Imaging features of lung cancer with cystic airspaces: clinical utility, challenges, and perspectives.

Lung cancer is a leading cause of cancer-related deaths worldwide and poses a significant health burden. Early diagnosis is critical for reducing lung cancer mortality. Lung Cancer with Cystic Airspaces (LCCA) is a distinct morphological subtype of lung cancer, characterized on imaging by cystic regions accompanied by solid components and/or ground-glass opacities. LCCA is relatively rare, with an incompletely understood pathogenesis, marked heterogeneity, and complex imaging manifestations. It accounts for approximately one-quarter of lung cancer cases that are missed or diagnosed late. With the widespread implementation of lung cancer screening, the detection rate of LCCA is increasing and has drawn growing attention. However, current research is limited by small sample sizes and predominantly retrospective study designs, posing significant clinical challenges in LCCA management. This article reviews the definition and underlying mechanisms of LCCA, systematically summarizes the clinical value of noninvasive imaging in diagnosis, classification, invasiveness prediction, staging, and prognosis assessment of LCCA, and discusses the limitations of existing studies as well as future research directions and challenges. The goal is to provide a theoretical basis for optimizing early lung cancer screening pathways and developing individualized intervention strategies, which holds important clinical significance for reducing lung cancer-related mortality.