Radiographic Imaging of Bronchioloalveolar Carcinoma: Screening, Patterns of Presentation and Response Assessment David R. Gandara, MD, Denise Aberle,

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Presentation transcript:

Radiographic Imaging of Bronchioloalveolar Carcinoma: Screening, Patterns of Presentation and Response Assessment David R. Gandara, MD, Denise Aberle, MD, Derick Lau, MD, PhD, James Jett, MD, Tim Akhurst, MD, PhD, James Mulshine, MD, Christine Berg, MD, Edward F. Patz, MD Journal of Thoracic Oncology Volume 1, Issue 9, Pages S20-S26 (November 2006) DOI: 10.1016/S1556-0864(15)30005-8 Copyright © 2006 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Axial CT scan with lung windows through the upper lobes in a 79-year-old male with a former 50 pack-year smoking history, having quit 29 years ago. A solitary, ovoid-shaped 16 × 10-mm diameter GGO is visible in the left upper lobe. A tiny, solid component is suggested along the inferior border (arrow). There was no intrathoracic lymphadenopathy. Percutaneous biopsy was suspicious for neoplasm, prompting left upper lobectomy. At histology, this proved to be an adenocarcinoma with mixed infiltrating acinar pattern and more prominent bronchioloalveolar pattern. The central scar measured less than 0.5 cm. Journal of Thoracic Oncology 2006 1, S20-S26DOI: (10.1016/S1556-0864(15)30005-8) Copyright © 2006 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Axial chest CT images from scans obtained 18 months apart in a 70-year-old male with a formerly heavy smoking history. (A) Baseline image shows a poorly circumscribed 18-mm-diameter nodule of mixed attenuation containing GGO with a small, central, solid component (arrow). There is an additional subtle area of pure GGO visible posteriorly. (B) At 18 months, the solid and GGO components of the nodule have increased. A corresponding FDG-PET scan was negative. At resection, this proved to be an adenocarcinoma with mixed bronchioloalveolar and invasive features, well differentiated. The posterior GGO was focal fibrosis. Lymph node dissection was negative for neoplasm. Journal of Thoracic Oncology 2006 1, S20-S26DOI: (10.1016/S1556-0864(15)30005-8) Copyright © 2006 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 (A) Soft-tissue and (B) lung windows from a chest CT scan in a 35-year-old male with multifocal, mucinous BAC. (A) Soft-tissue windows show the characteristic low attenuation of the consolidations. (B) Lung windows show multifocal areas of GGO and solid attenuation bilaterally in the lungs. Within the regions of malignant consolidation are scattered discrete cavitations and pseudocavities (arrows), representing patent bronchioles and air-containing spaces within the tumor. Journal of Thoracic Oncology 2006 1, S20-S26DOI: (10.1016/S1556-0864(15)30005-8) Copyright © 2006 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 CT images showing pretreatment (A) and posttreatment (B) responses to gefitinib in a patient in the S0126 SWOG trial using the CAIA program.61 The two-dimensional tumor size before treatment was 123; after treatment, it was 86, representing a 30% decrease [(123 − 86)/123 × 100]. In addition, there was a substantial decrease in attenuation of the tumor after treatment. In the future, response assessment may be routinely quantifiable based on imaging-based features, through the use of standardized software platforms. Journal of Thoracic Oncology 2006 1, S20-S26DOI: (10.1016/S1556-0864(15)30005-8) Copyright © 2006 International Association for the Study of Lung Cancer Terms and Conditions