Cardiothoracic Imaging| Volume 56, P63-68, July 2019

Peripheral vessel and air bronchograms for detecting the pathologic patterns of subsolid nodules


      • SSN association type with vessels and bronchi narrows pathological type probability.
      • Peripheral vessel type I and air bronchograms type V likely indicate benign tumors.
      • Peripheral vessel type III and/or IV are more likely to indicate malignancy.
      • Air bronchograms type I and/or II are more likely to indicate malignancy.



      To assess the relationships of subsolid nodules (SSNs) with peripheral vessels and aerated bronchi using computed tomography (CT), and to correlate the imaging features with the benign/malignant pathological diagnoses.


      This study retrospectively analyzed data from 83 patients with a solitary SSN (January 2008 to December 2016). SSNs were imaged (LightSpeed 64-slice spiral CT, General Electric, USA), their mean diameter determined, and the relationship with peripheral vessels (types I-IV) and aerated bronchi (types I-V) were classified. Pathologic diagnoses were obtained from the surgical specimens.


      SSNs were diagnosed as benign (n = 29), pre-invasive (n = 9), micro-invasive adenocarcinoma (n = 7) and invasive adenocarcinoma (n = 38). SSN size, peripheral vessel class and aerated bronchus class differed between pathologic types (P < 0.05). For benign SSNs, peripheral vessel type II (58.6%) was most common, followed by III (20.7%) and IV (6.9%). Aerated bronchus type V (65.5%) was most frequent, followed by IV (27.6%); type I aerated bronchus was not observed. No cases of micro-invasive or invasive adenocarcinoma were peripheral vessel type I or aerated bronchus type V. For invasive adenocarcinoma, 92.1% were peripheral vessel types III + IV while 71.8% were aerated bronchus types I + II.


      SSN pathologic types differ with regard to peripheral vessel and aerated bronchus types. Type I peripheral vessel and type V aerated bronchus (both least involved) suggest a benign lesion, whereas type III/IV peripheral vessel and type I/II aerated bronchus (both most involved) suggest malignancy.


