European Journal of Cardiovascular Medicine

Bronchogenic carcinoma remains one of the most frequently diagnosed malignancies worldwide and continues to be the leading cause of cancer-related deaths, surpassing those attributed to colorectal, breast, and prostate cancers combined (1). In the early 20th century, this form of lung cancer was considered rare; however, the widespread rise in tobacco use, air pollution, and occupational exposures has significantly escalated its global incidence (2). Particularly in developing nations like India, the burden of bronchogenic carcinoma is rising rapidly, necessitating focused efforts on prevention, early detection, and effective management (3).

Imaging techniques play a critical role in the diagnostic work-up, staging, treatment planning, and surveillance of lung cancer. Among the available imaging modalities, contrast-enhanced Multi-Detector Computed Tomography (MDCT) has become the cornerstone for the initial evaluation and staging of bronchogenic carcinoma due to its ability to provide high-resolution anatomical detail and rapid image acquisition (4). MDCT allows for volumetric data reconstruction and provides superior characterization of pulmonary lesions, aiding in differentiating malignant from benign nodules (5).

Accurate staging using the TNM classification system is essential for determining therapeutic strategies and predicting prognosis in lung cancer patients. MDCT effectively assesses tumor size, local invasion, lymphadenopathy, and metastatic spread, offering crucial information for staging, especially in distinguishing operable from inoperable disease (6). Despite its strengths, MDCT has demonstrated limitations, particularly in evaluating mediastinal lymph node involvement and distant metastases. In such cases, the addition of functional imaging with positron emission tomography-computed tomography (PET-CT) has been shown to enhance diagnostic precision by combining anatomical and metabolic data (7,8).

Several studies have highlighted the high sensitivity and diagnostic accuracy of MDCT in staging bronchogenic carcinoma, with substantial concordance observed between imaging findings and histopathological results. However, specificity can vary depending on the population studied and the prevalence of benign mimics (9,10). In light of these observations, the present study was undertaken to evaluate the utility of contrast-enhanced MDCT in assessing the radiological features and staging of bronchogenic carcinoma, with correlation to histopathological findings to determine its diagnostic accuracy and clinical reliability.

Study Design and Setting

This prospective observational study was conducted in the Department of Radiodiagnosis at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, over a period of two years from November 2020 to October 2022.

Study Population

The study enrolled 50 patients with clinical suspicion of bronchogenic carcinoma who were referred for contrast-enhanced Multi-Detector Computed Tomography (MDCT) imaging. Inclusion criteria comprised patients aged above 18 years presenting with symptoms such as cough, hemoptysis, breathlessness, chest pain, or unexplained weight loss, and radiological evidence suggestive of a mass lesion in the lungs. Patients with known extrapulmonary primary malignancies, known allergies to iodinated contrast, renal dysfunction (serum creatinine >1.5 mg/dL), or pregnancy were excluded from the study.

Sampling Technique

Non-probability consecutive sampling was used to recruit all eligible and consenting patients referred to the department during the study period.

Imaging Protocol

All patients underwent a contrast-enhanced MDCT scan using a 16-slice or higher CT scanner. Imaging included both plain and post-contrast axial scans from the thoracic inlet to the adrenal glands, reconstructed at 1–2 mm slice thickness. Intravenous contrast (non-ionic iodinated contrast agent) was administered at a dose of 1.5 mL/kg body weight, with a flow rate of 3–4 mL/sec using an automated injector.

The parameters assessed on MDCT included:

• Tumor location (central/peripheral),
• Tumor size and margins,
• Presence of cavitation, calcification, or necrosis,
• Enhancement characteristics (homogeneous or heterogeneous),
• Presence of bronchus cut-off sign,
• Lymphadenopathy (short-axis diameter >1 cm),
• Mediastinal invasion,
• Pleural effusion,
• Pericardial involvement,
• Distant metastasis (adrenals, bones, liver, brain).

Staging

The radiological staging of bronchogenic carcinoma was performed using the TNM classification as per the 8th edition of the American Joint Committee on Cancer (AJCC) guidelines.

Histopathological Correlation

All patients underwent tissue sampling via bronchoscopy or CT-guided transthoracic biopsy, based on lesion location and patient suitability. The histopathological examination was performed by experienced pathologists blinded to the imaging findings. The histological subtypes were classified into adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and others.

Statistical Analysis

Data were compiled using Microsoft Excel and analyzed using SPSS version 20.0. Categorical variables were presented as frequencies and percentages. Diagnostic performance parameters of MDCT—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy—were calculated using histopathological diagnosis as the gold standard. A p-value of <0.05 was considered statistically significant.

A total of 50 patients with clinically and radiologically suspected bronchogenic carcinoma were included in the study. The demographic and clinical profile of the patients is summarized in Table 1.

