OBJECTIVETo evaluate the high resolution CT (HRCT) features of cyst-like lung adenocarcinoma, explore the correlation between HRCT image features and histopathological characteristics, and observe the pathological basis of air-containing space.

METHODSHRCT and histopathologic findings of cyst-like lung adenocarcinoma in 86 patients were investigated retrospectively. The image features of both tumor and air-containing space were analyzed. All surgically resected specimens were reviewed. The pathological analysis included histologic subtype, differentiation degree, and the pathological basis of air-containing space formation. The correlation between HRCT image features and histopathologic grades was analyzed.

RESULTSOn HRCT, intratumoral necrosis was detected in 17 cases (19.8%), air-containing space with septa in 40 cases (46.5%), wall nodule in the air-containing space in 16 cases (18.6%), mixed thick and thin walls of air-containing space in 49 cases (57.0%). Air-containing space and its wall were observed in 63 cases on histological specimens, among which destruction of the alveolar wall by tumor cells might be the pathological basis of air-containing space in 42 (66.7%) cases. Differences of tumor attenuation (P = 0.030), intratumoral necrosis (P = 0.003) and proportion of thin-wall in air-containing space (P = 0.014) among different histopathologic grades were significant. The proportion of thin-wall in air-containing space was negatively correlated with histological grade (r = 0.267, P = 0.015). Differences of tumor contour (P = 0.002), tumor attenuation (P = 0.006), intratumoral necrosis (P < 0.001), septa in air-containing space (P = 0.016) and proportion of thin-wall in the air-containing space (P = 0.005) among different differentiation degrees were significant. The proportion of thin-wall in air-containing space was positively correlated with differentiation degree (r = 0.266, P = 0.013).

CONCLUSIONSOn HRCT, cyst-like lung adenocarcinoma may manifest as an air-containing space with septa and mixed thin and thick walls, whereas wall nodule of air-containing space and intratumoral necrosis are not common. There is a certain correlation of HRCT manifestation with pathological subtype grading and tumor differentiation. Analysis of HRCT image features is helpful in prediction of the histopathologic grading and histological differentiation degree of the tumors. Destruction of the alveolar structure by tumor cells may be the main pathological basis of air-containing space formation in cyst-liked lung adenocarcinoma.

Adenocarcinoma ; complications ; diagnostic imaging ; pathology ; Adult ; Aged ; Aged, 80 and over ; Cysts ; complications ; diagnostic imaging ; pathology ; Female ; Humans ; Lung Diseases ; complications ; diagnostic imaging ; pathology ; Lung Neoplasms ; complications ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; methods

OBJECTIVETo report the results of low-dose computed tomography (LDCT) screening for early lung cancer in 4 690 asymptomatic participants at the Cancer Hospital, Chinese Academy of Medical Sciences between July 2007 and June 2012.

METHODSAfter informed consent and questionnaire forms were obtained, 4 690 asymptomatic participants ≥ 40 years underwent chest low dose spiral CT scanning. According to the National Comprehensive Cancer Network (NCCN) guideline for lung cancer screening (version 1.1, 2012), all participants were assigned to three groups, namely high-risk, moderate-risk and low-risk groups. In terms of gender, smoking history and second-hand tobacco smoking exposure history, two other groups named male and female never-smoker groups who were exposed to second-hand tobacco smoking were designated. The positive results were identified as at least one solid or part-solid nodule measuring ≥ 5 mm, or non-solid nodule ≥ 8 mm in diameter. LDCT scanning protocol, criteria of management according to the size and consistency of pulmonary nodules were compliant with the International Early Lung Cancer Active Program (I-ELCAP). TNM staging of all lung cancers were based on the clinical evidence and pathological findings.

RESULTSIn various risk status group of the participants, the percentage of positive results of baseline CT were 27.0% (86/319), 19.3% (199/1 029) and 11.3% (377/3 342), respectively. A total of 26 participants (27 lesions) were diagnosed as lung cancer (11 in men, 15 in women). The detection rate of lung cancer was 0.6% (26/4 690). Besides a SCLC (limited-disease, LD), 25 cases (76.0%) were stage I including 24 NSCLC and one cacinoid on baseline LDCT and the surgical resection rate was 88.5% (23/26). The diameter of resected cancers was 6.9-29.5 mm (median, 16.3 mm). For female never smokers aged 40 years or older who were exposed to second-hand smoking, the detection rate of lung cancer was higher than that of the high-risk and male never smokers who were exposed to second-hand smoking (1.4% vs. 0.9%, 0.4%).

CONCLUSIONSThe results indicate that LDCT can detect small lung cancers and most of the cancers are detected at an early stage. Emphasis should be placed on the non-smoking female individuals who are exposed to second-hand smoking in China.

Carcinoma, Non-Small-Cell Lung ; diagnosis ; epidemiology ; China ; Early Detection of Cancer ; Female ; Humans ; Lung Neoplasms ; diagnosis ; epidemiology ; Male ; Mass Screening ; Neoplasm Staging ; Prevalence ; Risk Factors ; Smoking ; epidemiology ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

OBJECTIVETo investigate the feasibility of differentiation of lymphoma, metastatic lymph nodes of squamous cell carcinoma (SCC) and papillary thyroid carcinoma (PTC) in the head and neck by single-source dual-energy spectral CT.

