Slowly growing malignant nodules and rapidly growing benign nodules: Evaluation of the value of volume doubling time

Transcription

1 Slowly growing malignant nodules and rapidly growing benign nodules: Evaluation of the value of volume doubling time Poster No.: C-208 Congress: ECR 2009 Type: Educational Exhibit Topic: Chest Authors: Y. Zhao, Y. Wang, P. M. van Ooijen, M. Oudkerk; Groningen/NL Keywords: pulmonary nodules, low dose CT, volume doubling time DOI: /ecr2009/C-208 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 17

2 Learning objectives 1. To review the Volume Doubling Time(VDT) of some slowly growing malignant nodules and rapidly growing benign nodules on CT images 2. To outline other factors that should be taken into account in differentiation between malignant and benign lesions 3. To discuss the benefits and limitations of VDT Background 1. Growth rate of pulmonary nodules is measured in VDT VDT is the time required for a lesion to double in volume. It is regarded as one of the most accurate non-invasive methods of assessing risk of malignancy, as malignant nodules often display rapid growth. 2. To calculate the VDT, two reliable measurements of a lesion are needed. For this purpose, three-dimensional(3d) measurements are thought to be superior to twodimensional(2d) measurements. 3. Additional measurements, such as the Percent Volume Change(PVC), may also be useful. 4. A nodule with a VDT of 30~400 days has a high risk of being malignant. 5. Slow growing lesions often are benign tumors, such as granulomas or hamartomas.but the VDT of the slowest growing bronchioloalveolar carcinomas may be more than 3 years. 6. Although rapid growth significantly increases the risk of malignancy, there are also benign nodules that display a low VDT. Infection and systemic disease for instance may cause significant growth. Imaging findings OR Procedure details Case 1 Slowly growing malignant solid nodule Page 2 of 17

3 : 54 year old mana solid central lobulated nodule was found at baselinev0= mm3 Page 3 of 17

4 Page 4 of 17

5 54 year old man A solid central lobulated nodule was found at baseline V0= mm3 Page 5 of 17

6 After 1 1/2 years, V1= mm3 PVC= 36.4%, VDT=1136 Page 6 of 17

7 After 2 years, V2= mm3, PVC= 113.8%, VDT=657 Pathological result: Lung cancer Case 2 Rapidly growing benign solid nodule Page 7 of 17

8 Page 8 of 17

9 58-year-old man a smooth solid nodule was found at baseline V0= mm3 Page 9 of 17

10 After 4 months, V1= 69.37mm3 PVC= 66.5% VDT= 173 Page 10 of 17

11 After 1 year and 3 months, V3= 26.3mm3 Benign lesion Case 3 Slowly growing malignant partial solid nodule Page 11 of 17

12 59 year old man A pure GGO was found at baseline Diametermax=15mm Page 12 of 17

13 After 3 months, Diametermax=16.6mm Page 13 of 17

14 After 1 years, Diametermax=18.5mm Page 14 of 17

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16 After 3 years, lesion displayed a solid component Diametermax=24.4mm Pathological result: Lung cancer Conclusion 1. Malignant lesions can grow fast, but may also have a long VDT. 2. Given the fact that malignant nodules may be stable for a long period, and benign nodules may have rapid growth, the concept of lead time should be considered in managing these lesions. Page 16 of 17

17 3. Evaluation of pulmonary nodules based on VDT alone sometimes is complicated because the different natural histories. Other differential factors between benignity and malignity such as morphology, margin and density, are also important. Personal Information University Medical Center of Groningen, Netherlands References 1. Thoracic Imaging; W.Richard Webb, Charles B, Higgins 2. Software volumetric evaluation of doubling times for differentiating benign versus malignant pulmonary nodules; M.Revel, A.Merlin, A.Peyrard et.al. AJR 2006 Thoracic Imaging; W. Richard Webb, Charles B, Higgins Page 17 of 17