Elsevier

Lung Cancer

Volume 66, Issue 2, November 2009, Pages 211-217
Lung Cancer

Doubling time of lung cancer determined using three-dimensional volumetric software: Comparison of squamous cell carcinoma and adenocarcinoma

https://doi.org/10.1016/j.lungcan.2009.01.018Get rights and content

Abstract

The aim of the present study was to investigate the difference in doubling time between squamous cell carcinoma (SCC) and adenocarcinoma of solid pulmonary cancer using three-dimensional volumetric software.

We included 40 patients with adenocarcinoma and 11 patients with SCC, who underwent CT examinations more than once before surgical treatment. Tumor volumes and doubling times were obtained using three-dimensional volumetric computer software. Statistical analysis was performed using Mann–Whitney's U-test except for negative doubling times (doubling times less than 0 day).

Negative doubling time was found in 5 of the 40 adenocarcinomas (13%), but not in any of the patients with SCC. Doubling time was beyond 400 days in 11 of the 40 adenocarcinomas (28%), but was always less than 400 days in SCC. The mean doubling time of SCC was 126 ± 58 days (range, 39–221 days; median, 131 days), while that of adenocarcinomas, except for the negative doubling times, was 976 ± 3134 days (range, 69–18,678 days; median, 258 days). Doubling time differed significantly between adenocarcinomas and SCC (p < 0.01).

In conclusion, the median doubling time of SCC lung cancers is less than that of adenocarcinomas, as measured with automated volumetric measurement software.

Introduction

A pulmonary nodule is one of the most common findings on chest CT, and the majority of solid pulmonary nodules detected incidentally on chest CT are benign [1], [2], [3]. Multidetector CT technology allows thin-slice images of the entire lung to be obtained, and aids detection of more small pulmonary nodules [4]. Diagnostic evaluation of pulmonary nodules is necessary in radiologic daily practice, and some CT findings can be helpful in differentiating malignant nodules from benign nodules on the basis of the margin or the internal characteristics of the pulmonary nodules [5], [6], [7]. Contrast-enhanced CT, 18 FDG PET and PET-CT are also useful examinations [8], [9], [10].

Another management strategy for pulmonary nodule involves careful follow-up. Follow-up is recommended for pulmonary nodules detected during non-screening CT, except for nodules less than 4 mm in low-risk patients [11]. Some pulmonary nodules have been diagnosed as benign due to complete or partial resolution in short-term CT follow-up [12]. CT follow-up also enables evaluation of the growth rate of the pulmonary nodule. The growth of malignant nodules is generally more rapid than that of benign nodule, and it is generally accepted that the majority of malignant pulmonary nodules double in volume between 20 and 400 days, but many exceptions to this rule occur [13]. CT volumetric measurements have been shown to be highly accurate for determining volume and are useful in calculating the doubling times of pulmonary nodules [14]. The purpose of this study was to investigate the doubling time of adenocarcinoma and squamous cell carcinoma, which are the major histologic types of primary lung cancer, using three-dimensional volumetry software.

Section snippets

Patient population

This retrospective study had institutional review board approval. Patients treated with surgical resection for primary lung cancer of squamous cell carcinoma and adenocarcinoma from January 2001 to December 2006 were investigated. Patients who had undergone any preoperative treatment such as chemotherapy or radiation therapy were excluded from the study. The patients underwent at least two preoperative chest CT examinations because of the suspiciousness of the benign nodules, the impossibility

Results

The doubling times of the squamous cell carcinomas and adenocarcinomas are shown in Fig. 1. The each data of the doubling time, the reciprocal of doubling time (reciprocal DT = 365/DT) and the interval between scans is shown in Table 1. No squamous cell carcinoma had a negative doubling time (Fig. 2). However, the doubling times were negative in 5 of the 40 adenocarcinomas (13%) (Fig. 3). CT examinations were performed only twice in these five patients, and the second CT examinations were done

Discussion

The exponential model of tumor growth was first suggested by Collins et al. in 1956 [15]. The hypothesis assumes that a tumor cell divides into two cells, each of which divides to become four, eight and so on. If the tumor constantly grows, the tumor growth will be exponential and the growth rate is described as the volume doubling time. The doubling time of pulmonary nodules has been studied primarily using chest radiography [16], [17], [18], [19], [20], [21]. In these studies, the diameters

Conflict of interest statement

None.

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