Analysis Of CT Findings And Pathological Correlation Of Primary Lung Invasive Mucinous Adenocarcinoma

PartⅠAnalysis of CT and pathological features of primary lung invasive mucinous adenocarcinoma 【Objective】To investigate the CT features and related pathological features in primary lung invasive mucinous adenocarcinoma(PIMA),and improve understanding of the disease as well as diagnostic accuracy.【Materials and Methods】63 cases of pathologically confirmed PIMA were analyzed retrospectively.All patients were examined by CT.On the basis of imaging manifestation,63 cases of PIMA were divided into three types: nodule or mass type,pneumonia-like consolidation type and mixed type.【Results】The image findings of the 63 cases of PIMAs included: nodule or mass type in 48 cases,pneumonia-like consolidation type in 12 cases,mixed type in 2 cases.The CT plain densities of 63 cases were lower than that of the muscle at the same level.51 cases performed CT enhancement scanning,there were 39 cases with mildly enhanced,12 cases with moderate enhancement.Smooth edge in 17 cases,coarse edge in 38 cases,and blurred edge in 8 cases.Lobulation sign in 27 cases,spiculation sign in 15 cases,vacuole sign in 27 cases,air bronchogram in 16 cases,calcification in 3 cases,angiogram sign in 6 cases,cystic airspaces in 18 cases.Ground glass opacity(GGO)in 26 cases,thickening of the bronchovascular bundle in 4 cases,pleural indentation sign in 13 cases,vessel convergence sign in 10 cases,emphysema in 5 cases,obstructive pneumonia or pulmonary atelectasis in 4 cases,bronchial truncation in 6 cases,and a little pleural effusion in 1 case.【Conclusion】PIMA is mainly distributed in the lower lobes of lung.The nodule or mass type is more common.The lobulation sign,vacuole sign and air bronchogram sign are more common,and the density of CT plain scanning is often lower than muscle,CT enhancement scanning shows mild to moderate enhancement,these characteristics could contribute to the diagnosis of PIMA.PartⅡPrimary lung invasive mucinous adenoca-cinoma based on computed tomography findings: a clinicopathological study with survival analysis【Objective】 To investigate the correlation between the clinicopathological characteristics and prognosis of invasive mucinous adenocarcinoma based on computed tomography findings【Materials and Methods】 We reviewed 68 resected pure IMA patients between 2011 and 2017 and reclassified them according to the International multidisciplinary lung adenocarcinoma classification in 2011.Tumors were classified as solitary type or pneumonic type IMAs according to the CT imaging.We analyzed the relevance of this classification according to clinical,pathologic,and prognostic analysis.【Results】 For a series of 68 pure IMA patients,54 patients had solitary type and 14 patients had pneumonic type tumors.The median age of the patients was 61 years.Patients in stage I/II account for the majority(80.9%).Compared with solitary type tumors,the pneumonic type tumors showed a higher T,N and pathological stage,no distant metastasis lesion was observed.The survival analysis showed the pneumonic type had a significantly poorer DFS than solitary type IMAs(P=0.004).At univariate analysis,pneumonic pattern on CT scan,T stage,Pathologic stage and TTF-1 were significant predictive factors for survival(p=0.011,0.014,0.013,0.029,respectively).At multivariate analysis,pneumonic type IMA was an independent prognostic factors(HR6.764,95%CI:1.563-29.269,p=0.011)).【Conclusion】 Our results indicated that two types according to CT findings were related to clinicopathological characteristics and prognosis of pure IMA,the pneumonic type IMA was a significantly independent prognostic factor.