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High-Resolution CT Analysis of Small Peripheral Lung Adenocarcinomas Revealed on Screening Helical CT

¹ Department of Radiology, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390 8621, Japan.
² Present address: Azumi General Hospital, Ikeda, Nagano, 399-8695, Japan.
³ Department of Laboratory Medicine, Shinshu University School of Medicine, Asahi, Matsumoto, 390 8621, Japan.

View larger version (86K): [in a new window]   Fig. 1A. —66-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (13 x 13 mm) (type A of Noguchi et al. [11]) in lateral segment of middle lobe of right lung. Low-dose CT scan shows small faint lesion (arrowhead).

View larger version (129K): [in a new window]   Fig. 1B. —66-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (13 x 13 mm) (type A of Noguchi et al. [11]) in lateral segment of middle lobe of right lung. High-resolution CT scan shows nodule of pure ground-glass attenuation (arrowhead) through which small vessels are seen (type I).

View larger version (138K): [in a new window]   Fig. 1C. —66-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (13 x 13 mm) (type A of Noguchi et al. [11]) in lateral segment of middle lobe of right lung. Photomicrograph of histology specimen shows growth of tumor cells in alveolar lining without alveolar collapse (type A). (H and E, x1.25)

View larger version (122K): [in a new window]   Fig. 1D. —66-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (13 x 13 mm) (type A of Noguchi et al. [11]) in lateral segment of middle lobe of right lung. Posteroanterior chest radiograph obtained after B shows no evidence of nodule in middle and lower zones of right lung.

View larger version (85K): [in a new window]   Fig. 2A. —59-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (12 x 13 mm) (type B of Noguchi et al. [11]) in apical segment of upper lobe of right lung. Low-dose CT scan shows small faint nodule (arrowhead).

View larger version (111K): [in a new window]   Fig. 2B. —59-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (12 x 13 mm) (type B of Noguchi et al. [11]) in apical segment of upper lobe of right lung. High-resolution CT scan shows heterogeneous low-attenuation nodule (arrowhead). Small vessels running through tumor are not seen (type II).

View larger version (158K): [in a new window]   Fig. 2C. —59-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (12 x 13 mm) (type B of Noguchi et al. [11]) in apical segment of upper lobe of right lung. Photomicrograph of histology specimen shows growth of tumor cells in alveolar lining with scattered areas of alveolar collapse (type B). (H and E, x1.25)

View larger version (211K): [in a new window]   Fig. 2D. —59-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (12 x 13 mm) (type B of Noguchi et al. [11]) in apical segment of upper lobe of right lung. Photomicrograph of histology specimen with elastica—van Gieson staining of tumor shows thick wavy elastic fibers (grade 3) in alveolar walls and scattered areas of alveolar collapse. (x10)

View larger version (117K): [in a new window]   Fig. 2E. —59-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (12 x 13 mm) (type B of Noguchi et al. [11]) in apical segment of upper lobe of right lung. Posteroanterior chest radiograph obtained after B shows faint opacity in upper zone of right lung (arrowhead).

View larger version (91K): [in a new window]   Fig. 3A. —50-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (16 x 18 mm) (type C of Noguchi et al. [11]) in apical segment of upper lobe of right lung. Low-dose CT scan shows small faint lesion (arrowhead) with central high-density area.

View larger version (119K): [in a new window]   Fig. 3B. —50-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (16 x 18 mm) (type C of Noguchi et al. [11]) in apical segment of upper lobe of right lung. High-resolution CT scan shows ill-defined nodule with high-density central zone (arrow) and ground-glass attenuation in periphery (arrowhead) and convergence of bronchovascular structures from surrounding lung parenchyma (type III).

View larger version (172K): [in a new window]   Fig. 3C. —50-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (16 x 18 mm) (type C of Noguchi et al. [11]) in apical segment of upper lobe of right lung. Photomicrograph of histology specimen shows dense fibrotic tissue, thickened alveolar septa, and collapsed alveoli in central zone (C), as well as tumor cell growth in alveolar lining and deformed alveoli in peripheral zone (P), which corresponds to type C. (H and E, x1.25)

View larger version (188K): [in a new window]   Fig. 3D. —50-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (16 x 18 mm) (type C of Noguchi et al. [11]) in apical segment of upper lobe of right lung. Photomicrograph of histology specimen with elastica—van Gieson staining of tumor shows in increased amount of elastic fibers with disrupted framework caused by tumor invasion in central zone (C). (x2)

View larger version (116K): [in a new window]   Fig. 3E. —50-year-old woman, a nonsmoker, with well-differentiated adenocarcinoma (16 x 18 mm) (type C of Noguchi et al. [11]) in apical segment of upper lobe of right lung. Posteroanterior chest radiograph obtained after B shows no evidence of nodule in upper zone of right lung.

View larger version (95K): [in a new window]   Fig. 4A. —56-year-old man, a smoker, with poorly differentiated adenocarcinoma (16 x 17 mm) (type D of Noguchi et al. [11]) in posterior segment of upper lobe of right lung. Low-dose CT scan shows small nodule (arrow).

View larger version (117K): [in a new window]   Fig. 4B. —56-year-old man, a smoker, with poorly differentiated adenocarcinoma (16 x 17 mm) (type D of Noguchi et al. [11]) in posterior segment of upper lobe of right lung. High-resolution CT scan shows homogeneous nodule of soft-tissue density (type IV) (arrow).

View larger version (156K): [in a new window]   Fig. 4C. —56-year-old man, a smoker, with poorly differentiated adenocarcinoma (16 x 17 mm) (type D of Noguchi et al. [11]) in posterior segment of upper lobe of right lung. Photomicrograph of histology specimen shows solid tumor growth (type D). (H and E, x1.25)

View larger version (126K): [in a new window]   Fig. 4D. —56-year-old man, a smoker, with poorly differentiated adenocarcinoma (16 x 17 mm) (type D of Noguchi et al. [11]) in posterior segment of upper lobe of right lung. Posteroanterior chest radiograph obtained after B shows no evidence of nodule, probably because tumor is concealed by hilar structures.

View larger version (11K): [in a new window]   Fig. 5. —Scattergram shows correlation between CT values and retained air space in adenocarcinomas. Note negative correlation (Pearson's correlation coefficient, r = -0.87, p < 0.001) between density and retained air space of tumor. = type A adenocarcinoma, = type B adenocarcinoma, = type C adenocarcinoma, and = type D adenocarcinoma using the classification of Noguchi et al. [11].

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