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  • Title: Prognostic significance of using solid versus whole tumor size on high-resolution computed tomography for predicting pathologic malignant grade of tumors in clinical stage IA lung adenocarcinoma: a multicenter study.
    Author: Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, Okada M.
    Journal: J Thorac Cardiovasc Surg; 2012 Mar; 143(3):607-12. PubMed ID: 22104678.
    Abstract:
    OBJECTIVES: The present multicenter study compared the usefulness of the solid tumor size with that of the whole tumor size on preoperative high-resolution computed tomography for predicting pathologic high-grade malignancy (positive lymphatic, vascular, or pleural invasion) and the prognosis of clinical stage IA lung adenocarcinoma. METHODS: We performed high-resolution computed tomography and F-18 fluorodeoxyglucose-positron emission tomography/computed tomography before curative surgical resection in 502 patients with clinical stage IA lung adenocarcinoma. The revised maximum standardized uptake values on F-18 fluorodeoxyglucose-positron emission tomography/computed tomography were used to correct interinstitutional discrepancies. The whole and solid tumor sizes on high-resolution computed tomography were then analyzed in relation to surgical results. RESULTS: The mean whole and solid tumor size was 1.97 ± 0.59 cm and 1.20 ± 0.88 cm, respectively. The receiver operating characteristics area under the curve for the whole and solid tumor sizes used to identify high-grade malignancy were 0.590 and 0.829, respectively. Multiple logistic regression analyses demonstrated solid tumor size (P < .001) and maximum standardized uptake values of the tumor (P < .001) as independent variables for the prediction of high-grade malignancy. Multivariate Cox analysis of disease-free survival demonstrated the former (hazard ratio, 2.30; 95% confidence interval, 1.46-3.63; P < .001) and latter (hazard ratio, 1.08; 95% confidence interval, 1.00-1.17; P = .05) as independent prognostic factors. CONCLUSIONS: The solid tumor size on high-resolution computed tomography and maximum standardized uptake values on positron emission tomography/computed tomography have greater predictive value for high-grade malignancy and prognosis in clinical stage IA lung adenocarcinoma than that of whole tumor size.
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