Lung cancer associated with cystic airspaces

AJR Am J Roentgenol. 2012 Oct;199(4):781-6. doi: 10.2214/AJR.11.7812.


Objective: The objectives of this study were to determine the frequency of lung cancers associated with a discrete cystic airspace and to characterize the morphologic and pathologic features of the cancer and the cystic airspace.

Materials and methods: We reviewed all diagnosed cases of lung cancer resulting from baseline screening (n=595) and annual screening (n=111) in the International Early Lung Cancer Action Program to identify those abutting or in the wall of a cystic airspace. We also reviewed the pathologic specimens.

Results: A total of 26 lung cancers were identified abutting or in the wall of a cystic airspace. Of these, 13 were identified at baseline (13/595, 2%) and 13 at annual screening (13/111, 12%), which was significant (p<0.0001). The median circumferential portion of wall involved was less for the annual cancers than for the baseline ones, but this difference did not reach significance (90° vs 240°, p=0.07). The diagnosis was adenocarcinoma in all but three cases. Histologic analysis showed that the cystic space was a bulla, a fibrous walled cyst without a defined lining, or a pleural bleb and that in all but one case, the tumor was eccentric relative to the airspace and the wall of the airspace was unevenly thickened.

Conclusion: At annual repeat CT screening, the finding of an isolated cystic airspace with increased wall thickness should raise the suspicion of lung cancer.

MeSH terms

  • Adenocarcinoma / complications
  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / pathology
  • Aged
  • Cysts / complications
  • Cysts / diagnostic imaging*
  • Cysts / pathology
  • Female
  • Humans
  • Lung Neoplasms / complications
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed*