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

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 (R² = 0.245) was less correlated with the bronchioloalveolar carcinoma ratio than was the ground-glass opacity ratio (R² = 0.554) and tumor shadow disappearance rate (R² = 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.

CTSNet classification: 10

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