Computed Tomography Findings Predicting Invasiveness of Thymoma

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Presentation transcript:

Computed Tomography Findings Predicting Invasiveness of Thymoma Edith M. Marom, MD, Miguel A. Milito, MD, Cesar A. Moran, MD, Ping Liu, MS, Arlene M. Correa, PhD, Edward S. Kim, MD, Ritsuko Komaki, MD, Jeremy J. Erasmus, MD, Wayne L. Hofstetter, MD, David C. Rice, MD, Stephen G. Swisher, MD  Journal of Thoracic Oncology  Volume 6, Issue 7, Pages 1274-1281 (July 2011) DOI: 10.1097/JTO.0b013e31821c4203 Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Fifty-nine-year-old woman with stage IIb thymoma. Contrast-enhanced chest computed tomography (CT) scan demonstrates a 4.5-cm anterior mediastinal mass (arrow) that is round, is well demarcated, and does not infiltrate the surrounding fat. At surgery, microscopic tumor invasion of the capsule was found. A, ascending aorta. P, main pulmonary artery. Journal of Thoracic Oncology 2011 6, 1274-1281DOI: (10.1097/JTO.0b013e31821c4203) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Sixty-one-year-old man with stage III thymoma. Contrast-enhanced chest computed tomography (CT) scan demonstrates an 8.5-cm anterior mediastinal mass (arrow) that is lobulated, is poorly demarcated, does not infiltrate the surrounding fat, and abuts <50% of the circumference of the ascending aorta (A). At surgery, the tumor was found to invade the pleura, lung parenchyma, and innominate vein. P, left pulmonary artery. Journal of Thoracic Oncology 2011 6, 1274-1281DOI: (10.1097/JTO.0b013e31821c4203) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Nomogram to predict stage III/IV thymoma using computed tomography (CT) findings at presentation. The nomogram consists of six rows. Row 1 (points row) is the point assignment for each variable. Rows 2 to 4 correspond to the variables included in the model. For an individual patient, each variable in rows 2 to 4 is assigned a point value, which is determined by drawing a vertical line from the appropriate position on the variable row to the points row. The assigned points for all three variables are added, and the total is marked on row 5 (shaded row called: total points). Then, the probability of having stage III/IV disease is calculated by drawing a vertical line from the appropriate position on the total points row to the row 6, which shows the probability of stage III or IV disease. Thus, for a patient with a lobular, larger than 7 cm tumor, which infiltrates the surrounding fat, the points added would be 100, 55, and 63 points, respectively, which adds to 218 total points or a 75% probability of having stage III/IV disease. The concordance index of this nomogram is 0.804. After internal validation using 200 bootstrap samples, the bias-corrected concordance index was 0.795 with an optimism of 0.009. Using this point system, total points ≥164 predict a ≥50% probability of having stage III/IV disease. Journal of Thoracic Oncology 2011 6, 1274-1281DOI: (10.1097/JTO.0b013e31821c4203) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Receiver operating characteristic curve of our nomogram showing that the nomogram predicts stage III/IV disease very well, with the area under the curve or concordance index of 80. Journal of Thoracic Oncology 2011 6, 1274-1281DOI: (10.1097/JTO.0b013e31821c4203) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 Kaplan-Meier estimate of progression-free survival according to the nomogram-predicted probability of having stage III/IV disease (p = 0.005). Journal of Thoracic Oncology 2011 6, 1274-1281DOI: (10.1097/JTO.0b013e31821c4203) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions