Objective: Differentiation of bronchioloalveolar carcinoma from other subtypes of lung adenocarcinomas is important in the preoperative assessment of patients. We examined the biologic aggressiveness of small-sized adenocarcinomas according to the pathologically defined bronchioloalveolar carcinoma degree and its correlation with computed tomography findings. In addition, we attempted to predict which patients were suitable for a lesser resection. Methods: Of 424 consecutive patients who underwent operation for primary lung cancer in the last 3 years, 114 with a histopathologically proven adenocarcinoma 3 cm or less in diameter underwent complete removal of the primary tumor. We examined the characteristics of patients classified into 3 groups based on the proportion of the bronchioloalveolar carcinoma component: 0% to 20% (n = 40), 21% to 50% (n = 38), and 51% to 100% (n = 36). We also investigated the correlation of the bronchioloalveolar carcinoma component with computed tomography findings such as ground-glass opacity (defined as a hazy increase on the lung window) and tumor shadow disappearance rate (defined as the ratio of the tumor area of the mediastinal window to that of the lung window). Results: Male gender (P = .0001), advanced pathologic stage (P = .001), larger size of the tumor (P = .004), nodal involvement (P = .04), pleural invasion (P = .0003), lymphatic invasion (P = .002), and vascular invasion (P = .0002) were observed more often among patients with a smaller proportion of bronchioloalveolar carcinoma. A positive and significant correlation was found between the rate of bronchioloalveolar carcinoma component and ground-glass opacity (R2 = 0.488, P < .0001) and tumor shadow disappearance rate (R2 = 0.727, P < .0001). As an independent predictor of nodal status, tumor shadow disappearance rate (P = .015) and bronchioloalveolar carcinoma component (P = .015), as well as tumor size, were significantly valuable, although ground-glass opacity proportion (P = .086) was marginally informative. Conclusions: Small-sized adenocarcinomas with a greater ratio of bronchioloalveolar carcinoma component showed less aggressive behavior. Both tumor shadow disappearance rate and ground-glass opacity ratios, which are obtained preoperatively, were well associated with bronchioloalveolar carcinoma ratios, which are determined postoperatively. Furthermore, tumor shadow disappearance rate had a stronger impact as a predictor of bronchioloalveolar carcinoma component. Preoperative assessment of tumor shadow disappearance rate may be useful to identify patients requiring a less extensive pulmonary resection.
Okada, M., Nishio, W., Sakamoto, T., Uchino, K., Hanioka, K., Ohbayashi, C., & Tsubota, N. (2004). Correlation between computed tomographic findings, bronchioloalveolar carcinoma component, and biologic behavior of small-sized lung adenocarcinomas. Journal of Thoracic and Cardiovascular Surgery, 127(3), 857–861. https://doi.org/10.1016/j.jtcvs.2003.08.048