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KMID : 0880420190200030513
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Korean Journal of Radiology
2019 Volume.20 No. 3 p.513 ~ p.521
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Solitary Nodular Invasive Mucinous Adenocarcinoma of the Lung: Imaging Diagnosis Using the Morphologic-Metabolic Dissociation Sign
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Cha Min-Jae
Lee Kyung-Soo
Kim Tae-Jung
Kim Hyun-Su
Kim Tae-Sung
Chung Myung-Jin
Kim Byung-Tae
Kim Yang-Soo
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Abstract
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Objective: To evaluate the efficacy of the morphologic-metabolic (M-M) dissociation sign based on computed tomography (CT) and fluorine-18-fluorodeoxyglucose positron emission tomography (PET)/CT in discriminating invasive mucinous adenocarcinoma (IMA) from invasive non-mucinous adenocarcinomas (ADCs) of the lung.
Materials and Methods: The Institutional Review Board approved this retrospective study. Among surgically resected solitary pulmonary nodule (SPN)-type ADCs (< 3 cm in diameter), 35 patients with IMAs and 329 with invasive non-mucinous ADCs were included. Morphologic malignancy was established if the tumor with lobulated or spiculated margin on CT presented a tumor shadow disappearance rate of < 0.5. The M-M dissociation sign was determined when a malignant-morphologic nodule on CT showed maximum standardized uptake value (SUVmax) < 3.5 on PET/CT.
Results: Among 35 IMAs (size: 21 ± 7 mm, SUVmax: 1.8 ± 2.0) and 329 invasive non-mucinous ADCs (size: 21 ± 6 mm, SUVmax: 4.6 ± 4.2), the M-M dissociation sign was observed in 54% of IMAs (19/35) and 10% of invasive non-mucinous ADCs (34/329) (p < 0.001). The diagnostic performance of the sign in discriminating IMA from invasive non-mucinous ADCs showed a sensitivity of 54.3% (95% confidence interval [CI], 36.7?71.2), specificity 89.7% (95% CI, 85.9?92.7), positive predictive value 35.8% (95% CI, 26.5?46.5), and negative predictive value 94.9% (95% CI, 92.8?96.4). Multivariate analyses revealed metabolic benignity (odds ratio [OR] 2.99; 95% CI, 1.01?8.93; p = 0.047) and M-M dissociation sign (OR 6.35; 95% CI, 2.76?14.62; p < 0.001) to be significant predictors of SPN-type IMAs.
Conclusion: Identification of the absence of M-M dissociation sign is an accurate indicator for excluding IMA from SPN-type lung ADCs.
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KEYWORD
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Lung, Invasive mucinous adenocarcinoma, Dissociation, CT, PET/CT
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