A Novel Algorithm to Differentiate Between Multiple Primary Lung Cancers and Intrapulmonary Metastasis in Multiple Lung Cancers With Multiple Pulmonary Sites of Involvement

Young Joo Suh, Hyun Ju Lee, Pamela Sung, Heera Yoen, Sewoo Kim, Seungchul Han, Sungeun Park, Jung Hee Hong, Heekyung Kim, Jiyeon Lim, Hyungjin Kim, Soon Ho Yoon, Yoon Kyung Jeon, Young Tae Kim

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Differentiating between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) is critical for developing a therapeutic strategy to treat multiple lung cancers with multiple pulmonary sites of involvement. Methods: We retrospectively included 252 lesions (126 pairs) from 126 patients with surgically resected multiple lung adenocarcinomas. Each pair was classified as MPLC or IPM based on histopathologic findings as the reference standard. A novel algorithm was established with four sequential decision steps based on the combination of computed tomography (CT) lesion types (step 1), CT lesion morphology (step 2), difference of maximal standardized uptake values on positron-emission tomography/CT (step 3), and presence of N2/3 lymph node metastasis or distant metastasis (step 4). The diagnostic accuracy of the algorithm was analyzed. Performances of 11 observers were assessed without and with knowledge of algorithm. Results: Among 126 pairs, 90 (71.4%) were classified as MPLCs and 36 (28.6%) as IPMs. On applying the diagnostic algorithm, the overall accuracy for diagnosis of IPM among conclusive cases up to step 4 was 88.9%, and 65 and 44 pairs were correctly diagnosed based on step 1 and step 2, respectively. Specificity and positive predictive value for diagnosis of IPM increased significantly in all observers compared with reading rounds without the algorithm. Conclusions: Application of the algorithm based on comprehensive information on clinical and imaging variables can allow differentiation between MPLCs and IPMs. When both of two suspected malignant lesions appear as solid predominant lesions without spiculation or air-bronchogram on CT, IPM should be considered.

Original languageEnglish
Pages (from-to)203-215
Number of pages13
JournalJournal of Thoracic Oncology
Volume15
Issue number2
DOIs
StatePublished - Feb 2020

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Lung Neoplasms
Neoplasm Metastasis
Lung
Tomography
Reading
Lymph Nodes
Air

Keywords

  • Algorithm
  • Intrapulmonary metastasis
  • Lung adenocarcinoma
  • Multiple primary lung cancers

Cite this

@article{5107c41ec881422c9c77eb5cdc9b6281,
title = "A Novel Algorithm to Differentiate Between Multiple Primary Lung Cancers and Intrapulmonary Metastasis in Multiple Lung Cancers With Multiple Pulmonary Sites of Involvement",
abstract = "Introduction: Differentiating between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) is critical for developing a therapeutic strategy to treat multiple lung cancers with multiple pulmonary sites of involvement. Methods: We retrospectively included 252 lesions (126 pairs) from 126 patients with surgically resected multiple lung adenocarcinomas. Each pair was classified as MPLC or IPM based on histopathologic findings as the reference standard. A novel algorithm was established with four sequential decision steps based on the combination of computed tomography (CT) lesion types (step 1), CT lesion morphology (step 2), difference of maximal standardized uptake values on positron-emission tomography/CT (step 3), and presence of N2/3 lymph node metastasis or distant metastasis (step 4). The diagnostic accuracy of the algorithm was analyzed. Performances of 11 observers were assessed without and with knowledge of algorithm. Results: Among 126 pairs, 90 (71.4{\%}) were classified as MPLCs and 36 (28.6{\%}) as IPMs. On applying the diagnostic algorithm, the overall accuracy for diagnosis of IPM among conclusive cases up to step 4 was 88.9{\%}, and 65 and 44 pairs were correctly diagnosed based on step 1 and step 2, respectively. Specificity and positive predictive value for diagnosis of IPM increased significantly in all observers compared with reading rounds without the algorithm. Conclusions: Application of the algorithm based on comprehensive information on clinical and imaging variables can allow differentiation between MPLCs and IPMs. When both of two suspected malignant lesions appear as solid predominant lesions without spiculation or air-bronchogram on CT, IPM should be considered.",
keywords = "Algorithm, Intrapulmonary metastasis, Lung adenocarcinoma, Multiple primary lung cancers",
author = "Suh, {Young Joo} and Lee, {Hyun Ju} and Pamela Sung and Heera Yoen and Sewoo Kim and Seungchul Han and Sungeun Park and Hong, {Jung Hee} and Heekyung Kim and Jiyeon Lim and Hyungjin Kim and Yoon, {Soon Ho} and Jeon, {Yoon Kyung} and Kim, {Young Tae}",
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A Novel Algorithm to Differentiate Between Multiple Primary Lung Cancers and Intrapulmonary Metastasis in Multiple Lung Cancers With Multiple Pulmonary Sites of Involvement. / Suh, Young Joo; Lee, Hyun Ju; Sung, Pamela; Yoen, Heera; Kim, Sewoo; Han, Seungchul; Park, Sungeun; Hong, Jung Hee; Kim, Heekyung; Lim, Jiyeon; Kim, Hyungjin; Yoon, Soon Ho; Jeon, Yoon Kyung; Kim, Young Tae.

