Author of

• 12791

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  P3.19 - Poster Session 3 - Imaging (ID 181)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Imaging, Staging & Screening
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12800

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    P3.19-009 - Newly developed early lung cancer during follow-up of idiopathic interstitial pneumonia: serial HRCT observations (ID 1719)

    09:30 - 09:30  |  Author(s): J. Kim
    • Abstract

    Background
    To describe HRCT findings of newly developed peripheral T1 lung cancer in idiopathic interstitial pneumonia (IIP) during IIP follow-up

    Methods
    Between November 2001 and October 2012, 66 consecutive patients (62men, 4 women; median age 64, range 40~85 years) who were diagnosed as IIP, fulfilled the American Thoracic Society diagnostic criteria and new cancer (including fourteen small cell) simultaneously, were included. Two radiologists independently reviewed 132 serial CT scans of 66 patients, determined the earliest scan showing lung cancer, and evaluated tumor size (mm), lobar location, axial location on transverse image, shape, and density of tumor. The median interval between null-IIP to new cancer-IIP was measured. Delay in diagnosis was measured from the time of the earliest scan showing lung cancer and the subsequent clinical diagnosis. Formal radiologic reports as ‘first choice’ before diagnosis of cancer were reviewed.

    Results
    The inter-observer agreement was good (Kappa value > 0.77). The median smallest tumor size on axial scan at presentation was 17mm (± 6.57, range, 5-30mm) with T1a/T1b (48/18). Tumor was most commonly located in right lower lobe (29/66, 43.9%), followed by left lower lobe (13, 19.7%). Thirty five tumors (53.0%) were in the interface between normal and fibrotic lung cysts such as honeycomb cysts, twenty two (33.3%) were in the midst of fibrotic lung cysts, and nine (13.6%) were in the normal lung. Fifty nine (83.3%) tumors had round or oval shape, seven (10.6%) tumors had a stellate shape, and two had a band-like shape. Most of the tumors (90.3%) presented as solid density rather than part solid, ground-glass opacity or consolidation. Lung cancers were found during the mean follow-up CT period of 513 days. The median delay in diagnosis was 440 days. Most of the lesions (70%) were interpreted as lung cancer, but nine were interpreted as pneumonia or fungal infection and seven were missed (10.6%) on HRCT.

    Conclusion
    About one third of the tumors were misdiagnosed including missed in ten percents. Over fifty percent of the cancers are located at the interface between normal lung and fibrotic cysts. New lung cancers usually show as tumor with a round or oval shape and solid density.