WCLC 2025 - Posters & ePosters-P1.04.22 The Relationship Between Nodular Pleural Tail Sign and Metastasis or Recurrence of Peripheral Lung Cancer

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This study investigates the prognostic value of the nodular pleural tail sign (NTs) detected via maximum intensity projection (MIP) reconstructed thin-section CT images in predicting metastasis and recurrence of peripheral lung cancer. The cohort comprised 55 patients with peripheral lung cancer exhibiting pleural tail signs, analyzed using different CT slice thicknesses and MIP reconstruction to visualize the tail signs more clearly compared to standard thin-section CT.<br /><br />Two forms of pleural tail signs were distinguished: nodular tail signs (NTs), characterized by thickened, fused lines forming nodules and blurred interstitial spaces, often accompanying ground-glass or solid nodules; and non-nodular tail signs (N-NTs), showing smooth contours with clear spaces between five linear shadows. The study found that NTs strongly correlated with invasiveness and the likelihood of metastasis or recurrence. Among 44 NTs cases, 30 had preoperative imaging evidence of metastasis, and 21 had pathological confirmation; 10 cases showed postoperative metastasis or recurrence within 2 months to 4 years. Conversely, 10 of 11 N-NTs cases showed no recurrence or metastasis during extensive follow-up. Statistical analysis confirmed the high predictive significance of NTs for metastasis/recurrence (p<0.001), with an AUC-ROC of 0.861.<br /><br />MIP reconstruction improves visualization by differentiating tumor invasion in pulmonary interstitium from vascular structures, enhancing diagnostic accuracy. The nodular tail sign likely represents tumor infiltration into interstitial structures like lymphatic and blood vessels, facilitating tumor spread. Limitations include the small sample size and the need for further imaging-pathological correlation to confirm underlying histology of these signs.<br /><br />In summary, this pioneering work demonstrates that the nodular pleural tail sign on MIP-reconstructed CT images can serve as a valuable imaging biomarker for assessing tumor invasiveness and risk of metastasis or recurrence in peripheral lung cancer, aiding clinical decision-making and prognosis prediction.

Asset Subtitle

Anle Yu

Meta Tag

Speaker Anle Yu

Topic Screening and Early Detection

Keywords

nodular pleural tail sign

maximum intensity projection

thin-section CT

peripheral lung cancer

metastasis prediction

recurrence prediction

tumor invasiveness

MIP reconstruction

imaging biomarker

CT imaging