In: Journal of Thoracic Oncology, Vol. 15, No. 2, 02.2020, p. 203-215.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Novel Algorithm to Differentiate Between Multiple Primary Lung Cancers and Intrapulmonary Metastasis in Multiple Lung Cancers With Multiple Pulmonary Sites of Involvement

AU - Suh, Young Joo

AU - Lee, Hyun Ju

AU - Sung, Pamela

AU - Yoen, Heera

AU - Kim, Sewoo

AU - Han, Seungchul

AU - Park, Sungeun

AU - Hong, Jung Hee

AU - Kim, Heekyung

AU - Lim, Jiyeon

AU - Kim, Hyungjin

AU - Yoon, Soon Ho

AU - Jeon, Yoon Kyung

AU - Kim, Young Tae

PY - 2020/2

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N2 - Introduction: Differentiating between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) is critical for developing a therapeutic strategy to treat multiple lung cancers with multiple pulmonary sites of involvement. Methods: We retrospectively included 252 lesions (126 pairs) from 126 patients with surgically resected multiple lung adenocarcinomas. Each pair was classified as MPLC or IPM based on histopathologic findings as the reference standard. A novel algorithm was established with four sequential decision steps based on the combination of computed tomography (CT) lesion types (step 1), CT lesion morphology (step 2), difference of maximal standardized uptake values on positron-emission tomography/CT (step 3), and presence of N2/3 lymph node metastasis or distant metastasis (step 4). The diagnostic accuracy of the algorithm was analyzed. Performances of 11 observers were assessed without and with knowledge of algorithm. Results: Among 126 pairs, 90 (71.4%) were classified as MPLCs and 36 (28.6%) as IPMs. On applying the diagnostic algorithm, the overall accuracy for diagnosis of IPM among conclusive cases up to step 4 was 88.9%, and 65 and 44 pairs were correctly diagnosed based on step 1 and step 2, respectively. Specificity and positive predictive value for diagnosis of IPM increased significantly in all observers compared with reading rounds without the algorithm. Conclusions: Application of the algorithm based on comprehensive information on clinical and imaging variables can allow differentiation between MPLCs and IPMs. When both of two suspected malignant lesions appear as solid predominant lesions without spiculation or air-bronchogram on CT, IPM should be considered.

AB - Introduction: Differentiating between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) is critical for developing a therapeutic strategy to treat multiple lung cancers with multiple pulmonary sites of involvement. Methods: We retrospectively included 252 lesions (126 pairs) from 126 patients with surgically resected multiple lung adenocarcinomas. Each pair was classified as MPLC or IPM based on histopathologic findings as the reference standard. A novel algorithm was established with four sequential decision steps based on the combination of computed tomography (CT) lesion types (step 1), CT lesion morphology (step 2), difference of maximal standardized uptake values on positron-emission tomography/CT (step 3), and presence of N2/3 lymph node metastasis or distant metastasis (step 4). The diagnostic accuracy of the algorithm was analyzed. Performances of 11 observers were assessed without and with knowledge of algorithm. Results: Among 126 pairs, 90 (71.4%) were classified as MPLCs and 36 (28.6%) as IPMs. On applying the diagnostic algorithm, the overall accuracy for diagnosis of IPM among conclusive cases up to step 4 was 88.9%, and 65 and 44 pairs were correctly diagnosed based on step 1 and step 2, respectively. Specificity and positive predictive value for diagnosis of IPM increased significantly in all observers compared with reading rounds without the algorithm. Conclusions: Application of the algorithm based on comprehensive information on clinical and imaging variables can allow differentiation between MPLCs and IPMs. When both of two suspected malignant lesions appear as solid predominant lesions without spiculation or air-bronchogram on CT, IPM should be considered.

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