Correlation between Computed Tomography Imaging Features and Clinical Characteristics of Thymic Epithelial Tumors

Abstract Objective: To explore the correlation between computed tomography (CT) imaging features and clinical characteristics, Masaoka-Koga stage, tumor-node-metastasis (TNM) stage and World Health Organization (WHO) histological classification of patients with thymic epithelial tumors (TETs). Methods: A total of 209 patients with TETs who underwent preoperative contrast-enhanced CT from October 2013 to October 2020 were retrospectively analyzed. Clinical information, CT imaging features and pathological findings were assessed for each patient. A total of 164 patients were followed up from the date of surgery until January 2022, and information on survival and postoperative recurrence were obtained. The relationship between CT imaging features and clinical features, Masaoka-Koga stage, TNM stage and WHO histological classification of TETs was evaluated. Risk factors related to Masaoka-Koga stage, TNM stage and WHO histological classification were determined.Results: Among all radiographic and clinical features, tumor shape, contour, calcification, internal density, fat plane separating tumor from vessels, infiltration of surrounding fat, adjacent lung changes, degree of abutment of vessel circumference, presence of effusion, lymphadenopathy, CA125 and CA724 differed significantly between TNM stage I/II and III/IV TETs. Infiltration of surrounding fat (odds ratio [OR] = 4.296, P = 0.015) and lymphadenopathy (OR = 3.753, P = 0.041) were independent risk factors. Tumor shape, contour, calcification, internal density, fat plane separating tumor from vessels, infiltration of surrounding fat, adjacent lung changes, degree of abutment of vessel circumference, presence of effusion, lymphadenopathy and pleural nodularity differed significantly between Masaoka-Koga stage I/II and III/IV thymomas and thymic carcinomas. Infiltration of surrounding fat (OR = 11.855, P<0.0001) was an independent risk factor. Tumor shape, fat plane separating tumor from vessels, infiltration of surrounding fat, lymphadenopathy and myasthenia gravis differed significantly between WHO classification high-risk and low-risk group. Gender (OR = 2.27, P = 0.044), tumor shape (OR = 4.044, P = 0.001), infiltration of surrounding fat (OR = 3.617, P = 0.005), lymphadenopathy (OR = 4.565, P = 0.015) and myasthenia gravis (OR = 4.309, P<0.0001) were independent risk factors.Conclusions: Some CT imaging and clinical features were significantly correlated with Masaoka-Koga stage, TNM stage and WHO histological classification in TET patients. Therefore, knowledge of CT features considered independent risk factors can aid in preoperative evaluation, decision-making and postoperative management of TET patients.