RADIOLOGICAL FEATURES OF LUNG CANCER SUBTYPES: A STUDY OF CT PATTERNS AND PATHOLOGICAL CORRELATES

Sonja Nikolova

doi:10.35120/medisij040404n

Authors

Sonja Nikolova University Institute of Radiology, Skopje, North Macedonia, Medical Faculty “Ss. Cyril and Methodius”, Skopje, North Macedonia Author

DOI:

https://doi.org/10.35120/medisij040404n

Keywords:

Computed tomography, lung cancer, adenocarcinoma, squamous cell carcinoma, necrosis, TNM staging, metastases

Abstract

Primary lung cancer encompasses heterogeneous histopathological subtypes with distinct clinical and radiological features. Accurate correlation of CT patterns with histology can improve diagnostic assessment and contribute to earlier recognition of aggressive tumor behavior. A retrospective study was conducted on 33 patients (25 males, 8 females; mean age 67.3 years) with histologically confirmed primary lung cancer. Demographic factors, smoking history, histological subtype, and CT characteristics—including lesion size, lobar and segmental distribution, necrosis, and metastatic spread—were analyzed. Radiological staging was performed according to the TNM system, and findings were correlated with histopathology.

Results:

Histology: Adenocarcinoma was the most frequent subtype (51.5%), followed by squamous cell carcinoma (27.3%), with fewer cases of large cell, small cell, mixed, and plano-cellular carcinomas. Adenocarcinoma predominated in both smokers and non-smokers, whereas squamous carcinoma was more frequent among smokers.
Tumor size and location: Mean lesion diameter was 5.9 cm (range: 1.5–13 cm). The most common sites were the right lower lobe (33.3%) and right upper lobe (30.3%), particularly in posterior basal and posterior segments.
Necrosis: Present in 54.5% of tumors, necrosis was more frequent in squamous carcinomas (44.4%) compared with adenocarcinomas (33.3%), while adenocarcinomas were more often necrosis-free (75%).
Metastases: Distant spread occurred in 27.3% of patients, predominantly to adrenal glands (44.4%) and brain (22.2%), with additional involvement of liver (11.1%) and lymph nodes/contralateral lung (55.6%). Adenocarcinoma accounted for two-thirds of metastatic cases.
Staging: Advanced disease predominated, with stage IIIB (27.3%) and stage IVA (18.2%) most frequent. Only 24.2% of patients were diagnosed at early operable stages (IA–IIB).

CT–pathology correlation demonstrated that adenocarcinoma is the predominant subtype across smoking categories, whereas squamous carcinoma more frequently exhibited necrosis. Most patients presented with large tumors and advanced disease, with metastases reflecting typical spread patterns. These findings underscore the diagnostic value of CT in characterizing histological subtypes, staging, and guiding clinical management, while reinforcing the need for earlier detection and screening strategies.

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