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A. Snoeckx
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-028 - Wolf in Sheep's Clothing - Primary Lung Cancer Mimicking Benign Diseases (ID 3937)
14:30 - 14:30 | Author(s): A. Snoeckx
- Abstract
Background:
Lung cancer is the biggest cancer killer and typically presents as mass or nodule, round or oval in shape. Recognition and diagnosis of these typical cases is often straightforward, whereas diagnosis of uncommon manifestations of primary lung cancer certainly is far more challenging. The aim of this pictorial essay is to illustrate the Computed Tomography (CT) and histopathology findings of uncommon manifestations of primary lung cancer with focus on these entities that mimic benign diseases.
Methods:
Cases presented were collected during the Multidisciplinary Thoracic Oncology Tumor Board between January 2014 and May 2016 and have histopathologic proof.
Results:
Lung cancer can mimic a variety of benign diseases, including infection, granulomatous disease, lung abscess, postinfectious scarring, mediastinal mass, emphysema, atelectasis and pleural disease. Previous history, clinical and biochemical parameters are certainly helpful and necessary in the assessment of these cases, but often aspecific and inconclusive. Whereas 18FDG-PET is the cornerstone in diagnosis and staging of lung cancer, it’s role in these uncommon manifestations is less straightforward since benign diseases, such as granulomatous and infectious diseases may also present with increased FDG-uptake. Chest CT is the imaging modality of choice and plays a central role in these cases. ‘Irregular air bronchogram sign’ in pneumonia-like lung cancer, ‘drowned lung sign’ in obstructive atelectasis and cortical bone erosion in lung cancer mimicking pleural disease are important signs that point to a malignant etiology. The stippled and eccentric morphology of calcifications in apical lesions aids in differentiating these lesions from postinfectious scarring. Mucinous tumours can mimic a pulmonary abscess and small cell lung cancer can typically present as mediastinal mass without parenchymal abnormalities. Lung cancer presenting with a miliary pattern or cavitating nodules can mimic granulomatous disease. Lung cancer presenting with cystic airspaces and ‘emphysema-like’ morphology is an uncommon entity in which early recognition is crucial since these tumors have an aggressive nature. Key imaging findings and tips and tricks for recognizing these uncommon faces of primary lung cancer will be discussed and illustrated.
Conclusion:
Primary lung cancer can mimic a wide variety of benign entities. Knowledge of these uncommon and atypical manifestations is crucial to avoid delay in diagnosis and treatment. A multidisciplinary approach in these cases is mandatory.
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P1.03-078 - Size Matters...but Don't Underestimate the Power of Morphology (ID 4181)
14:30 - 14:30 | Author(s): A. Snoeckx
- Abstract
Background:
The detection of solitary pulmonary nodules has increased due to the widespread use of Computed Tomography (CT) and will increase even more in the future when lung cancer screening will be embedded in daily practice. In addition to the clinical information, size is one of the most important parameters to assess the likelihood of malignancy. Although there is a considerable overlap in imaging characteristics of benign and malignant solitary pulmonary nodules, the power of morphology –even in small nodules- should not be underestimated. The aim of this pictorial essay is to give an overview of the wide range of morphologic characteristics and to address the available evidence on sensitivity and specificity of these characteristics.
Methods:
Cases presented were collected during the Multidisciplinary Thoracic Oncology Tumor Board between January 2014 and May 2016. All malignant cases have histopathologic proof, whereas benign lesions were included when the benign nature was suggested after follow-up, negative PET-scan and/or multidisciplinary consensus.
Results:
With regard to margin characteristics, spiculation is highly suggestive of a malignant nature. It is the only feature that is incorporated as ‘morphologic’ variable in most risk prediction models. Other features however may also be strong indicators of malignancy. Lobulation, halo sign, pleural indentation, vascular convergence sign and pitfall sign are frequently encountered in malignant nodules. The nodule-bronchus relationship can give additional information regarding the nature of the nodule, with signs such as air bronchogram, bubble like lucencies and bronchus cutoff sign being indicative of a malignant nature. In cavitated nodules, a very thin wall might indicate a benign cause, whereas a very thick wall is more common in malignant nodules. Calcification is typically seen in benign nodules, but depending on the calcification pattern a malignant etiology cannot be excluded. The presence of fat is a relative reliable sign of benignity. Thin-section CT will enable detection of subtle findings. Nodules rarely present with only one characteristic and combination of findings can definitely increase the likelihood of a correct diagnosis.
Conclusion:
The management of solitary pulmonary nodules involves both clinical and imaging assessment. Although a great overlap exists in morphologic features of benign and malignant nodules, thorough knowledge and recognition of subtle morphologic findings will aid in early detection of nodules with a high likelihood of malignancy and will avoid unnecessary follow-up and delay in diagnosis and treatment.