Demographic and Clinical Characteristics

The mean age of the study participants was 62.4 ± 11.3 years, with the majority (54%) being over the age of 60. Males constituted 70% of the sample, reflecting the known male predominance of bronchogenic carcinoma. The most commonly reported symptom was cough (70%), followed by weight loss (58%), loss of appetite (58%), chest pain (46%), and hemoptysis (36%) (Table 1).

Table 1: Demographic and Clinical Profile of Study Population (n=50)

Imaging Features

CT evaluation revealed that the most common tumor size ranged from 3 to 5 cm (36%), followed by tumors >5 cm (28%). Tumor location was more frequently central (60%) than peripheral (40%). A bronchus cut-off sign was observed in 86% of cases. Enhancement after contrast administration was present in 86% of lesions, with 74% showing homogeneous enhancement. Mediastinal lymphadenopathy was noted in 88% of patients, and distant metastases were seen in 52% of cases (Table 2).

Table 2: CT Imaging Features of Lesions (n=50)

Histopathological Subtypes

Histopathology confirmed adenocarcinoma as the most prevalent subtype (44%), followed by squamous cell carcinoma (32%), small cell carcinoma (14%), and others (10%) (Table 3).

Table 3: Distribution of Histopathological Subtypes (n=50)

TNM Staging Based on MDCT

Radiological staging using MDCT showed that T3 lesions were most common (28%), followed by T2 (24%) and T4 (22%). Nodal staging revealed N2 involvement in 38% of patients, while distant metastases (M1) were observed in 36% (Table 4).

Table 4: Radiological TNM Staging by MDCT (n=50)

Diagnostic Performance of MDCT

When compared with histopathological findings as the reference standard, MDCT showed high sensitivity (95.74%) and diagnostic accuracy (92%), though specificity was relatively low (33.3%). Positive predictive value (PPV) and negative predictive value (NPV) were 95.74% and 33.3%, respectively (Table 5).

Table 5: Diagnostic Validity of MDCT in Bronchogenic Carcinoma (n=50)

The findings of this study demonstrate that contrast-enhanced Multi-Detector Computed Tomography (MDCT) remains a highly sensitive imaging modality for the detection and staging of bronchogenic carcinoma. With a sensitivity of 95.74% and diagnostic accuracy of 92%, MDCT proved effective in identifying primary tumors, mediastinal lymphadenopathy, and distant metastases. These results align with prior studies reporting MDCT sensitivity ranging from 89% to 97% in lung cancer diagnosis (1,2).

Bronchogenic carcinoma showed a strong male predominance in this study (70%), which is consistent with previous epidemiological trends reflecting higher smoking prevalence among males in India (3,4). The peak incidence was observed in patients aged over 60 years, reinforcing the fact that bronchogenic carcinoma is predominantly a disease of the elderly (5). Cough, weight loss, and appetite loss were the most common presenting symptoms, mirroring findings from earlier clinical observations (6,7).

CT imaging features such as the bronchus cut-off sign (seen in 86% of cases), contrast enhancement (86%), and homogeneous lesion density (74%) were useful in suggesting malignancy. These radiological signs are frequently cited as reliable indicators of endobronchial tumor involvement and vascularity (8). Central lesions were more commonly observed than peripheral lesions, particularly among squamous cell carcinoma cases, which tend to arise near major airways (9,10).

The predominant histological subtype in our study was adenocarcinoma (44%), followed by squamous cell carcinoma (32%). This is in line with recent literature showing a global shift from squamous cell to adenocarcinoma, particularly among non-smokers and females (11,12). Small cell carcinoma accounted for 14% of cases, a figure comparable to global estimates for this aggressive subtype (13).

MDCT accurately staged primary tumors, with the T3 stage being the most frequently identified. However, limitations in nodal staging were evident, particularly in distinguishing reactive from metastatic lymphadenopathy, contributing to the low specificity (33.3%). This finding reflects previous studies which have highlighted the reduced specificity of MDCT in mediastinal staging, often due to size-based criteria (14). In such cases, functional imaging like PET-CT offers enhanced specificity and can complement MDCT findings (15).

Contrast-enhanced Multi-Detector Computed Tomography (MDCT) is a highly sensitive and accurate imaging modality for the initial diagnosis and staging of bronchogenic carcinoma. It effectively delineates the size, location, enhancement characteristics, and extent of tumor involvement, as well as mediastinal lymphadenopathy and distant metastases. In this study, MDCT demonstrated excellent correlation with histopathological findings in terms of tumor detection and subtype differentiation, particularly for adenocarcinoma and squamous cell carcinoma. Although its specificity in nodal staging remains limited, MDCT remains indispensable for pre-treatment evaluation, surgical planning, and guiding biopsy decisions. Integration of MDCT with clinical, pathological, and, where available, PET-CT data can enhance overall diagnostic precision and patient management outcomes in bronchogenic carcinoma.

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