Multilobulated thymoma with an acute angle: a new predictor of lung invasion

European Radiology
Daniel B GreenJames F Gruden

Abstract

Imaging features of thymomas such as lobulation, infiltration into lung, and adjacent lung abnormality have been associated with lung invasion but are unreliable. The goal of this study was to develop a more objective and reproducible method for predicting lung invasion by thymomas. Fifty-four thymomas resected from 2007 to 2017 were included for analysis. Pre-operative CT scans for these thymomas were reviewed, and multiple features were evaluated, including the interface of each thymoma with the adjacent lung. A multilobulated thymoma with at least one acute angle between lobulations was considered suspicious for lung invasion. Two blinded radiologists then tested this hypothesis by reviewing all 54 CT scans and using this single criterion to predict lung invasion. Twelve thymomas invaded the lung. All lung-invasive thymomas were multilobulated. Twenty-nine thymomas had a multilobulated interface with the lung. Multilobulated thymomas were more likely to invade the lung than thymomas with a single lobulation or no lobulation (p = 0.0008). Using the criterion of multilobulation with at least one acute angle between lobulations to predict lung invasion, the two readers achieved a sensitivity of 67-83%, specificity of 93-98%, po...Continue Reading

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