Research progress in clinical diagnosis and treatment of lung cancer associated with cystic airspaces_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHEN Xu ^1,2 ,  SHEN Cheng ² ,  ZHU Yunke ²

1. Department of Thoracic Surgery, Shangjin Hospital West China Hospital/Chengdu Shangjin Nanfu Hospital, Chengdu, 611743, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

SHEN Cheng, Email: shencheng568_hx@163.com; ZHU Yunke, Email: yunke_zhu@qq.com

Keywords：

Lung cancer associated with cystic airspaces; pathogenesis; imaging features; pathological features; genetic mutation characteristics; clinical treatment; prognosis

DOI：

10.7507/1007-4848.202512076

Video：

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Lung cancer is the malignant tumor with the highest global incidence and mortality rates. With the widespread application of chest CT, its detection rate has shown a gradual upward trend. Early-stage lung cancer lesions typically appear on chest CT as pure ground-glass nodules, solid nodules, and mixed ground-glass nodules. Lung cancer associated with cystic airspaces (LCCA), as a subtype with distinctive imaging features, is also being detected with increasing frequency. Pathologically, LCCA is predominantly adenocarcinoma or squamous cell carcinoma, often characterized by thick walls, solid components, and necrotic tissue, suggesting a more aggressive behavior. Given that the early imaging manifestations of LCCA lack specificity, it is prone to clinical misdiagnosis as benign conditions such as pulmonary infection, pulmonary bullae, or tuberculosis, leading to missed or incorrect diagnosis. Currently, related research primarily focuses on its pathogenesis, imaging morphology, and diagnosis, while systematic investigation into its clinical treatment strategies and prognosis remains insufficient. Therefore, this article provides a review of recent research advances in the pathogenesis, imaging features, radiomics and histopathological characteristics, diagnosis, genetic mutation profiles, as well as treatment and prognosis of LCCA.

