Visceral pleural invasion
Citation, DOI, disclosures and article data
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosuresAt the time the article was last revised Yuranga Weerakkody had no financial relationships to ineligible companies to disclose.
View Yuranga Weerakkody's current disclosures- Visceral pleural invasion (VPI)
- PL grading system (pleural invasion)
Visceral pleural invasion is a feature that can be seen in lung cancers. It is defined as tumor extension beyond the elastic layer of the visceral pleura, and in some cases may result in a cancer crossing a fissure to invade an adjacent lobe of the lung. It is considered an aggressive sign and one of the most important adverse prognostic factors in non-small cell lung cancers 1.
On this page:
Pathology
Grading
There are three described levels of invasion (based on histology):
PL0: represents tumor invading either the subpleural lung parenchyma or superficially the pleural connective tissue beneath the elastic layer
PL1: refers to a tumor that invades beyond the elastic layer without being exposed on the pleural surface
PL2: refers to a tumor that is exposed on the pleural surface, but it does not involve adjacent anatomic structures
Radiographic features
CT
The presence of type 2 pleural tags has been shown to have a moderate association with visceral pleural invasion 7.
Other reported features to be associated with pleural invasions include 8
jellyfish sign - multiple linear septations between nodule and pleural mimicking jelly tentacles 9
adjacent - pleural thickening
increased contact surface area (pleural-attached nodules)
multiple tags to different pleural surfaces
Treatment and prognosis
According to one study, there was ~20% (range 10-30%) worse 5-year survival in tumors with visceral pleural invasion compared to those without visceral pleural invasion.
See also
References
- 1. Zhao LL, Xie HK, Zhang LP, Zha JY, Zhou FY, Jiang GN, Chen C. Visceral pleural invasion in lung adenocarcinoma ≤3 cm with ground-glass opacity: a clinical, pathological and radiological study. Journal of thoracic disease. 8 (7): 1788-97. doi:10.21037/jtd.2016.05.90 - Pubmed
- 2. Hattori A, Suzuki K, Matsunaga T, Takamochi K, Oh S. Visceral pleural invasion is not a significant prognostic factor in patients with a part-solid lung cancer. The Annals of thoracic surgery. 98 (2): 433-8. doi:10.1016/j.athoracsur.2014.04.084 - Pubmed
- 3. Huang H, Wang T, Hu B, Pan C. Visceral pleural invasion remains a size-independent prognostic factor in stage I non-small cell lung cancer. The Annals of thoracic surgery. 99 (4): 1130-9. doi:10.1016/j.athoracsur.2014.11.052 - Pubmed
- 4. Manac'h D, Riquet M, Medioni J, Le Pimpec-Barthes F, Dujon A, Danel C. Visceral pleura invasion by non-small cell lung cancer: an underrated bad prognostic factor. The Annals of thoracic surgery. 71 (4): 1088-93. Pubmed
- 5. Kang JH, Kim KD, Chung KY. Prognostic value of visceral pleura invasion in non-small cell lung cancer. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 23 (6): 865-9. Pubmed
- 6 . Imai K, Minamiya Y, Ishiyama K, Hashimoto M, Saito H, Motoyama S, Sato Y, Ogawa J. Use of CT to evaluate pleural invasion in non-small cell lung cancer: measurement of the ratio of the interface between tumor and neighboring structures to maximum tumor diameter. Radiology. 267 (2): 619-26. doi:10.1148/radiol.12120864 - Pubmed
- 7. Hsu JS, Han IT, Tsai TH, Lin SF, Jaw TS, Liu GC, Chou SH, Chong IW, Chen CY. Pleural Tags on CT Scans to Predict Visceral Pleural Invasion of Non-Small Cell Lung Cancer That Does Not Abut the Pleura. Radiology. 279 (2): 590-6. doi:10.1148/radiol.2015151120 - Pubmed
- 8. Sun Q, Li P, Zhang J et al. CT Predictors of Visceral Pleural Invasion in Patients with Non–Small Cell Lung Cancers 30 Mm or Smaller. Radiology. 2024;310(1):e231611. doi:10.1148/radiol.231611 - Pubmed
- 9. Nishino M. Jellyfish Sign for Visceral Pleural Invasion in Lung Cancer: Reviving the Lost Art of Radiology. Radiology. 2024;310(1):e233171. doi:10.1148/radiol.233171 - Pubmed
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