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Do Hemodynamic Studies of Stage T1 Lung Cancer Enable the Prediction of Hilar or Mediastinal Nodal Metastasis?

¹ Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
² Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
³ Biostatistics Unit, Samsung Medical Center, Seoul, Korea.

OBJECTIVE. We aimed to identify CT enhancement characteristics that predict hilar or mediastinal nodal metastasis in patients with stage T1 lung cancer.

SUBJECTS AND METHODS. Eighty-four patients (50 men and 34 women; age range, 39-80 years; mean age, 61 years) with stage T1 lung cancer underwent a hemodynamic and a conventional morphologic CT study before curative surgical resection. Peak enhancement (maximum attenuation over the entire time course), net enhancement (peak enhancement minus preenhancement attenuation), maximum enhancement ratio (MER), time to peak enhancement, slope of enhancement on dynamic studies, nodule size, presence of tumor necrosis or thickening of bronchovascular bundles, and marginal characteristics on morphologic studies were analyzed and correlated with the presence of histologically determined mediastinal or hilar nodal metastasis.

RESULTS. Mediastinal or hilar nodal metastases were found at surgery in 26 (31%) of 84 patients: mediastinal nodes in 13 (15%) and hilar nodes in 19 (23%). Six (7%) had both mediastinal and hilar nodal metastasis. Peak enhancement, net enhancement, and MER were significantly associated (p = 0.001, 0.002, and 0.008, respectively) with the presence of mediastinal or hilar nodal metastasis. A peak attenuation of 110 H or greater and a net enhancement of 60 H or greater predicted nodal metastasis with accuracies of 73% (61/84 nodules) and 73% (61/84 nodules) and odd ratios of 4.98 and 5.94, respectively.

CONCLUSION. Stage T1 lung cancers showing peak enhancement of 110 H or greater or net enhancement of 60 H or greater on dynamic CT indicate a high likelihood of hilar or mediastinal nodal metastasis.

Keywords: chest imaging • CT • hemodynamic studies • lung • lung cancer • metastasis • oncology

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