We retrospectively studied the correlation between high-resolution computed tomography (HRCT) findings and both pathologic findings and prognosis in 137 patients with small pulmonary adenocarcinomas (tumor diameter 20 mm or less). We then evaluated the usefulness of our classification on HRCT findings for predicting outcome and formulating a therapeutic strategy. Tumors were classified according to attenuation of on HRCT images as the 'air-containing type' or the 'solid-density type'. The air-containing type adenocarcinomas (n = 66) revealed no lymphnode involvement detected surgically or pathologically, and revealed minimal microscopic evidence of metastasis (pleural involvement, vascular invasion, or lymphatic permeation). Furthermore, the relapse-free and overall survival curves of the air-containing types revealed no relapses or deaths. Patients with solid-density type adenocarcinomas (n = 71), on the other hand, demonstrated a poor prognosis. Consequently, it seems likely that air-containing adenocarcinomas 20 mm or less in diameter on HRCT may be treated successfully by limited lung resection.
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