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. 2012 Apr;263(1):279-86.
doi: 10.1148/radiol.11101372.

Internal growth of nonsolid lung nodules: radiologic-pathologic correlation

Lijuan Zhang1, David F Yankelevitz, Darryl Carter, Claudia I Henschke, Rowena Yip, Anthony P Reeves
Affiliations
Free PMC article

Internal growth of nonsolid lung nodules: radiologic-pathologic correlation

Lijuan Zhanget al. Radiology. 2012 Apr.
Free PMC article

Abstract

Purpose:To determine whether computed tomographic (CT) attenuation values correlate with the histologic measurements of a lung cancer manifesting as a nonsolid nodule and to quantify the extent to which the tumor replaces the airspace within the nodule.

Materials and methods:Informed consent was obtained to analyze images from CT and pathologic examination under an institutional review board-approved protocol. Fifteen patients who had undergone resection of nonsolid lung cancer were evaluated. On the basis of the CT attenuation values of nonsolid nodules, nonneoplastic lung, soft tissue, and air, the overall proportion of soft tissue in the nodule and nonneoplastic lung and the difference between these two measures were calculated. The analogous measures were obtained from a representative digitized histologic slide. The area of each nodule and the proportion of air within it were measured, and the proportion of soft tissue in the nodule and nonneoplastic lung and the difference between the two were calculated. The difference between the two proportions at CT and histologic examination are the proportions attributable to the cancer on the basis of CT and histologic examinations, respectively. Linear regression was performed to assess the relationship between these measures.

Results:The average proportions of soft tissue in the nodule at CT and histologic examination were 48% and 69%, respectively, and they showed significant correlation with each other (P = .02); in addition, each showed significant correlation with the attenuation of the nodule (P < .0001 and P = .02, respectively). The difference between the proportions of soft tissue in nodule and nonneoplastic lung at CT and histologic examination were 37% and 30%, respectively, and both were independent of the tumor diameter (P = .26 and P = .41).

Conclusion:The proportion of soft tissue within a nonsolid nodule is correlated with attenuation at CT. This allows for measurement of change within the nodule. An increase of 100 HU in nodule attenuation represents an approximately 10% increase in tumor volume.

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Assessment of CT scans. For each nonsolid nodule, a representative scan was used and attenuation (in Hounsfield units) was obtained for four ROIs. For this 12-mm-diameter nodule (nodule 3), attenuation was 2504 HU within nonsolid nodule (DN), 2978 for air in trachea (DA), 2905 HU for nonneoplastic lung (DL), and 58 HU for muscle (DST).
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(a)Digitized image of histologic slide from nodule 3. Tumor border was manually defined as well as a preset ROI over a representative part of nonneoplastic lung tissue (shown for illustrative purposes). (Hematoxylin-eosin stain; original magnification, 340.)(b, c)Automated segmentation was performed to determine areas of air-filled spaces in(b)tumor and(c)nonneoplastic lung..
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(a)Digitized image of histologic slide from nodule 3. Tumor border was manually defined as well as a preset ROI over a representative part of nonneoplastic lung tissue (shown for illustrative purposes). (Hematoxylin-eosin stain; original magnification, 340.)(b, c)Automated segmentation was performed to determine areas of air-filled spaces in(b)tumor and(c)nonneoplastic lung..
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(a)Digitized image of histologic slide from nodule 3. Tumor border was manually defined as well as a preset ROI over a representative part of nonneoplastic lung tissue (shown for illustrative purposes). (Hematoxylin-eosin stain; original magnification, 340.)(b, c)Automated segmentation was performed to determine areas of air-filled spaces in(b)tumor and(c)nonneoplastic lung..
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(a)Graph shows that the proportion of soft tissue in each nodule at CT (PCN,ST, blue dots) (R 2= 0.98,P, .0001) and the difference in the proportion of soft tissue in nonsolid nodules and nonneoplastic lung at CT (PC,DIFF, red dots) (R 2= 0.87,P, .0001) have a significant linear relationship with nodule attenuation (DN). The proportion of soft tissue increases with increasing attenuation.(b)Graph shows that both of these CT measures were independent of tumor diameter (R 2= 0.058,P= .39 andR 2= 0.10,P= .26, respectively).
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(a)Graph shows that the proportion of soft tissue in each nodule at CT (PCN,ST, blue dots) (R 2= 0.98,P, .0001) and the difference in the proportion of soft tissue in nonsolid nodules and nonneoplastic lung at CT (PC,DIFF, red dots) (R 2= 0.87,P, .0001) have a significant linear relationship with nodule attenuation (DN). The proportion of soft tissue increases with increasing attenuation.(b)Graph shows that both of these CT measures were independent of tumor diameter (R 2= 0.058,P= .39 andR 2= 0.10,P= .26, respectively).
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Graph obtained with linear regression analysis shows a significant linear relationship between proportion of soft tissue in nodule at histologic examination (PHN,ST) and at CT (PCN,ST) (R 2= 0.35,P= .02). Dashed lines are 95% confidence intervals.
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Graph obtained with linear regression analysis shows a significant linear relationship between proportion of soft tissue in nodule at histologic examination (PHN,ST) and nodule attenuation (DN) (R 2= 0.34,P= .02). The proportion of soft tissue in nodule at histologic examination increased with increasing attenuation. Dashed lines are 95% confidence intervals.
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