ALC  Vol.2 No.4 , December 2013
Spreading pattern and CT findings of very early-stage peripheral small-cell lung cancer
Abstract: Chest CT frequently reveals small pulmonary lesions. If there is no associated hilar or mediastinal lymphadenopathy, small-cell lung cancer (SCLC) is considered to be very early-stage. Few studies, however, have described the characteristic CT findings of very early-stage SCLC. Clarifying these findings would reduce diagnostic delay. The purpose of this study was to determine the characteristic CT findings of very earlystage SCLC. Computed tomography images obtained from 547 consecutive patients with lung cancer between 2003 and 2012 at Tokyo Dental College Ichikawa General Hospital were reviewed retrospectively. One hundred of these patients had SCLC and 447 had non-SCLC (NSCLC). These CT images, along with any that had also been obtained prior to the one on which the final diagnosis was based, were reviewed. In 5 of the cases reviewed, specific findings and a characteristic spreading pattern were identified on CT images that might have allowed a diagnosis of SCLC to have been made sooner. The findings included a sub-pleural, small nodule accompanied by daughter nodules spreading longitudinally along the bronchovascular bundle, no air bronchogram or cavitation, and background emphysematous change. These were not identified on CT images of very earlystage NCSLC, however (n = 22). Awareness of the relevance of these findings would help physicians and radiologists arrive at a differential diagnosis of small pulmonary nodules.
Cite this paper: Terashima, T. , Matsuzaki, T. , Chubachi, S. , Sakamaki, F. , Satoh, M. , Tomioka, E. , Horio, G. , Ogawa, R. , Naitoh, A. and Ojiri, H. (2013) Spreading pattern and CT findings of very early-stage peripheral small-cell lung cancer. Advances in Lung Cancer, 2, 73-78. doi: 10.4236/alc.2013.24010.

[1]   Shepherd, F. A., Ginsberg, R. J., Haddad, R., Feld, R., Sagman, U., Evans, W. K., DeBoer, G. and Maki, E. (1993) Importance of clinical staging in limited small-cell lung cancer: A valuable system to separate prognostic subgroups. Journal of Clinical Oncology, 11, 1592-1597.

[2]   Lim, E., Belcher, E., Yap, Y. K., Nicholson, A. G. and Goldstraw, P. (2008) The role of surgery in the treatment of limited disease small cell lung cancer: Time to reevaluate. Journal of Thoracic Oncology, 3, 1267-1271.

[3]   Holmes, E. C. (1995) The role of surgery in small cell carcinoma of the lung (SCLC). Lung Cancer, 12, S17-S21.

[4]   Simon, G. R. and Wagner, H. (2003) Small cell lung cancer. Chest, 123, 259S-271S.

[5]   Ost, D., Fein, A. M. and Feinsilver, S. H. (2003) The solitary pulmonary nodule. New England Journal of Medicine, 348, 2535-2542.

[6]   Libby, D. M., Smith, J. P., Altorki, N. K., Pasmantier, M. W., Yankelevitz, D. and Henschke, C. I. (2004) Managing the small pulmonary nodule discovered by CT. Chest, 125, 1522-1529. 10.1378/chest.125.4.1522

[7]   Piyavisetpat, N., Aquino, S. L., Hahn, P. F., Halpern, E. F. and Thrall, J. H. (2005). Small incidental pulmonary nodules: How useful is short-term interval CT follow-up? Journal of Thoracic Imaging, 20, 5-9.

[8]   MacMahon, H., Austin, J. H. M., Gamsu, G., Herold, C. J., Jett, J. R., Naidich, D. P., Patz Jr., E.F. and Swensen, S. J. (2005) Guidelines for management of small pulmonary nodules detected on CT scans: A statement from the fleischner society. Radiology, 237, 395-400. radiol.2372041887

[9]   Winer-Muram, H. T. (2006) The solitary pulmonary nodule. Radiology, 239, 34-49.

