standardized uptake value (R 2 = 0.245) was less correlated with the bronchioloalveolar carcinoma ratio than was the ground-glass opacity ratio (R 2 = 0.554) and tumor shadow disappearance rate (R 2 = 0.671).

Conclusions: The malignant behavior of small adenocarcinomas with a lower maximum standardized uptake value and a greater proportion of ground-glass opacity, tumor shadow disappearance rate, and bronchioloalveolar carcinoma was less aggressive. Maximum standardized uptake value was a more powerful clinical predictor of biologic tumor performance, independent of pathologic bronchioloalveolar carcinoma proportion. Preoperative assessment of maximum standardized uptake value on positron emission tomographic/computed tomographic findings, in addition to the ground-glass opacity ratio and tumor shadow disappearance rate on high-resolution computed tomographic scans, might be useful to guide treatment strategies for small adenocarcinomas.

Abbreviations and Acronyms BAC = bronchioloalveolar carcinoma; CEA = serum carcinoembryonic antigen; GGO = ground-glass opacity; HR-CT = high-resolution computed tomography; HU = Hounsfield units; maxD = maximum dimensions of the tumors; perD = largest dimension perpendicular to the maximum axis; PET = positron emission tomography; SUV = standardized uptake value; TDR = tumor shadow disappearance rate




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