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      Efficacy of computed tomography features in predicting stage III thymic tumors

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          Abstract

          Accurate assessment of the invasion of intrathoracic structures by stage III thymic tumors assists their appropriate management. The present study aimed to evaluate the efficacy of computed tomography (CT) features for the prediction of stage III thymoma invasion. The pre-operative CT images of 66 patients with confirmed stage III thymic tumors were reviewed retrospectively. The CT features of invasion into the mediastinal pleura, lungs, pericardium and great vessels were analyzed, and their sensitivity, specificity, positive predictive value (PPV), negative predictive value and accuracy were calculated. For mediastinal pleural and pericardial invasion, an absence of space between the tumor and the mediastinal pleura/pericardium with mediastinal pleural/pericardial thickening and pleural/pericardial effusion exhibited a specificity and PPV of 100%, respectively. For lung invasion, a multi-lobular tumor convex to the lung with adjacent lung abnormalities exhibited a specificity and PPV of 91.2 and 81.3%, respectively. For vessel invasion, the specificity and PPV were each 100% for tumors abutting ≥50% of the vessel circumference, and for tumor oppression, deformation and occlusion of the vessel. In conclusion, recognition of the appropriate CT features can serve as a guide to invasion by stage III thymic tumors, and can facilitate the selection of appropriate pre-operative treatment.

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          Most cited references29

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          A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma.

          A clinicopathological study of surgically resected thymomas was performed using Masaoka's staging and modified Masaoka's staging systems, and the utility of these two staging systems was compared. The modification enabled adjustment for the disproportion in the number of cases between Stage I and Stage II. Analysis of survival rates, according to the tumor stage, indicated that the old classification should be reappraised, that is, division into non-invasive and invasive thymomas, although staging may contribute to the indication for postoperative radiotherapy, especially for Stage II disease. Analysis of the cases showed a wide spectrum of aggressiveness, varying from cases showing slow progression with a relatively favorable prognosis, such as the spindle cell type, to cases with rapid progression leading to tumor death in a relatively short time, such as the epithelial cell predominant and polygonal cell type. The pathological stage at the time of first surgical resection would reflect the degree of aggressiveness of thymoma in many instances. Therefore, not only staging the tumor extent but also grading of its aggressiveness are needed in order to predict the prognosis of patients with thymoma. For the latter, histology and cytopathology are helpful.
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            The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms.

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              Thymic epithelial tumours: a population-based study of the incidence, diagnostic procedures and therapy.

              The population-based incidence, diagnostic procedures, therapy and survival of thymic epithelial tumours were determined using the Netherlands National Pathological Archives and the Netherlands Cancer Registry. Excess mortality compared to the Netherlands standard population was estimated by relative survival analysis. Between 1994 and 2003, 537 thymic epithelial tumours were diagnosed. The incidence of all thymic epithelial tumours was 3.2/1,000,000. Diagnosis was obtained by primary resection in 56% of cases. Survival data were available for 232 cases. Not only thymic carcinomas (type C) but also thymomas (types B1-B3) were associated with excess mortality. Cases that underwent resection (78%) had a better survival than non-operated cases (median survival >10 years versus 1.1 years, p<0.001). Amongst the surgically treated cases (n=180), the completeness of resection did not predict survival (p=0.53). Thymic epithelial tumours are rare. Excess mortality was observed in the majority of tumours. Surgery offers the best perspectives, even if the resection is incomplete.
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                Author and article information

                Journal
                Oncol Lett
                Oncol Lett
                OL
                Oncology Letters
                D.A. Spandidos
                1792-1074
                1792-1082
                January 2017
                23 November 2016
                23 November 2016
                : 13
                : 1
                : 29-36
                Affiliations
                [1 ]Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
                [2 ]Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P.R. China
                [3 ]Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, P.R. China
                [4 ]Department of Radiology, Shanghai Jinshan Hospital, Fudan University, Shanghai 201508, P.R. China
                [5 ]Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
                Author notes
                Correspondence to: Dr Minghua Li, Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, P.R. China, E-mail: liminghua1952@ 123456126.com
                [*]

                Contributed equally

                Article
                OL-0-0-5429
                10.3892/ol.2016.5429
                5245091
                e5285707-438c-4251-b18a-991a25b8c42f
                Copyright: © Shen et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                : 01 April 2015
                : 13 May 2016
                Categories
                Articles

                Oncology & Radiotherapy
                computed tomography,feature,thymic tumor,stage,invasion
                Oncology & Radiotherapy
                computed tomography, feature, thymic tumor, stage, invasion

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