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. 2015;21(2):102-8.
doi: 10.5761/atcs.oa.14-00093. Epub 2014 Jun 3.

Imaging Characteristics in ALK Fusion-Positive Lung Adenocarcinomas by Using HRCT

Takeo Nakada  1 , Sakae Okumura, Hiroaki Kuroda, Hirofumi Uehara, Mingyon Mun, Kengo Takeuchi, Ken Nakagawa
Affiliations

Imaging Characteristics in ALK Fusion-Positive Lung Adenocarcinomas by Using HRCT

Takeo Nakada et al. Ann Thorac Cardiovasc Surg. 2015.

Abstract

Objectives: We aimed to identify high-resolution computed tomography (HRCT) features useful to distinguish the anaplastic lymphoma kinase gene (ALK) fusion-positive and negative lung adenocarcinomas.

Methods: We included 236 surgically resected adenocarcinoma lesions, which included 27 consecutive ALK fusion-positive (AP) lesions, 115 epidermal growth factor receptor mutation-positive lesions, and 94 double-negative lesions. HRCT parameters including size, air bronchograms, pleural indentation, spiculation, and tumor disappearance rate (TDR) were compared. In addition, prevalence of small lesions (≤20 mm) and solid lesions (TDR ≤20%) were compared.

Results: AP lesions were significantly smaller and had lower TDR (%) than ALK fusion-negative (AN) lesions (tumor diameter: 20.7 mm ± 14.1 mm vs. 27.4 mm ± 13.8 mm, respectively, p <0.01; TDR: 22.8% ± 24.8% vs. 44.8% ± 33.2%, respectively, p <0.01). All AP lesions >20 mm (n = 7, 25.9%) showed a solid pattern. Among all small lesions, AP lesions had lower TDR and more frequent spiculation than AN lesions (p <0.01). Among solid lesions, AP lesions were smaller than AN lesions (p = 0.01).

Conclusion: AP lung lesions were significantly smaller and had a lower TDR than AN lesions. Spiculation was more frequent in small lesions. Non-solid >20 mm lesions may be ALK fusion-negative.

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Figures

Fig. 1
Fig. 1
High-resolution computed tomography images of anaplastic lymphoma kinase (ALK) fusion-positive lung cancer. (A) A 12-mm lesion with a tumor disappearance rate (TDR) of 25%, spiculation and air bronchogram. (B) A 17-mm lesion with a TDR of 35.3% and pleural indentation. (C) A 16-mm lesion with a TDR of 12.5% and spiculation. (D) A 42-mm lesion with a TDR of 4.8%.
Fig. 2
Fig. 2
When the cutoff level of our graphic assay was set as y = −2x + 80 according to the proportional formula, the number of anaplastic lymphoma kinase fusion-positive (AP) lesions falling under this formula line was 88.9% (24/27) (A), whereas that for exon 19 was 29.5% (13/44) (B) and for exon 21 was 19.0% (12/63) (C). Significant differences were found between exon 19 and AP lesions (p <0.01) and between exon 21 and AP lesions (p <0.01). The area under the receiver operating characteristic curve for tumor disappearance rate (TDR) in AP lesions was 0.70 (D).
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