Diagnostic and Interventional Radiology (Jan 2023)

Peritumoral imaging features of thymic epithelial tumors for the prediction of transcapsular invasion: beyond intratumoral analysis

  • Jongmin Park,
  • Byunggeon Park,
  • Jihoon Hong,
  • Jung Guen Cha,
  • Kyung Min Shin,
  • Jaehee Lee,
  • An Na Seo,
  • Young Woo Do,
  • Won Kee Lee,
  • Jae-Kwang Lim

DOI
https://doi.org/10.4274/dir.2022.21803
Journal volume & issue
Vol. 29, no. 1
pp. 109 – 116

Abstract

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PURPOSEThe purpose of this study was to differentiate cases without transcapsular invasion (Masaoka–Koga stage I) from cases with transcapsular invasion (Masaoka–Koga stage II or higher) in patients with thymic epithelial tumors (TETs) using tumoral and peritumoral computed tomography (CT) features.METHODSThis retrospective study included 116 patients with pathological diagnoses of TETs. Two radiologists evaluated clinical variables and CT features, including size, shape, capsule integrity, presence of calcification, internal necrosis, heterogeneous enhancement, pleural effusion, pericardial effusion, and vascularity grade. Vascularity grade was defined as the extent of peritumoral vascular structures in the anterior mediastinum. The factors associated with transcapsular invasion were analyzed using multivariable logistic regression. In addition, the interobserver agreement for CT features was assessed using Cohen’s or weighted kappa coefficients. The difference between the transcapsular invasion group and that without transcapsular invasion was evaluated statistically using the Student’s t-test, Mann–Whitney U test, chi-square test, and Fisher’s exact test.RESULTSBased on pathology reports, 37 TET cases without and 79 with transcapsular invasion were identified. Lobular or irregular shape [odds ratio (OR): 4.19; 95% confidence interval (CI): 1.53–12.09; P = 0.006], partial complete capsule integrity (OR: 5.03; 95% CI: 1.85–15.13; P = 0.002), and vascularity grade 2 (OR: 10.09; 95% CI: 2.59–45.48; P = 0.001) were significantly associated with transcapsular invasion. The interobserver agreement for shape classification, capsule integrity, and vascularity grade was 0.840, 0.526, and 0.752, respectively (P < 0.001 for all).CONCLUSIONShape, capsule integrity, and vascularity grade were independently associated with transcapsular invasion of TETs. Furthermore, three CT TET features demonstrated good reproducibility and help differentiate between TET cases with and without transcapsular invasion.

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