Volumetric measurements hold prognostic value for lung adenocarcinoma

Two volumetric measurements are independent indicators associated with an increased likelihood of recurrence or death in patients with stage I adenocarcinoma, according to a study published online April 6 in Radiology.

Though a new method for classifying adenocarcinomas was created in 2011 to standardize diagnostic criteria and terminology, challenges still remain in determining the cancer’s prognosis. Measurements of solid components are crucial in the process because they are associated with a higher likelihood of an invasive tumor.

“However,” wrote lead author Masahiro YanagawaMD, PhD, of Stanford University School of Medicine in California, and colleagues, “ integration of this type of prognostic CT data into clinical management algorithms for adenocarcinoma has been relatively hindered by the lack of standardized methods for tumor characterization and measurement, particularly in the setting of part-solid nodules.”

Volumetric nodule measurement holds promise for quantifying small solid nodules. The researchers performed volumetric analysis of stage I adenocarcinoma through use of an automated computer program. They also sought to discover the value of volumetric CT measurements associated with prognostic factors and patient outcome.

The study included 145 patients with stage I adenocarcinoma who underwent surgery after preoperative chest CT. The automated computer program classified nodules into three groups: pure ground glass, part solid or solid. 

Results revealed that all 22 recurrences were found in patients with nodules classified as part solid or solid. Solid volume of at least 63 percent was an independent indicator associated with pleural invasion. This percentage range also significantly indicated lower disease-free survival.

Solid tumor volume of 1.5 cm3 or greater and percentage of solid volume of 63 percent or greater were significant indicators of decreased overall survival.

“Automated volumetric analysis of early-stage adenocarcinomas can be associated with prognosis and may be helpful in determining appropriate treatment of patients with subsolid nodules,” concluded Yanagawa and colleagues.