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3.	Womack NA, Graham EA. Epithelial metaplasia in congenital cystic disease of the lung: its possible relation to carcinoma of the bronchus. Am J Pathol, 1941, 17(5): 645-654.
4.	Snoeckx A, Reyntiens P, Carp L, et al. Diagnostic and clinical features of lung cancer associated with cystic airspaces. J Thorac Dis, 2019, 11(3): 987-1004.
5.	陳文慧, 張雪麗, 張鐳, 等. 表現為雙肺多發空洞影的原發或轉移性惡性腫瘤的臨床特點. 中華結核和呼吸雜志, 2016, 39(2): 88-92.Chen WH, Zhang XL, Zhang L, et al. The clinical features of primary or metastatic malignancies presenting with multiple lung cavities. Chin J Tuberc Respir Dis, 2016, 39(2): 88-92.
6.	Mendoza DP, Heeger A, Mino-Kenudson M, et al. Clinicopathologic and longitudinal imaging features of lung cancer associated with cystic airspaces: a systematic review and meta-analysis. AJR Am J Roentgenol, 2021, 216(2): 318-329.
7.	Guo J, Liang C, Sun YJ, et al. Lung cancer presenting as thin-walled cysts: an analysis of 15 cases and review of literature. Asia Pac J Clin Oncol, 2016, 12(1): e105-e112.
8.	Wang K, Leng XC, Yi H, et al. Lung cancer associated with cystic airspaces: current insights into diagnosis, pathophysiology, and treatment strategies. Cancers (Basel), 2024, 16(23): 3930.
9.	Guiance I, Meade C, McCambridge A, et al. Pulmonary artery pseudoaneurysm arising from primary lung neoplasm: a proposed mechanism. Respir Med Case Rep, 2023, 47: 101965.
10.	Wang C, Jin Y, Liu C, et al. Comparative study on CT image characteristics of pneumoconiosis large shadow and primary lung cancer mass. Chin J Ind Hyg Occup Dis, 2024, 42(7): 523-529.
11.	Liu Z, Feng HX, Zhang ZR, et al. Clinicopathological characteristics of solitary cavitary lung cancer: a case-control study. J Thorac Dis, 2020, 12(6): 3148-3156.
12.	Nguyen N, Abhishek K, Nyon S, et al. Are there radiographic, metabolic, and prognostic differences between cavitary and noncavitary nonsmall cell lung carcinoma? A retrospective fluorodeoxyglucose positron emission tomography/computed tomography study. Ann Thorac Med, 2016, 11(1): 49-54.
13.	Habib S, Leifer L, Azam M, et al. Giant cell carcinoma of the lung successfully treated with surgical resection and adjuvant vinorelbine and cisplatin. Respir Med Case Rep, 2018, 25: 300-302.
14.	Gao L, Xie S, Liu H, et al. Lung cancer in patients with combined pulmonary fibrosis and emphysema revisited with the 2015 World Health Organization classification of lung tumors. Clin Respir J, 2016, 12(2): 652-658.
15.	Yoo H, Jeong BH, Chung M, et al. Risk factors and clinical characteristics of lung cancer in idiopathic pulmonary fibrosis: a retrospective cohort study. BMC Pulm Med, 2019, 19(1): 149.
16.	Xu X, Zhang M, Guo J, et al. The impact of cystic lesions on the postoperative prognosis of non-small cell lung cancer: a comparative study. Clin Radiol, 2024, 79(11): 842-850.
17.	Verma R, Bhalla A, Goyal A, et al. Ominous lung cavity "Tambourine sign". World J Clin Cases, 2017, 5(4): 153-158.
18.	Arwi G, Fogarty P, Mant A, et al. Multilobar massive cavitating adenocarcinoma: a case report. J Med Case Rep, 2025, 19(1): 269.
19.	Ciofiac C, M?muleanu M, Florescu L, et al. CT imaging patterns in major histological types of lung cancer. Life (Basel), 2024, 14(4): 462.
20.	Takamori S, Yamaguchi M, Taguchi K, et al. Uncommon features of surgically resected ALK-positive cavitary lung adenocarcinoma: a case report. Surg Case Rep, 2017, 3(1): 46.
21.	Shubietah A, Hamadi O, Doudein M, et al. Metastatic lung adenocarcinoma presenting with cavitary and consolidative lung findings: a diagnostic dilemma. Case Rep Oncol Med, 2025, 2025: 5007092.
