• Hisashi Saji, Jun Matsubayashi, Soichi Akata, Yoshihisa Shimada, Yasufumi Kato, Yujin Kudo, Toshitaka Nagao, Jinho Park, Masatoshi Kakihana, Naohiro Kajiwara, Tatsuo Ohira, and Norihiko Ikeda.
• Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan Department of Chest Surgery, St. Marianna University School of Medicine, Kanagawa, Japan saji-q@ya2.so-net.ne.jp.
• Acta Radiol. 2015 Oct 1; 56 (10): 1187-95.

BackgroundThe presence of ground glass opacity (GGO) on high-resolution computed tomography (HRCT) is well known to be pathologically closely associated with adenocarcinoma in situ.PurposeTo determine whether it is more useful to evaluate the whole tumor size or only the solid component size to predict the pathologic high-grade malignancy and the prognostic outcome in lung adenocarcinoma.Material And MethodsUsing HRCT data of 232 patients with adenocarcinoma who underwent curative resection, we retrospectively measured the whole tumor and solid component sizes with lung window setting (WTLW and SCLW) and whole tumor sizes with a mediastinal window setting (WTMW).ResultsThere was significant correlation between the WTLW and the measurements of pathological whole tumor (pWT) (r = 0.792, P < 0.0001). The SCLW and WTLW values significantly correlated with the area of pathological invasive component (pIVS) (r = 0.762, P < 0.0001 and r = 0.771, P < 0.0001, respectively). The receiver operating characteristics area under the curve for WTLW, SCLW, and WTMW used to identify lymph node metastasis or lymphatic or vascular invasion were 0.693, 0.817, and 0.824, respectively. Kaplan-Meier curves of disease-free survival (DFS) and overall survival (OS) were better divided according to SCLW and WTMW, compared with WTLW. Multivariate analysis of DFS and OS revealed that WTMW was an independent prognostic factor (HR = 0.72, 95% confidence interval [CI] = 0.58-0.90, P = 0.004 and HR = 0.74, 95% CI = 0.57-0.96, P = 0.022, respectively).ConclusionThe predictive values of the solid tumor size visualized on HRCT especially in the mediastinal window for pathologic high-grade malignancy and prognosis in lung adenocarcinoma were greater than those of whole tumor size.© The Foundation Acta Radiologica 2014.

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