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T1 Non–Small Cell Lung Cancer: Imaging and Histopathologic Findings and Their Prognostic Implications¹

¹ From the Department of Radiology and Center for Imaging Science (K.S.L., Y.J.J.), the Department of Diagnostic Pathology (J.H.), the Department of Nuclear Medicine (B.T.K.), and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (H.K., O.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135–710, Korea. Presented as an education exhibit at the 2003 RSNA scientific assembly. Received February 13, 2004; revision requested March 26; final revision received April 19; accepted April 19. Supported in part by a grant from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (00-PJ1-PG1-CY03–0001). All authors have no financial relationships to disclose. Address correspondence to K.S.L. (e-mail: melon2@samsung.co.kr).

About 5% of T1 non–small cell lung cancers (ie, lung cancers less than 3 cm in diameter), mostly focal nodular bronchioloalveolar carcinomas and carcinoid tumors, demonstrate no uptake at fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and appear to be indolent in growth; consequently, they are associated with long-term patient survival. About 21% of T1 lung cancers show mediastinal nodal metastasis at the time of diagnosis and about 24% show extrathoracic metastasis, mostly brain metastasis, either at the time of diagnosis or at 1-year follow-up. T1 lung cancers with a large ground-glass attenuation component (50% of tumor volume) at thin-section computed tomography (CT) have a good prognosis with less likelihood of mediastinal nodal or extrathoracic metastasis. On the other hand, solid cancer lesions, especially those with a spiculated margin or with bronchovascular bundle thickening in the surrounding lung, more frequently demonstrate local vessel invasion, lymph node metastasis, and extrathoracic metastasis. In these tumors, work-up for extrathoracic metastases (including whole-body FDG PET or brain magnetic resonance imaging and mediastinoscopy for mediastinal nodes) may be needed, even when CT demonstrates no enlarged nodes in the mediastinum.

© RSNA, 2004

Index Terms: Lung neoplasms, 60.321 • Lung neoplasms, CT, 60.1211 • Lung neoplasms, diagnosis • Lung neoplasms, PET, 60.12163 • Lung neoplasms, screening, 60.1211, 60.12163 • Lung neoplasms, staging

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