22.	Guo J, Liao ZJ, Dong AS. FDG PET/CT in a case of lung adenocarcinoma with diffuse cavitary intrapulmonary metastases. Clin Nucl Med, 2023, 48(5): 428-430.
23.	Gundogdu N. A case of lung abscess mimicking lung cancer. J Coll Physicians Surg Pak, 2021, 31(11): 1366-1368.
24.	Xie LJ, Li JF, Liu Z, et al. Immunoglobulin G4-related lung disease presenting as lung cavitating mass and mimicking lung cancer. Arch Rheumatol, 2017, 32(4): 365-369.
25.	Martell M, Linton-Reid K, Chen M, et al. Radiomics for lung cancer diagnosis, management, and future prospects. Clin Radiol, 2025, 86: 106926.
26.	Gao H, Li J, Wu Y, et al. Imaging-aided diagnosis and treatment based on artificial intelligence for pulmonary nodules: a review. Phys Med, 2025, 136: 105050.
27.	Tang X, Wu F, Chen X, et al. Current status and prospect of PET-related imaging radiomics in lung cancer. Front Oncol, 2023, 13: 1297674.
28.	Li CR, Li YZ, Li YM, et al. Dynamic and contrast enhanced CT imaging of lung carcinoma, pulmonary tuberculoma, and inflammatory pseudotumor. Eur Rev Med Pharmacol Sci, 2017, 21(7): 1588-1592.
29.	Tang W, Xing W, Li C, et al. Differences in CT imaging signs between patients with tuberculosis and those with tuberculosis and concurrent lung cancer. Am J Transl Res, 2022, 14(9): 6234-6242.
30.	Gafoor K, Patel S, Girvin F, et al. Cavitary lung diseases: a clinical-radiologic algorithmic approach. Chest, 2018, 153(6): 1443-1465.
31.	Wang BN, Shen C, Liu DL, et al. A comprehensive review of advances in molecular mechanisms and targeted therapies for the specific type of cystic lung cancer. Onco Targets Ther, 2025, 18: 211-224.
32.	Chen GQ, Yu Q, Ran HF, et al. Rare cavitary lymphoepithelioma-like carcinoma of lung: clinical experience and literature review. BMC Pulm Med, 2023, 23(1): 246.
33.	Watanabe A, Fukunari H, Mito M, et al. A case of cavitary lung metastasis of rectal cancer. Gan To Kagaku Ryoho, 2020, 47(13): 2080-2082.
34.	Tsuji T, Nishimura A, Tawara H, et al. Unusual case of cavitary lung metastasis of esophageal cancer: a case report. Int J Surg Case Rep, 2021, 80: 105662.
35.	Funasaka T, Makino Y, Shibata T, et al. Multiple cavitary pulmonary metastases from pancreatic cancer diagnosed using transbronchial lung cryobiopsy. Respirol Case Rep, 2024, 12(9): e70031.
36.	Dong J, Li B, Lin D, et al. Advances in targeted therapy and immunotherapy for non-small cell lung cancer based on accurate molecular typing. Front Pharmacol, 2019, 10: 230.
37.	Lee S. Chemotherapy for lung cancer in the era of personalized medicine. Tuberc Respir Dis (Seoul), 2018, 82(3): 179-189.
38.	Sha C, Lee P. EGFR-targeted therapies: a literature review. J Clin Med, 2024, 13(21): 6391.
39.	Reyes A, Pharaon R, Mohanty A, et al. Arising novel agents in lung cancer: are bispecifics and ADCs the new paradigm. Cancers (Basel), 2023, 15(12): 3162.
40.	La'ah A, Chiou SH. Cutting-edge therapies for lung cancer. Cells, 2024, 13(5): 436.
41.	Yang T, Xiong Y, Zeng Y, et al. Current status of immunotherapy for non-small cell lung cancer. Front Pharmacol, 2022, 13: 989461.
42.	陳雪, 宋曉. 光動力療法在肺癌聯合治療中的應用與進展. 中華結核和呼吸雜志, 2023, 46(4): 424-429.Chen X, Song X. Application and progress of photodynamic therapy in combination therapy of lung cancer. Chin J Tuberc Respir Dis, 2023, 46(4): 424-429.
43.	Watanabe Y, Kusumoto M, Yoshida A, et al. Cavity wall thickness in solitary cavitary lung adenocarcinomas is a prognostic indicator. Ann Thorac Surg, 2016, 102(6): 1863-1871.

