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Visibility of small peripheral lung cancers on chest radiographs: influence of densitometric parameters, CT values and tumour type

¹ Departments of Radiology
² Laboratory Medicine, Shinshu University School of Medicine, Asahi, Matsumoto, 390 8621, Japan

View larger version (80K): [in a new window]   Figure 1. 67-year-old male smoker with squamous cell carcinoma (16 mmx16 mm) in the apical segment of the right lower lobe, with hilic growth pattern. (a) Low dose CT shows a small nodule (arrow). (b) High resolution CT shows a homogeneous solid tissue density nodule (arrow). (c) Histopathological examination of the tumour shows hilic (solid) tumour growth (H&E stain; original magnificationx1.25). (d) Close-up view of the posteroanterior chest radiograph shows the lung nodule (arrow). (e) Optical densitometric measurement of visible tumour on the chest radiograph. The contrast and gradient values are 0.21 OD and 0.11 OD mm-1, respectively, which corresponds to the histopathological findings of hilic tumour growth.

View larger version (119K): [in a new window]   Figure 2. 56-year-old male smoker with a well differentiated type A adenocarcinoma (11 mmx12 mm) in the apical segment of the right lower lobe, with lepidic growth pattern. (a) Low dose CT shows a small faint lesion (arrow). (b) High resolution CT shows a ground-glass attenuation nodule through which the small vessels are visible (arrow). (c) Histopathological examination shows alveolar lining tumour growth without alveolar collapse (H&E stain; original magnificationx1.25). (d) Close-up view of the posteroanterior chest radiograph shows no evidence of the nodule in the middle zone of the right lung field.

View larger version (90K): [in a new window]   Figure 3. 33-year-old male non-smoker with a well differentiated type B adenocarcinoma (8 mmx9 mm) in the apical segment of the left lower lobe, with lepidic growth pattern. (a) Low dose CT shows a small, faint lesion (arrow). (b) High resolution CT shows a heterogeneous, low attenuation nodule (arrow). (c) Histopathological examination shows alveolar lining tumour growth with scattered foci of alveolar collapse (H&E stain; original magnificationx1.25). (d) Close-up view of the posteroanterior chest radiograph shows no evidence of the nodule in the middle zone of the left lung field.

View larger version (11K): [in a new window]   Figure 4. Relationship between tumour size and the difference in CT values between the tumour and its surrounding lung parenchyma (CT) in visible and invisible tumours in cases detected on CT screening and those detected clinically. The detection rates onchest radiographs were 18% (4/22) for tumours 10 mm in diameter and 66% (27/41) for tumours 11–20 mm in diameter, and 8% (2/24) fortumours 400 HU CT and 74% (29/39) fortumours >400 HU CT. , Invisible tumour in CT screening group; , visible tumour in CT screening group; , invisible tumour in clinical group; •, visible tumour in clinical group.