Radiological-pathological correlation of subsolid pulmonary nodules: A single centre retrospective evaluation of the 2011 IASLC adenocarcinoma classification system

•Any solid component within a resected pulmonary nodule is suspicious for invasive adenocarcinoma.•The suspicion of invasive adenocarcinoma rises with increasing solid component on CT.•Multiple solid components within a part-solid nodule leads to variability in classification.•Scar and stromal colla...

Full description

Saved in:
Bibliographic Details
Published in:Lung cancer (Amsterdam, Netherlands) Netherlands), 2020-09, Vol.147, p.39-44
Main Authors: Roberts, James M., Greenlaw, Kristin, English, John C., Mayo, John R., Sedlic, Anto
Format: Article
Language:English
Subjects:
Adenocarcinoma
Computed tomography
Part-solid
Pathology
Radiology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:•Any solid component within a resected pulmonary nodule is suspicious for invasive adenocarcinoma.•The suspicion of invasive adenocarcinoma rises with increasing solid component on CT.•Multiple solid components within a part-solid nodule leads to variability in classification.•Scar and stromal collapse within a nodule can cause radiologists to overestimate cancer invasion.•Discordant radiology and pathology interpretations are common in part-solid pulmonary nodules. The 2011 IASLC classification system proposes guidelines for radiologists and pathologists to classify adenocarcinomas spectrum lesions as preinvasive, minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IA). IA portends the worst clinical prognosis, and the imaging distinction between MIA and IA is controversial. Subsolid pulmonary nodules resected by microcoil localization over a three-year period were retrospectively reviewed by three chest radiologists and a pulmonary pathologist. Nodules were classified radiologically based on preoperative computed tomography (CT), with the solid nodule component measured on mediastinal windows applied to high-frequency lung kernel reconstructions, and pathologically according to 2011 IASLC criteria. Radiology interobserver and radiological-pathological variability of nodule classification, and potential reasons for nodule classification discordance were assessed. Seventy-one subsolid nodules in 67 patients were included. The average size of invasive disease focus at histopathology was 5 mm (standard deviation 5 mm). Radiology interobserver agreement of nodule classification was good (Cohen’s Kappa = 0.604, 95 % CI: 0.447 to 0.761). Agreement between consensus radiological interpretation and pathological category was fair (Cohen’s Kappa = 0.236, 95 % CI: 0.054−0.421). Radiological and pathological nodule classification were concordant in 52 % (37 of 71) of nodules. The IASLC proposed CT solid component cut-off of 5 mm to distinguish MIA and IA yielded a sensitivity of 59 % and specificity of 80 %. Common reasons for nodule classification discordance included multiple solid components within a nodule on CT, scar and stromal collapse at pathology, and measurement variability. Solid component(s) within persistent part-solid pulmonary nodules raise suspicion for invasive adenocarcinoma. Preoperative imaging classification is frequently discordant from final pathology, reflecting interpretive and technical challenges in radiological and patholo
ISSN:0169-5002
1872-8332
DOI:10.1016/j.lungcan.2020.06.031