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    P2.05 - Interventional Diagnostic/Pulmonology (ID 168)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.05-03 - Tumor Atelectasis Gives Rise to Solid Appearance in Pulmonary Adenocarcinomas (ID 758)

      10:15 - 18:15  |  Author(s): Chris Dickhoff

      • Abstract
      • Slides

      Background

      Ground glass opacities (GGO) on CT scan, if malignant, correlate with adenocarcinoma in situ in histology. Solid appearance on HRCT, either ground glass nodule (GGN) or a solid nodule (SN), is considered to be invasive carcinoma. Histological recognition of invasion in pulmonary adenocarcinoma revealed low kappa scores among expert pathologists. A likely explanation is that morphological collapse is not taken into account in the WHO lung cancer classification.

      This study aims to compare radiological features in HRCT and histological features of primary adenocarcinomas in resection specimen for the presence of collapse.

      Method

      Patients with primary adenocarcinoma in the lung, resected between November 2016 and November 2018, were selected. HRCT scans and CT-PET imaging were evaluated for GGO, GGN , and SN. For pathology diagnosis the 2015 WHO classification was used. Both evaluations were blinded for other information. Lepidic growth pattern with collapse was considered if reduction of air in the histological section was present, while underlying pulmonary architecture was maintained (organoid pattern without invasion).

      Result

      In total 47 lesions of 41 patients were evaluated. The number of GGO, GGN and solid nodules was 2, 8 and 37, respectively. Lepidic growth pattern with collapse was present in both GGO lesions, 7 out of 8 (88%) GGN lesions and 24 out of 37 (65%) solid lesions.

      Remarkably, pre-existing pulmonary architecture with air spaces between alveoli covered with epithelial tumor cells (lepidic pattern) can be detected in over 50% of the adenocarcinomas with solid appearance on HRCT. This can only be explained by tumor related atelectasis (collapse) in vivo.

      Conclusion

      Tumor related atelectasis is a frequent finding in pulmonary adenocarcinomas and may be a feature in a solid appearance on HRCT. Therefore, a solid appearance on HRCT cannot be solely attributed to invasion, as has been the assumption until now.

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