1. World Health Organization/International Agency for Research on Cancer. Latest global cancer data: cancer burden rises to 19.3 million new cases and 10.0 million cancer deaths in 2020. (2020-12-16) [2021-03-01].
2. Farooqi AO, Cham M, Zhang L, et al. Lung cancer associated with cystic airspaces. AJR Am J Roentgenol, 2012, 199(4): 781-786.
3. Womack NA, Graham EA. Epithelial metaplasia in congenital cystic disease of the lung: its possible relation to carcinoma of the bronchus. Am J Pathol, 1941, 17(5): 645-654.
4. Snoeckx A, Reyntiens P, Carp L, et al. Diagnostic and clinical features of lung cancer associated with cystic airspaces. J Thorac Dis, 2019, 11(3): 987-1004.
5. 陳文慧, 張雪麗, 張鐳, 等. 表現為雙肺多發空洞影的原發或轉移性惡性腫瘤的臨床特點. 中華結核和呼吸雜志, 2016, 39(2): 88-92.Chen WH, Zhang XL, Zhang L, et al. The clinical features of primary or metastatic malignancies presenting with multiple lung cavities. Chin J Tuberc Respir Dis, 2016, 39(2): 88-92.
6. Mendoza DP, Heeger A, Mino-Kenudson M, et al. Clinicopathologic and longitudinal imaging features of lung cancer associated with cystic airspaces: a systematic review and meta-analysis. AJR Am J Roentgenol, 2021, 216(2): 318-329.
7. Guo J, Liang C, Sun YJ, et al. Lung cancer presenting as thin-walled cysts: an analysis of 15 cases and review of literature. Asia Pac J Clin Oncol, 2016, 12(1): e105-e112.
8. Wang K, Leng XC, Yi H, et al. Lung cancer associated with cystic airspaces: current insights into diagnosis, pathophysiology, and treatment strategies. Cancers (Basel), 2024, 16(23): 3930.
9. Guiance I, Meade C, McCambridge A, et al. Pulmonary artery pseudoaneurysm arising from primary lung neoplasm: a proposed mechanism. Respir Med Case Rep, 2023, 47: 101965.
10. Wang C, Jin Y, Liu C, et al. Comparative study on CT image characteristics of pneumoconiosis large shadow and primary lung cancer mass. Chin J Ind Hyg Occup Dis, 2024, 42(7): 523-529.
11. Liu Z, Feng HX, Zhang ZR, et al. Clinicopathological characteristics of solitary cavitary lung cancer: a case-control study. J Thorac Dis, 2020, 12(6): 3148-3156.
12. Nguyen N, Abhishek K, Nyon S, et al. Are there radiographic, metabolic, and prognostic differences between cavitary and noncavitary nonsmall cell lung carcinoma? A retrospective fluorodeoxyglucose positron emission tomography/computed tomography study. Ann Thorac Med, 2016, 11(1): 49-54.
13. Habib S, Leifer L, Azam M, et al. Giant cell carcinoma of the lung successfully treated with surgical resection and adjuvant vinorelbine and cisplatin. Respir Med Case Rep, 2018, 25: 300-302.
14. Gao L, Xie S, Liu H, et al. Lung cancer in patients with combined pulmonary fibrosis and emphysema revisited with the 2015 World Health Organization classification of lung tumors. Clin Respir J, 2016, 12(2): 652-658.
15. Yoo H, Jeong BH, Chung M, et al. Risk factors and clinical characteristics of lung cancer in idiopathic pulmonary fibrosis: a retrospective cohort study. BMC Pulm Med, 2019, 19(1): 149.
16. Xu X, Zhang M, Guo J, et al. The impact of cystic lesions on the postoperative prognosis of non-small cell lung cancer: a comparative study. Clin Radiol, 2024, 79(11): 842-850.
17. Verma R, Bhalla A, Goyal A, et al. Ominous lung cavity "Tambourine sign". World J Clin Cases, 2017, 5(4): 153-158.
18. Arwi G, Fogarty P, Mant A, et al. Multilobar massive cavitating adenocarcinoma: a case report. J Med Case Rep, 2025, 19(1): 269.
19. Ciofiac C, M?muleanu M, Florescu L, et al. CT imaging patterns in major histological types of lung cancer. Life (Basel), 2024, 14(4): 462.
20. Takamori S, Yamaguchi M, Taguchi K, et al. Uncommon features of surgically resected ALK-positive cavitary lung adenocarcinoma: a case report. Surg Case Rep, 2017, 3(1): 46.
