Correlation between epidermal growth factor receptor mutation and histologic subtypes or characteristics of computed tomography findings in patients with resected pulmonary adenocarcinoma
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To investigate the correlation between epidermal growth factor receptor (EGFR) mutation and the histologic subtypes features or computed tomography (CT) findings in patients with resected pulmonary adenocarcinoma.We retrospectively reviewed 153 patients underwent surgical resected pulmonary adenocarcinoma. EGFR mutations were detected using the amplification refractory mutation system. Histologic subtype was classified according to the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society pulmonary adenocarcinoma classification. Characteristics of CT in the tumor were retrospectively analyzed, and compared to mutation-negative cohort.EGFR mutations were found in 67 (43.79%) cases. The prevalent histologic subtypes of invasive adenocarcinoma were acinar predominant adenocarcinoma (33.99%), papillary predominant adenocarcinoma (24.18%), micropapillary predominant adenocarcinoma (MPA; 18.95%), solid predominant adenocarcinoma (11.76%), and lepidic predominant adenocarcinoma (LPA; 11.11%). EGFR mutations were correlated with the MPA and LPA subtypes (P = 0.009 and P = 0.018) and was correlated with the air bronchograms (P = 0.008). EGFR mutations were independently associated with other CT characteristics including ground-glass opacity/tumor ratio (P = 0.054).Correlation exists between EGFR mutations and histologic subtypes of invasive adenocarcinoma or air bronchograms on CT images, which could use to predict EGFR mutation status in patients with pulmonary adenocarcinoma.Keywords:
Pulmonary adenocarcinoma
Ground-glass opacity
Papillary adenocarcinoma
To investigate the correlation between epidermal growth factor receptor (EGFR) mutation and the histologic subtypes features or computed tomography (CT) findings in patients with resected pulmonary adenocarcinoma.We retrospectively reviewed 153 patients underwent surgical resected pulmonary adenocarcinoma. EGFR mutations were detected using the amplification refractory mutation system. Histologic subtype was classified according to the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society pulmonary adenocarcinoma classification. Characteristics of CT in the tumor were retrospectively analyzed, and compared to mutation-negative cohort.EGFR mutations were found in 67 (43.79%) cases. The prevalent histologic subtypes of invasive adenocarcinoma were acinar predominant adenocarcinoma (33.99%), papillary predominant adenocarcinoma (24.18%), micropapillary predominant adenocarcinoma (MPA; 18.95%), solid predominant adenocarcinoma (11.76%), and lepidic predominant adenocarcinoma (LPA; 11.11%). EGFR mutations were correlated with the MPA and LPA subtypes (P = 0.009 and P = 0.018) and was correlated with the air bronchograms (P = 0.008). EGFR mutations were independently associated with other CT characteristics including ground-glass opacity/tumor ratio (P = 0.054).Correlation exists between EGFR mutations and histologic subtypes of invasive adenocarcinoma or air bronchograms on CT images, which could use to predict EGFR mutation status in patients with pulmonary adenocarcinoma.
Pulmonary adenocarcinoma
Ground-glass opacity
Papillary adenocarcinoma
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Pulmonary adenocarcinoma
Ground-glass opacity
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“Adenocarcinoma, mixed subtype” is the most common histologic subtype of lung adenocarcinomas in the World Health Organization classification of 2004. For small peripheral adenocarcinomas, for example, those measuring 2 cm or less in greatest diameter, invasive areas can present various histologic patterns. The purpose of this study is to present the radiologic features of small peripheral lung adenocarcinomas with or without a bronchioloalveolar component and with or without invasive areas, in comparison with histopathologic findings. For this purpose, a detailed evaluation of the characteristics of solid regions in ground-glass opacity on high-resolution computerized tomographic images of lung adenocarcinoma is useful.
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The purpose of this study was to evaluate the effect of the size and location of lung tumour and the extent of ground-glass opacity (GGO) on thin-section CT for the detection of peripheral lung cancer on chest radiographs. 100 posteroanterior chest radiographs of peripheral lung cancer 20 mm in diameter or smaller were reviewed retrospectively by two chest radiologists individually. Lung cancer was detectable on chest radiographs in 51 (51%) cases. However, in six cases, the tumour was recognized not as a nodular opacity but as a subpleural linear or localized hazy opacity. The median size of detectable lung cancer (17 mm) was larger than that of undetectable lung cancer (14 mm; p<0.001). The frequency of tumours with extent of GGO less than 70% was 94% in detectable cases and 59% in undetectable cases (p<0.001). The frequency of tumours located in unobscured lung was 94% in detectable cases and 59% in undetectable cases (p<0.001). The detectability of peripheral lung cancer on chest radiographs is influenced by tumour size, location and extent of GGO seen on thin-section CT. It should also be noted that some tumours may not be recognized as a nodular opacity even if they are detectable.
