Using the length of pleural tag to predetermine pleural invasion by lung adenocarcinomas

Introduction: Pleural contact is present when the underlying pathology of the pleural tag (PT) involves the pleura. This study aimed to preoperatively predict PI by lung adenocarcinomas (ACCs) with PT, exploring CT imaging parameters indicative of PT consisting of pleura and tumor invasiveness.

Methods: This single-center, retrospective study included 84 consecutive patients diagnosed with solid ACCs with PT, who underwent resection at our hospital between May 2019 and July 2023. CT imaging parameters analyzed included: LPT (the length of PT), defined as the shortest distance from the tumor edge to the retracted pleura. Patients were divided into PI -ve group and PI +ve group according to PI status. Regression analyses were used to determine predictive factors for PI.

Results: The study evaluated 84 patients (mean age, 62.0 ± 13.8 years; 45 females) pathologically diagnosed with ACCs with PT on CT. Multivariate regression analysis identified tumor size (OR 1.18, 95% CI 1.09-1.29, p = 0.000), LPT (OR 0.48, 95% CI 0.25-0.91, p = 0.03) and multiple PTs to multiple types of pleura (OR 3.58, 95% CI 1.13-11.20, p = 0.03) as independent predictors for PI. The combination of these CT features improved the predictive performance for preoperatively identifying PI, achieving high specificity and moderate accuracy. The sensitivity of predicting PI with only LPT < 3 mm was 96.9%.

Conclusion: This study determined that LPT is effective for predetermining PI in ACCs with PT.