21. Shubietah A, Hamadi O, Doudein M, et al. Metastatic lung adenocarcinoma presenting with cavitary and consolidative lung findings: a diagnostic dilemma. Case Rep Oncol Med, 2025, 2025: 5007092.
22. Guo J, Liao ZJ, Dong AS. FDG PET/CT in a case of lung adenocarcinoma with diffuse cavitary intrapulmonary metastases. Clin Nucl Med, 2023, 48(5): 428-430.
23. Gundogdu N. A case of lung abscess mimicking lung cancer. J Coll Physicians Surg Pak, 2021, 31(11): 1366-1368.
24. Xie LJ, Li JF, Liu Z, et al. Immunoglobulin G4-related lung disease presenting as lung cavitating mass and mimicking lung cancer. Arch Rheumatol, 2017, 32(4): 365-369.
25. Martell M, Linton-Reid K, Chen M, et al. Radiomics for lung cancer diagnosis, management, and future prospects. Clin Radiol, 2025, 86: 106926.
26. Gao H, Li J, Wu Y, et al. Imaging-aided diagnosis and treatment based on artificial intelligence for pulmonary nodules: a review. Phys Med, 2025, 136: 105050.
27. Tang X, Wu F, Chen X, et al. Current status and prospect of PET-related imaging radiomics in lung cancer. Front Oncol, 2023, 13: 1297674.
28. Li CR, Li YZ, Li YM, et al. Dynamic and contrast enhanced CT imaging of lung carcinoma, pulmonary tuberculoma, and inflammatory pseudotumor. Eur Rev Med Pharmacol Sci, 2017, 21(7): 1588-1592.
29. Tang W, Xing W, Li C, et al. Differences in CT imaging signs between patients with tuberculosis and those with tuberculosis and concurrent lung cancer. Am J Transl Res, 2022, 14(9): 6234-6242.
30. Gafoor K, Patel S, Girvin F, et al. Cavitary lung diseases: a clinical-radiologic algorithmic approach. Chest, 2018, 153(6): 1443-1465.
31. Wang BN, Shen C, Liu DL, et al. A comprehensive review of advances in molecular mechanisms and targeted therapies for the specific type of cystic lung cancer. Onco Targets Ther, 2025, 18: 211-224.
32. Chen GQ, Yu Q, Ran HF, et al. Rare cavitary lymphoepithelioma-like carcinoma of lung: clinical experience and literature review. BMC Pulm Med, 2023, 23(1): 246.
33. Watanabe A, Fukunari H, Mito M, et al. A case of cavitary lung metastasis of rectal cancer. Gan To Kagaku Ryoho, 2020, 47(13): 2080-2082.
34. Tsuji T, Nishimura A, Tawara H, et al. Unusual case of cavitary lung metastasis of esophageal cancer: a case report. Int J Surg Case Rep, 2021, 80: 105662.
35. Funasaka T, Makino Y, Shibata T, et al. Multiple cavitary pulmonary metastases from pancreatic cancer diagnosed using transbronchial lung cryobiopsy. Respirol Case Rep, 2024, 12(9): e70031.
36. Dong J, Li B, Lin D, et al. Advances in targeted therapy and immunotherapy for non-small cell lung cancer based on accurate molecular typing. Front Pharmacol, 2019, 10: 230.
37. Lee S. Chemotherapy for lung cancer in the era of personalized medicine. Tuberc Respir Dis (Seoul), 2018, 82(3): 179-189.
38. Sha C, Lee P. EGFR-targeted therapies: a literature review. J Clin Med, 2024, 13(21): 6391.
39. Reyes A, Pharaon R, Mohanty A, et al. Arising novel agents in lung cancer: are bispecifics and ADCs the new paradigm. Cancers (Basel), 2023, 15(12): 3162.
40. La'ah A, Chiou SH. Cutting-edge therapies for lung cancer. Cells, 2024, 13(5): 436.
41. Yang T, Xiong Y, Zeng Y, et al. Current status of immunotherapy for non-small cell lung cancer. Front Pharmacol, 2022, 13: 989461.
42. 陳雪, 宋曉. 光動力療法在肺癌聯合治療中的應用與進展. 中華結核和呼吸雜志, 2023, 46(4): 424-429.Chen X, Song X. Application and progress of photodynamic therapy in combination therapy of lung cancer. Chin J Tuberc Respir Dis, 2023, 46(4): 424-429.
43. Watanabe Y, Kusumoto M, Yoshida A, et al. Cavity wall thickness in solitary cavitary lung adenocarcinomas is a prognostic indicator. Ann Thorac Surg, 2016, 102(6): 1863-1871.

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