Nomair Issa1, Elias Arfanis1, Thomas Hager2, Clemens Aigner1, Sarah Dietz-Terjung1, Dirk Theegarten2, Hilmar Kühl3, Stefan Welter4. 1. Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany. 2. Institute of Pathology, University Clinic Essen, University of Duisburg-Essen, Essen, Germany. 3. Department of Radiology, St. Bernhard-Hospital, Kamp-Lintfort, Germany. 4. Department of Thoracic Surgery, Lung Clinic Hemer, Hemer, Germany.
Abstract
BACKGROUND: The histologic presence of aggressive local growth of pulmonary metastases is associated with an increased risk for local intrapulmonary recurrence after enucleation or wedge resection. Patient tailored resection planning is possible when morphologic pattern of aggressive growth could be identified based on preoperative CT scans. METHODS: Radiomorphology and microscopic growth characteristics from 232 pulmonary metastases from 87 patients were prospectively compared for the presence or absence of aggressive patterns of local intrapulmonary dissemination. RESULTS: Microscopic aggressive local growth was found: pleural involvement (18.5%), lymphatic invasion (6.9%), vascular invasion (7.3%), interstitial growth (38.4%), micro satellite nodules (24.5%), spread through air spaces (STAS) (13.4%), and a smooth, slightly blurred or irregular surface in 34.1%, 43.1% and 22.8%. The radiologic margin demarcation was smooth in 37.1%, blurred in 27.6% or irregular in 35.3% and spiculae were present in 26.3% of the lesions. The microscopic and radiologic description of the metastasis surface correlated well [correlation coefficient (CC) =0.75, P<0.001]. A smooth surface on CT scan corresponded with a smooth microscopic surface in 72/86 (83.7%) of the lesions. The radiomorphologic feature of an irregular or cloudy surface was highly associated with the presence of at least one aggressive pattern of local dissemination (P<0.001). The presence of spiculae on CT scan was well associated with the presence of aggressive local spread (P<0.001) and the microscopic features corresponding with spiculae were interstitial growth, STAS and L1. CONCLUSIONS: Radiomorphologic characteristics of lung metastases correspond well with the microscopic appearance of the resected lesion. Therefore it seems possible to adjust safety margins based on the radiologic appearance of the metastasis.
BACKGROUND: The histologic presence of aggressive local growth of pulmonary metastases is associated with an increased risk for local intrapulmonary recurrence after enucleation or wedge resection. Patient tailored resection planning is possible when morphologic pattern of aggressive growth could be identified based on preoperative CT scans. METHODS: Radiomorphology and microscopic growth characteristics from 232 pulmonary metastases from 87 patients were prospectively compared for the presence or absence of aggressive patterns of local intrapulmonary dissemination. RESULTS: Microscopic aggressive local growth was found: pleural involvement (18.5%), lymphatic invasion (6.9%), vascular invasion (7.3%), interstitial growth (38.4%), micro satellite nodules (24.5%), spread through air spaces (STAS) (13.4%), and a smooth, slightly blurred or irregular surface in 34.1%, 43.1% and 22.8%. The radiologic margin demarcation was smooth in 37.1%, blurred in 27.6% or irregular in 35.3% and spiculae were present in 26.3% of the lesions. The microscopic and radiologic description of the metastasis surface correlated well [correlation coefficient (CC) =0.75, P<0.001]. A smooth surface on CT scan corresponded with a smooth microscopic surface in 72/86 (83.7%) of the lesions. The radiomorphologic feature of an irregular or cloudy surface was highly associated with the presence of at least one aggressive pattern of local dissemination (P<0.001). The presence of spiculae on CT scan was well associated with the presence of aggressive local spread (P<0.001) and the microscopic features corresponding with spiculae were interstitial growth, STAS and L1. CONCLUSIONS: Radiomorphologic characteristics of lung metastases correspond well with the microscopic appearance of the resected lesion. Therefore it seems possible to adjust safety margins based on the radiologic appearance of the metastasis.
Authors: Stefan Welter; Elias Arfanis; Daniel Christoph; Thomas Hager; Christian Roesel; Clemens Aigner; Gerhard Weinreich; Dirk Theegarten Journal: Eur J Cardiothorac Surg Date: 2017-07-01 Impact factor: 4.191
Authors: Stefan Welter; Florian Grabellus; Sebastian Bauer; Kurt Werner Schmid; Georgios Stamatis; Martin Tötsch Journal: Virchows Arch Date: 2011-07-06 Impact factor: 4.064
Authors: Kyuichi Kadota; Jun-Ichi Nitadori; Camelia S Sima; Hideki Ujiie; Nabil P Rizk; David R Jones; Prasad S Adusumilli; William D Travis Journal: J Thorac Oncol Date: 2015-05 Impact factor: 15.609
Authors: Mathieu Lederlin; Michael Puderbach; Thomas Muley; Philipp A Schnabel; Albrecht Stenzinger; Hans-Ulrich Kauczor; Claus Peter Heussel; Felix J F Herth; Hans Hoffmann; Hendrik Dienemann; Wilko Weichert; Arne Warth Journal: Eur Respir J Date: 2012-07-26 Impact factor: 16.671