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        • Siegel R.
        • Naishadham D.
        • Jemal A.
        Cancer statistics, 2013.
        CA Cancer J Clin. 2013; 63: 2013
        • Wei M.M.
        • Zhou G.B.
        Long non-coding RNAs and their roles in non-small-cell lung cancer.
        Genomics Proteomics Bioinformatics. 2016; 14: 2016
        • Kodaz H.
        • Tastekin E.
        • Erdogan B.
        • Hacibekiroglu I.
        • Tozkir H.
        • Gurkan H.
        • et al.
        KRAS mutation in small cell lung carcinoma and extrapulmonary small cell cancer.
        Balkan Med J. 2016; 33: 2016
        • Yano M.
        • Yoshida J.
        • Koike T.
        • Kameyama K.
        • Shimamoto A.
        • Nishio W.
        • et al.
        The outcomes of a limited resection for non-small cell lung cancer based on differences in pathology.
        World J Surg. 2016; 40: 2016
        • Konopka K.E.
        Diagnostic pathology of lung cancer.
        Semin Respir Crit Care Med. 2016; 37: 2016
        • de Groot P.
        • Munden R.F.
        Lung cancer epidemiology, risk factors, and prevention.
        Radiol Clin North Am. 2012; 50: 2012
        • Aoki T.
        • Tomoda Y.
        • Watanabe H.
        • Nakata H.
        • Kasai T.
        • Hashimoto H.
        • et al.
        Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival.
        Radiology. 2001; 220: 2001
        • Godoy M.C.
        • Naidich D.P.
        Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management.
        Radiology. 2009; 253: 2009
        • Kim H.
        • Park C.M.
        • Koh J.M.
        • Lee S.M.
        • Goo J.M.
        Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy.
        Diagn Interv Radiol. 2014; 20: 2014
        • Henschke C.I.
        • Yankelevitz D.F.
        • Mirtcheva R.
        • McGuinness G.
        • McCauley D.
        • Miettinen O.S.
        CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules.
        AJR Am J Roentgenol. 2002; 178: 2002
        • Jacobs C.
        • van Rikxoort E.M.
        • Twellmann T.
        • Scholten E.T.
        • de Jong P.A.
        • Kuhnigk J.M.
        • et al.
        Automatic detection of subsolid pulmonary nodules in thoracic computed tomography images.
        Med Image Anal. 2014; 2014
        • Seidelman J.L.
        • Myers J.L.
        • Quint L.E.
        Incidental, subsolid pulmonary nodules at CT: etiology and management.
        Cancer Imaging. 2013; 13: 2013
        • Zhang Y.
        • Qiang J.W.
        • Shen Y.
        • Ye J.D.
        • Zhang J.
        • Zhu L.
        Using air bronchograms on multi-detector CT to predict the invasiveness of small lung adenocarcinoma.
        Eur J Radiol. 2016; 85: 2016
        • Gao F.
        • Li M.
        • Ge X.
        • Zheng X.
        • Ren Q.
        • Chen Y.
        • et al.
        Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels.
        Eur Radiol. 2013; 23: 2013
        • Asamura H.
        • Hishida T.
        • Suzuki K.
        • Koike T.
        • Nakamura K.
        • Kusumoto M.
        • et al.
        Radiographically determined noninvasive adenocarcinoma of the lung: survival outcomes of Japan Clinical Oncology Group 0201.
        J Thorac Cardiovasc Surg. 2013; 146: 2013
        • Fukui T.
        • Mitsudomi T.
        Small peripheral lung adenocarcinoma: clinicopathological features and surgical treatment.
        Surg Today. 2010; 40: 2010
        • Tsutani Y.
        • Miyata Y.
        • Nakayama H.
        • Okumura S.
        • Adachi S.
        • Yoshimura M.
        • et al.
        Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy.
        Chest. 2014; 145: 2014
        • Naidich D.P.
        • Bankier A.A.
        • MacMahon H.
        • Schaefer-Prokop C.M.
        • Pistolesi M.
        • Goo J.M.
        • et al.
        Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society.
        Radiology. 2013; 266: 2013
        • MacMahon H.
        • Naidich D.P.
        • Goo J.M.
        • Lee K.S.
        • Leung A.N.C.
        • Mayo J.R.
        • et al.
        Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017.
        Radiology. 2017; 284: 2017
        • Takahashi S.
        • Tanaka N.
        • Okimoto T.
        • Tanaka T.
        • Ueda K.
        • Matsumoto T.
        • et al.
        Long term follow-up for small pure ground-glass nodules: implications of determining an optimum follow-up period and high-resolution CT findings to predict the growth of nodules.
        Jpn J Radiol. 2012; 30: 2012
        • Shi C.L.
        • Zhang X.Y.
        • Han B.H.
        • He W.Z.
        • Shen J.
        • Chu T.Q.
        A clinicopathological study of resected non-small cell lung cancers 2 cm or less in diameter: a prognostic assessment.
        Med Oncol. 2011; 28: 2011
        • Wang Y.
        • Liang K.R.
        • Liu X.G.
        • Wang J.A.
        • Kang J.H.
        • Liang M.Z.
        Relationship between peripheral lung cancer and the surrounding bronchi, pulmonary arteries, pulmonary veins: a multidetector CT observation.
        Clin Imaging. 2011; 35: 2011
        • Travis W.D.
        • Brambilla E.
        • Noguchi M.
        • Nicholson A.G.
        • Geisinger K.R.
        • Yatabe Y.
        • et al.
        International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma.
        J Thorac Oncol. 2011; 6: 2011
        • Travis W.D.
        • Brambilla E.
        • Nicholson A.G.
        • Yatabe Y.
        • Austin J.H.M.
        • Beasley M.B.
        • et al.
        The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification.
        J Thorac Oncol. 2015; 10: 2015
        • Folkman J.
        Annu Rev Med. 2006; 57: 2006
        • Jackson A.L.
        • Zhou B.
        • Kim W.Y.
        HIF, hypoxia and the role of angiogenesis in non-small cell lung cancer.
        Expert Opin Ther Targets. 2010; 14: 2010
        • Yao L.
        • Zhang D.
        • Zhao X.
        • Sun B.
        • Liu Y.
        • Gu Q.
        • et al.
        Dickkopf-1-promoted vasculogenic mimicry in non-small cell lung cancer is associated with EMT and development of a cancer stem-like cell phenotype.
        J Cell Mol Med. 2016; 20: 2016
        • Wu S.
        • Yu L.
        • Cheng Z.
        • Song W.
        • Zhou L.
        • Tao Y.
        Expression of maspin in non-small cell lung cancer and its relationship to vasculogenic mimicry.
        J Huazhong Univ Sci Technolog Med Sci. 2012; 32: 2012
        • Tsutani Y.
        • Miyata Y.
        • Nakayama H.
        • Okumura S.
        • Adachi S.
        • Yoshimura M.
        • et al.
        Prognostic significance of using solid versus whole tumor size on high-resolution computed tomography for predicting pathologic malignant grade of tumors in clinical stage IA lung adenocarcinoma: a multicenter study.
        J Thorac Cardiovasc Surg. 2012; 143: 2012
        • Lee H.J.
        • Goo J.M.
        • Lee C.H.
        • Park C.M.
        • Kim K.G.
        • Park E.A.
        • et al.
        Predictive CT findings of malignancy in ground-glass nodules on thin-section chest CT: the effects on radiologist performance.
        Eur Radiol. 2009; 19: 2009
        • Suzuki K.
        • Koike T.
        • Asakawa T.
        • Kusumoto M.
        • Asamura H.
        • Nagai K.
        • et al.
        A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201).
        J Thorac Oncol. 2011; 6: 2011