The prognosis of different types of pleural tags based on radiologic- pathologic comparison

Objectives: There are increasing numbers of studies of pleural tags (PTs). The purpose of this case series was to classify the PTs in patients with peripheral pulmonary adenocarcinoma based on radiologic-pathologic comparison and to study the prognosis. Methods: : The clinical, imaging, pathological and prognostic data of 161 patients with peripheral pulmonary adenocarcinoma in three hospitals were analyzed retrospectively. We classified PTs using computed tomography (CT) for pathologic comparison. Results: : The CT features were classified into non-interlobular PTs ( type 1, one or more linear non-interlobular PT; type 2, one or more linear non-interlobular PT with soft tissue component at the pleural end; type 3, one soft tissue cord-like non-interlobular PT; type 4, directly abutting the non-interlobular pleura) and interlobular PTs (type 1, pulling the interlobular pleura to the homolateral side; type 2, one or more linear interlobular PT; and type 3, pushing the interlobular pleura to the contralateral side). In these PTs, the incidence of visceral pleural invasion (VPI) was high in type 2 (46.88%) and type 3 (56.41%) of non-interlobular PTs. Our prognostic analysis showed that micropapillary or solid histological subtype (HR = 5.766, 95% CI: 1.435-23.159, P = 0.014) and type 3 of non-interlobular PTs (HR = 11.058, 95% CI: 1.349-90.623, P = 0.025) were two independent risk factors for tumor progression. Conclusions: PT is a risk factor for poor prognosis of patients, the presence of which on CT images can remind us to provide patients with a more reasonable treatment.