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Does CT of Thymic Epithelial Tumors Enable Us to Differentiate Histologic Subtypes and Predict Prognosis?

¹ Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, South Korea.
² Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
³ Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea.

OBJECTIVE. The aims of our study were to describe the CT findings of thymic epithelial tumors and to correlate these findings with the histopathologic subtypes and prognosis.

MATERIALS AND METHODS. The CT findings of thymic epithelial tumors were analyzed in 91 patients who had undergone surgery between May 1995 and June 2002. Two observers, who were unaware of the histopathologic classification made in accordance with World Health Organization (WHO) recommendations and the prognosis of the tumors, retrospectively reviewed the initial CT findings in terms of the contours and shapes of the tumors and the presence of necrosis, calcification, mediastinal fat or great vessel invasion, pleural seeding, contrast enhancement, and lymph node enlargement. These findings were compared with the simplified subgroups of WHO histologic classification (low-risk thymomas [types A, AB, and B1], high-risk thymomas [types B2 and B3], and thymic carcinomas [type C]) and with postoperative recurrence.

RESULTS. The study found 31 low-risk thymomas (eight type A, 16 type AB, and seven type B1 tumors), 45 high-risk thymomas (25 type B2 and 20 type B3), and 15 thymic carcinomas (type C). Lobulated contour was more often seen in high-risk thymomas (26/45, 58%; p = 0.0456) and thymic carcinomas (10/15, 67%; p = 0.033) than in low-risk thymomas (9/31, 29%). Mediastinal fat invasion was more often seen in thymic carcinomas (5/15, 33%; p = 0.0133) than in low-risk thymomas (1/31, 3%). Great vessel invasion was seen only in thymic carcinomas (2/15, 13%; p = 0.0244). Tumors with a lobulated or irregular contour, an oval shape, mediastinal fat or great vessel invasion, and pleural seeding showed significantly more frequent recurrence and metastasis (all, p < 0.05).

CONCLUSION. Although CT is of limited value in differentiating histologic subtypes according to the WHO classification, CT findings may serve as predictors of postoperative recurrence or metastasis for the thymic epithelial tumors.

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