Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
STAGING –
MONDAY, DECEMBER 5, 2016
P1.03-078 SIZE MATTERS...BUT DON’T UNDERESTIMATE THE
POWER OF MORPHOLOGY
Annemie Snoeckx 1 , Damien Desbuquoit 1 , Maarten Spinhoven 1 , Annelies
Janssens 2 , Patrick Lauwers 3 , Michèle De Waele 3 , Christel De Pooter 4 , Patrick
Pauwels 5 , Jan Van Meerbeeck 6 , Paul Parizel 1
1 Department of Radiology, Antwerp University Hospital and University of Antwerp,
Edegem/Belgium, 2 Department of Thoracic Oncology, Antwerp University Hospital
and University of Antwerp, Edegem/Belgium, 3 Department of Thoracic and Vascular
Surgery, Antwerp University Hospital and University of Antwerp, Edegem/Belgium,
4 Departement of Radiotherapy, Gza Hospital Sint-Augustinus, Wilrijk/Belgium,
5 Department of Pathology, Antwerp University Hospital and University of Antwerp,
Edegem/Belgium, 6 Thoracic Oncology, University Hospital of Antwerp, Edegem/
Belgium
Background: The detection of solitary pulmonary nodules has increased
due to the widespread use of Computed Tomography (CT) and will increase
even more in the future when lung cancer screening will be embedded in
daily practice. In addition to the clinical information, size is one of the most
important parameters to assess the likelihood of malignancy. Although there
is a considerable overlap in imaging characteristics of benign and malignant
solitary pulmonary nodules, the power of morphology –even in small nodulesshould
not be underestimated. The aim of this pictorial essay is to give an
overview of the wide range of morphologic characteristics and to address
the available evidence on sensitivity and specificity of these characteristics.
Methods: Cases presented were collected during the Multidisciplinary Thoracic
Oncology Tumor Board between January 2014 and May 2016. All malignant
cases have histopathologic proof, whereas benign lesions were included when
the benign nature was suggested after follow-up, negative PET-scan and/or
multidisciplinary consensus. Results: With regard to margin characteristics,
spiculation is highly suggestive of a malignant nature. It is the only feature that
is incorporated as ‘morphologic’ variable in most risk prediction models. Other
features however may also be strong indicators of malignancy. Lobulation,
halo sign, pleural indentation, vascular convergence sign and pitfall sign
are frequently encountered in malignant nodules. The nodule-bronchus
relationship can give additional information regarding the nature of the
nodule, with signs such as air bronchogram, bubble like lucencies and bronchus
cutoff sign being indicative of a malignant nature. In cavitated nodules, a
very thin wall might indicate a benign cause, whereas a very thick wall is more
common in malignant nodules. Calcification is typically seen in benign nodules,
but depending on the calcification pattern a malignant etiology cannot be
excluded. The presence of fat is a relative reliable sign of benignity. Thinsection
CT will enable detection of subtle findings. Nodules rarely present with
only one characteristic and combination of findings can definitely increase
the likelihood of a correct diagnosis. Conclusion: The management of solitary
pulmonary nodules involves both clinical and imaging assessment. Although a
great overlap exists in morphologic features of benign and malignant nodules,
thorough knowledge and recognition of subtle morphologic findings will aid in
early detection of nodules with a high likelihood of malignancy and will avoid
unnecessary follow-up and delay in diagnosis and treatment.
Keywords: morphology, lung cancer, solitary pulmonary nodule, computed
tomography
well as lesion features were collected. Descriptive statistics were tabulated
and chi-square statistical analysis performed. Results: 57.44% of the patients
were female, with average age of 67 years (35-91) and 65.42% had history of
smoking. Lesion size varied from 0.8 cm to 15.6 cm, with average of 3.9 cm.
83.51% were spiculated, 78.72% solid, 12.23% presented intralesional low
attenuation (20% tumor) and if adequate had DNA extracted and sequenced
with a 50-gene multiplex platform (Ion Torrent Personal Genome Machine).
If the material was not adequate for NGS, the requested genes mutation
analyses were performed with SGS. Demographics, procedure technique as
Copyright © 2016 by the International Association for the Study of Lung Cancer
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