Noninvasive risk stratification of lung adenocarcinoma using quantitative computed tomography.

Raghunath S, Maldonado F, Rajagopalan S, Karwoski RA, DePew ZS, Bartholmai BJ, Peikert T, Robb RA
J Thorac Oncol. 2014 9 (11): 1698-703

PMID: 25170645 · PMCID: PMC4254143 · DOI:10.1097/JTO.0000000000000319

INTRODUCTION - Lung cancer remains the leading cause of cancer-related deaths in the United States and worldwide. Adenocarcinoma is the most common type of lung cancer and encompasses lesions with widely variable clinical outcomes. In the absence of noninvasive risk stratification, individualized patient management remains challenging. Consequently a subgroup of pulmonary nodules of the lung adenocarcinoma spectrum is likely treated more aggressively than necessary.

METHODS - Consecutive patients with surgically resected pulmonary nodules of the lung adenocarcinoma spectrum (lesion size ≤3 cm, 2006-2009) and available presurgical high-resolution computed tomography (HRCT) imaging were identified at Mayo Clinic Rochester. All cases were classified using an unbiased Computer-Aided Nodule Assessment and Risk Yield (CANARY) approach based on the quantification of presurgical HRCT characteristics. CANARY-based classification was independently correlated to postsurgical progression-free survival.

RESULTS - CANARY analysis of 264 consecutive patients identified three distinct subgroups. Independent comparisons of 5-year disease-free survival (DFS) between these subgroups demonstrated statistically significant differences in 5-year DFS, 100%, 72.7%, and 51.4%, respectively (p = 0.0005).

CONCLUSIONS - Noninvasive CANARY-based risk stratification identifies subgroups of patients with pulmonary nodules of the adenocarcinoma spectrum characterized by distinct clinical outcomes. This technique may ultimately improve the current expert opinion-based approach to the management of these lesions by facilitating individualized patient management.

MeSH Terms (15)

Adenocarcinoma Adenocarcinoma of Lung Adult Aged Aged, 80 and over Female Humans Lung Neoplasms Male Middle Aged Radiographic Image Interpretation, Computer-Assisted Retrospective Studies Risk Assessment Survival Analysis Tomography, X-Ray Computed

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