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CT Manifestations of Tumor Spread Through Airspaces in Pulmonary Adenocarcinomas Presenting as Subsolid Nodules

de Margerie-Mellon, Constance, MD*; Onken, Allison, MD; Heidinger, Benedikt H., MD*; VanderLaan, Paul A., MD, PhD; Bankier, Alexander A., MD, PhD*

doi: 10.1097/RTI.0000000000000344
Lung Nodules/Pulmonary Neoplasm

Purpose: The aim of this study was to identify potential computed tomography manifestations of pulmonary adenocarcinomas presenting as subsolid nodules and associated with the histologic evidence of spread of tumor through air spaces (STAS).

Materials and Methods: From a radiologic-pathologic repository of resected pulmonary adenocarcinomas including 203 subsolid nodules, 40 STAS-positive nodules were randomly selected and matched to 40 STAS-negative nodules. Total average diameter, as well as average and long-axis diameters of the solid component, was measured. The proportion of solid component diameter to total average diameter was calculated. Measurements and proportions between STAS-positive and STAS-negative nodules were compared with paired samples t test, χ2 test, or the Fisher exact test.

Results: The total average diameter in STAS-positive nodules was significantly larger than in STAS-negative nodules (P=0.024). The average and long-axis diameters of the solid component of STAS-positive nodules were significantly larger than that of STAS-negative nodules (P=0.001 and 0.003). The proportion of solid component to total average diameter was significantly larger in STAS-positive than in STAS-negative nodules (P=0.041). At a threshold of ≥10 mm for the average and the solid component long-axis diameters, significantly more nodules were STAS-positive than STAS-negative (P=0.015 and 0.001).

Conclusions: Total average diameter, average and long-axis diameters of the solid component, and a high proportion of solid component diameter compared with total average diameter are computed tomography manifestations of subsolid pulmonary adenocarcinomas with STAS. These findings could serve as an in-vivo tool for the likelihood estimation of STAS, and consequently influence management of subsolid adenocarcinomas.

Departments of *Radiology

Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA

C.d.M.-M.: reports grants from Institut Servier and Olea Medical outside the submitted work. Received grant from Société Française de Radiologie—Collège des Enseignants en Radiologie de France. P.A.V.: reports personal fees from Gala Therapeutics outside the submitted work. A.A.B.: reports personal fees from Daiichi Sankyo Company outside the submitted work. The remaining authors declare no conflicts of interest.

Correspondence to: Constance de Margerie-Mellon, MD, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215 (e-mail:

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