METHODS25 cases of non-Hodgkin lymphoma (NHL) with 236 lymph nodes, 3 cases of Hodgkin's lymphoma (HL) with 32 lymph nodes, 21 cases of SCC with 86 lymph nodes and 19 cases of PTC with 92 lymph nodes were evaluated by enhanced GSI. CT attenuation of lymph nodes in the monochromatic images at different keV levels and the iodine and water contents of these lymph nodes were measured. The slope of spectral curve was calculated using CT value at 40 keVand 90 keV. All results were analyzed with ANOVA and t test.

RESULTS70 keV had the best single energy images. Normalized Hounsfield unit (NHU) of diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), T lymphoblastic lymphoma (T-LBL), HL, PTC and SCC was 0.32 ± 0.10, 0.46 ± 0.08, 0.41 ± 0.11, 0.41 ± 0.11, 0.56 ± 0.15 and 0.34 ± 0.16, respectively. Normalized iodine concentration (NIC) of them was 0.20 ± 0.08, 0.32 ± 0.08, 0.25 ± 0.09, 0.30 ± 0.12, 0.49 ± 0.18 and 0.23 ± 0.18, respectively. The slope of spectral curve (k) of them was -1.92 ± 0.55, -2.45 ± 0.60, -1.82 ± 0.57, -2.57 ± 0.54, -5.44 ± 2.41 and -1.97 ± 0.81, respectively. Compared with the NHU, there was a statistically significant difference in each pair except DLBCL and SCC, and T-LBL and HL. Compared with the NIC, there was a statistically significant difference in each pair except DLBCL and SCC, FL and HL, T-LBL and SCC, and T-LBL and HL. Compared with the slope of spectral curve, there was statistically significant difference in each pair except DLBCL and T-LBL, DLBCL and SCC, FL and HL, and T-LBL and SCC.

CONCLUSIONSMalignant lymph nodes of different types of diseases have certain different values of quantitative parameters in spectral CT imaging. By using CT attenuation, the shape and slope of spectral curve and the iodine content, single-source dual-energy CT may potentially provide a quantitative analysis tool for the diagnosis and differential diagnosis of lymph node alterations.

Carcinoma ; diagnostic imaging ; Carcinoma, Papillary ; Carcinoma, Squamous Cell ; diagnostic imaging ; Diagnosis, Differential ; Head and Neck Neoplasms ; diagnostic imaging ; Hodgkin Disease ; diagnostic imaging ; Humans ; Lymph Nodes ; diagnostic imaging ; Lymphoma ; diagnostic imaging ; Lymphoma, Follicular ; diagnostic imaging ; Lymphoma, Large B-Cell, Diffuse ; diagnostic imaging ; Lymphoma, Non-Hodgkin ; diagnostic imaging ; Neck ; Thyroid Neoplasms ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVETo assess the relationship between preoperative maximum standardized uptake value (SUVmax) measured on (18)F-FDG PET-CT and clinicopathologic parameters in patients with surgically resected non-small cell lung cancer (NSCLC).

METHODSA total of 540 patients (348 men and 192 women, mean age 60 ± 10 years) with histologically proven non-small cell lung cancer, who had undergone both preoperative (18)F-FDG PET-CT imaging and curative surgery in our institution from October 2006 to January 2013, were analyzed retrospectively in this study. Primary tumor (18)F-FDG uptake, measured as SUVmax corrected for lean body mass, was compared among different variables and correlated with tumor size, histologic grade and postoperative pathologic TNM stage. Histologic grade was categorized into three degrees, where grade I represents highly, grade II moderately and grade III poorly differentiated. Large cell carcinomas were all assessed as poorly differentiated (grade III). Pathologic stage was assigned according to the seventh AJCC TNM staging system.

RESULTSThere were 344 adenocarcinomas (AC, non- BAC type), 146 squamous cell carcinomas (SCC), 28 bronchioloalveolar carcinomas (BAC), 10 adenosquamous carcinomas (ASC) and 12 other type carcinomas (OTC, including 6 large cell carcinomas, 5 sarcomatoid carcinomas and 1 lymphoepitheloid carcinoma); the SUVmax in ascending order was BAC (1.3 ± 1.1), AC (5.1 ± 3.4), ASC (8.5 ± 2.8), SCC (9.9 ± 4.6) and OTC (10.9 ± 5.1), respectively. There were 76 grade I, 251 grade II and 213 grade III; the SUVmax in ascending order was grade I (2.4 ± 2.2), grade II(5.9 ± 3.9), grade III (8.4 ± 4.4), respectively, and significant difference was identified among grade I, grade II and grade III (all P < 0.01). The SUV max was positively correlated with tumor size (r = 0.564, P < 0.01), histologic grade (r = 0.492, P < 0.01), T stage (r = 0.306, P < 0.01), N stage (r = 0.368, P < 0.01), and TNM stage (r = 0.437, P < 0.01).

CONCLUSIONSThe preoperative SUV max of the primary tumor differed significantly among histologic types in NSCLC. There were positive correlations between SUV max and tumor size, histologic grade and pathologic stage. Our findings may suggest that a high SUVmax could be used to identify a high-risk population who would benefit most from adjuvant therapies.

Adenocarcinoma ; diagnosis ; pathology ; Adenocarcinoma, Bronchiolo-Alveolar ; diagnosis ; pathology ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; diagnosis ; pathology ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lung Neoplasms ; diagnosis ; pathology ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Positron-Emission Tomography ; Retrospective Studies ; Tomography, X-Ray Computed ; Tumor Burden