Imaging Features Correlation With Epidermal Growth Factor Receptor Mutations And Lymph Node Metastasis In Lung Adenocarcinoma

Chapter I CT and clinical features associated with epidermal growth factor receptor mutation status in Stage ?-? Lung AdenocarcinomaBackgroundTo investigate the relationship between EGFR gene mutation status,preoperative CT and clinical features in patients with Stage ?/? lung adenocarcinomaMethodsA total of 209 patients who underwent surgical resection in Nanjing general hospital for stage ? or ? lung adenocarcinoma between December 2010 and May 2016 were included.All patients underwent a pretreatment chest CT with a multi-slice CT scanner.Molecular analysis of mutation status of EGFR exons 18,19,20,and 21 was examined with Human EGFR Gene Mutations Detection Kit,which is a polymerase chain reaction(PCR)-based amplification-refractory mutation system(ARMS).The aim of this study was to identify the relationship between EGFR mutation status,clinical features,and CT characteristics in surgically resected lung adenocarcinomasResultsAmong the 209 included patients,126/209(60.3%)were positive for EGFR mutation.EGFR mutations appeared more frequently in female patients(P =0.025),never-smokers(P<0.001),and patients with CEA level less than 2.6ng/ml(P=0.045).Moreover,papillary predominant adenocarcinomas(P=0.014),intermediate/low pathologic grade tumors(P=0.003),tumors in the upper lobe(p=0.028),and tumors showing ground-glass opacity(GGO)or mixed GGO on CT(P=0.039)also more frequently harbored EGFR mutations.In the multivariable analyses of risk factors,including both clinical and CT features,for predicting EGFR mutation status,the most important and significantly independent risk factors identified were GGO on CT,acinar or papillary predominant adenocarcinoma and non-smoker.The multiple logistic regression model produced from these CT and clinical features showed high predictive power(AUC= 0.737;95%CI:0.661,0.814)for identifying EGFR mutations.ConclusionsCombined CT and clinical features may be helpful for determining the presence of EGFR mutations in patients with small peripheral lung adenocarcinoma.Chapter ? Investgate association between 18F-FDG PET-CT/CT Features and Lymph Node Metastasis in Peripheral Lung AdenocarcinomaBackgroundTo investigate the risk factors of lymph node metastasis of peripheral lung adenocarcinoma by using CT and PET/CT scans.MethodsA total of 248 patients who underwent surgical resection were included.All of them underwent chest CT and 80 patients underwent PET/CT examination.The relationship between lymph node metastasis and sex,age,smoking status,blood CEA,maximal standard uptake(SUV),tumor size,pathologic subtype were analyzed by univariate analysis.Multiple logistic regression analyses were performed to identify independent risk factors for prediction of lymph node metastasisResultsSeventy-four patients(29.8%)had regional lymph node metastases.Univariate analysis showed that lymph node metastasis was related to the serum CEA level,differentiation,SUVmax,tumor size,lobulation/spiculation,pleural retraction,density,mediastinal or hilar lymphadenopathy(P<0.05).In the multivariable analyses of risk factors,including both serum CEA,SUVmax and CT features,for predicting lymph node metastasis,the most important and significantly independent risk factors identified were SUVmax,CEA level,mediastinal or hilar lymphadenopathy,cavitation/bubble-like lucency and pleural retraction(P<0.05)ConclusionThe combination of radiographic features and serum CEA can help to more accurately to determine the risk of lymph node metastasis in patients with peripheral lung adenocarcinoma.