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Ground-glass opacity
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Ground-glass opacity
High-resolution computed tomography
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To identify epidermal growth factor receptor (EGFR) mutation status between different lesions in lung adenocarcinoma presenting as multiple ground-glass opacity (GGO) lesions and analyse its association with clinical characteristics.Seventy-eight patients with lung adenocarcinoma presenting as multiple GGO lesions were identified to investigate EGFR mutation in exon 18-21. Lesions with the largest size in diameter were defined as the primary lesions; the others were defined as the secondary lesions. One hundred and fifty-nine lesions of these patients were classified into pure GGO and mixed GGO by computed tomography scan images.The EGFR mutation rate in the patients was 48.7% (38 of 78). Patients with high frequency of EGFR mutation were females and non-smokers. The EGFR mutation rate of invasive adenocarcinoma was higher than that of atypical adenomatous hyperplasia/adenocarcinoma in situ and minimally invasive adenocarcinoma (P = 0.001). Although 19-deletion and L858R were the most common EGFR mutations, there was no difference of EGFR mutation in pathological subtypes of adenocarcinoma. Of the 38 paired lesions in patients harbouring EGFR mutation, the discordance rate of EGFR mutation was 92.1%.The study showed different EGFR mutational profiles in multiple GGO lesions, suggesting that lesions seem to arise as independent events. It would offer useful information for determining the appropriate treatment strategy for lung adenocarcinoma presenting as multiple GGO lesions.
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Lung cancer remains a major cause of cancer mortality with a 5-year survival in advanced stages around 4%. Platinum-based chemotherapy was routinely used as the standard of care in patients with advanced nonsmall cell lung cancer, but it is being progressively replaced by targeted molecular therapy. One of the molecular aberrations harbored by lung adenocarcinoma is the epidermal growth factor receptor (EGFR). A large ethnic variation has been reported in the prevalence of EGFR mutations in patients with lung adenocarcinoma. Data regarding its prevalence from the Middle East area remains limited. This paper aims at reviewing the data available for the prevalence of this mutation in the Middle Eastern patient population and comparing it with other reported series.
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With the widespread use of multi-slice spiral computed tomography(CT) and the increasing level of diagnosis and treatment, the incidence of pulmonary ground glass opacity(GGO)is increasing. The etiology of GGO is complex and the pathological types are diverse. In addition to benign lesions, GGO can be a specific type of lung adenocarcinoma or its invasive lesions. Some scholars think it is closely related to early lung adenocarcinoma. Histopathology of lung cancer is crucial for the prognosis and treatment of lung cancer. However, under normal circumstances, the pathology of the patient can be known by surgery, bronchoscopy or puncture. However, many patients may not have the pathological conditions for obtaining the pathological specimen. CT as the primary method of diagnosis of lung adenocarcinoma, lung adenocarcinoma in the new classification, based on the lung GGO CT findings to determine its ability to provide a characteristic indicator of tumor histopathology in order to help GGO diagnosis and guidance of clinical treatment.
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We report two autopsy cases of primary pulmonary adenocarcinoma associated with unusual pleural spread. Both patients had confirmed history of asbestos exposure. In the first patient the tumor was localized in one pulmonary lobe with marked infiltration into pleura, chest wall and diaphragm. In the second patient the entire right lung was covered by irregularly thickened tumor. Both tumors were mainly located in the extrapulmonary area and the intrapulmonary portions represented only minor components. Histologically, tumor cells demonstrated glandular and papillary growth patterns associated with focal hobnail-like features. Immunohistochemical evaluation revealed diffuse and marked immunoreactivity of TTF-1, CEA, CD15 and MOC31 in both cases, while calretinin, CK5/6, vimentin, thrombomodulin and HBME-1 were broadly positive in one case. D2-40 was not detected in either case. Examination using electron microscopy revealed the presence of sparse and short microvilli in tumor cells. All of the above findings are consistent with adenocarcinoma of the lung. Primary adenocarcinoma with a characteristic pleural extention grossly resembling malignant mesothelioma has been previously reported in the literature as pseudomesotheliomatous adenocarcinoma. This is the first report of pseudomesotheliomatous adenocarcinoma displaying variable immunoprofile with a diagnosis using electron microscopical examination. Additionally, we performed quantitative analysis of asbestos bodies in pseudomesotheliomatous adenocarcinoma.
Calretinin
Papillary adenocarcinoma
Pulmonary adenocarcinoma
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