Korean J Radiol.  2018 Oct;19(5):930-937. 10.3348/kjr.2018.19.5.930.

Role of CT in Differentiating Malignant Focal Splenic Lesions

Affiliations
  • 1Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. jhkim2008@gmail.com
  • 2Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
  • 3Department of Radiology, National Cancer Center, Goyang 10408, Korea.

Abstract


OBJECTIVE
The purpose of this study was to asses the CT findings and clinical features differentiating malignant from benign focal splenic lesions.
MATERIALS AND METHODS
Among 673 patients with splenectomy, we included 114 patients with pathologically confirmed focal splenic lesions (malignant = 66, benign = 48). Two radiologists retrospectively assessed CT findings including: size, number, solid component, margin, wall, calcification, contrast-enhancement, lymph node (LN) enlargement and possible malignancy. We assessed clinical features including age, sex, underlying malignancy, fever, and leukocytosis. Multivariate logistic regression analysis was performed to identify significant predictors of malignant lesion. We used receiver operating curve analysis for determination of diagnostic performance.
RESULTS
Common findings of malignant lesions include enhanced, mainly solid, ill-defined margin, absence of splenomegaly, absence of the wall, absence of calcification, LN enlargement, and presence of underlying malignancy (p < 0.05). Among them, mainly solid features (odds ratio [OR], 39.098, p = 0.007), LN enlargement (OR, 6.326, p = 0.005), and presence of underlying malignancy (OR, 8.615, p = 0.001) were significant predictors of malignancy. The mean size of benign splenic lesions (5.8 ± 3.3 cm) was larger than that of malignant splenic lesions (4.0 ± 3.4 cm). Diagnostic performance of CT findings by two reviewers using receiver operating characteristic curve analysis for differentiation of malignant lesions was 0.856 and 0.893, respectively.
CONCLUSION
Solid nature of the splenic mass on CT images, LN enlargement, and presence of underlying malignancy are significant predictors of malignant splenic lesion.

Keyword

Spleen; Splenic diseases; Splenectomy; Computed tomography; Malignancy
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