[10]   Gould, M. K., Fletcher, J., Iannettoni, M. D., Lynch, W. R., Midthun, D. E., Naidich, D. P. and Ost, D. E. (2007) Evaluation of patients with pulmonary nodules: When is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd Edition). Chest, 132, 108S-130S.

[11]   Van’t Westeinde, S. C., de Koning, H. J., Xu, D. M., Hoogsteden, H. C. and van Klaveren, R. J. (2008) How to deal with incidentally detected pulmonary nodules less than 10 mm in size on CT in a healthy person. Lung Cancer, 60, 151-159.

[12]   Geddes, D. M. (1979) The natural history of lung cancer: A review based on rates of tumour growth. British Journal of Diseases of the Chest, 73, 1-17.

[13]   Onuma, Y., Tanabe, K., Nakazawa, G., Aoki, J., Nakajima, H., Ibukuro, K. and Hara, K. (2006) Noncardiac findings in cardiac imaging with multidetector computed tomography. Journal of the American College of Cardiology, 48, 402-406.

[14]   Haller, S., Kaiser, C., Buser, P., Bongartz, G. and Bremerich, J. (2006) Coronary artery imaging with contrastenhanced MDCT: Extracardiac findings. American Journal of Roentgenology, 187, 105-110.

[15]   Kim, T. J., Han, D. H., Jin, K. N. and Lee, K. W. (2010) Lung cancer detected at cardiac CT: Prevalence, clinicoradiologic features, and importance of full-field-ofview images. Radiology, 255, 369-376.

[16]   Wood, D. E., Eapen, G. A., Ettinger, D. S., Hou, L., Jackman, D., Kazerooni, E., Klippenstein, D., Lackner, R.P., Leard, L., Leung, A.N.C., Massion, P.P., Meyers, B.F., Munden, R.F., Otterson, G.A., Peairs, K., Pipavath, S., Pratt-Pozo, C., Reddy, C., Reid, M.E., Rotter, A.J., Schabath, M.B., Sequist, L.V., Tong, B.C., Travis, W.D., Unger, M. and Yang, S. C. (2012) Lung cancer screening: Clinical practice guidelines in oncology. JNCCN Journal of the National Comprehensive Cancer Network, 10, 240-265.

[17]   Kazawa, N., Kitaichi, M., Hiraoka, M., Togashi, K., Mio, N., Mishima, M. and Wada, H. (2006) Small cell lung carcinoma: Eight types of extension and spread on computed tomography. Journal of Computer Assisted Tomography, 30, 653-661.

[18]   Sone, S., Nakayama, T., Honda, T., Tsushima, K., Li, F., Haniuda, M., Takahashi, Y., Hanaoka, T., Takayama, F., Koizumi, T., Kubo, K., Yamada, T., Kondo, R., Fushimi, H. and Suzuki, T. (2007) CT findings of early-stage small cell lung cancer in a low-dose CT screening programme. Lung Cancer, 56, 207-215.

[19]   Hashimoto, M., Heianna, J., Okane, K., Hirano, Y. and Watarai, J. (1999) Small cell carcinoma of the lung: CT findings of parenchymal lesions. Radiation Medicine— Medical Imaging and Radiation Oncology, 17, 417-421.

[20]   Deslauriers, J. (1997) Surgery for small cell lung cancer. Lung Cancer, 17, S91-S98.

[21]   Karrer, K., Shields, T. W., Denck, H., Hrabar, B., Vogt-Moykopf, I. and Salzer, G. M. (1989). The importance of surgical and multimodality treatment for small cell bronchial carcinoma. Journal of Thoracic and Cardiovascular Surgery, 97, 168-176.

[22]   Quoix, E., Fraser, R., Wolkove, N., Finkelstein, H. and Kreisman, H. (1990) Small cell lung cancer presenting as a solitary pulmonary nodule. Cancer, 66, 577-582.<577::AID-CNCR2820660328>3.0.CO;2-Y