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Yang Y, Zhang L, Wang H, Zhao J, Liu J, Chen Y, Lu J, Duan Y, Hu H, Peng H, Ye L. Development and validation of a risk prediction model for invasiveness of pure ground-glass nodules based on a systematic review and meta-analysis. BMC Med Imaging 2024; 24:149. [PMID: 38886695 PMCID: PMC11184730 DOI: 10.1186/s12880-024-01313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Assessing the aggressiveness of pure ground glass nodules early on significantly aids in making informed clinical decisions. OBJECTIVE Developing a predictive model to assess the aggressiveness of pure ground glass nodules in lung adenocarcinoma is the study's goal. METHODS A comprehensive search for studies on the relationship between computed tomography(CT) characteristics and the aggressiveness of pure ground glass nodules was conducted using databases such as PubMed, Embase, Web of Science, Cochrane Library, Scopus, Wanfang, CNKI, VIP, and CBM, up to December 20, 2023. Two independent researchers were responsible for screening literature, extracting data, and assessing the quality of the studies. Meta-analysis was performed using Stata 16.0, with the training data derived from this analysis. To identify publication bias, Funnel plots and Egger tests and Begg test were employed. This meta-analysis facilitated the creation of a risk prediction model for invasive adenocarcinoma in pure ground glass nodules. Data on clinical presentation and CT imaging features of patients treated surgically for these nodules at the Third Affiliated Hospital of Kunming Medical University, from September 2020 to September 2023, were compiled and scrutinized using specific inclusion and exclusion criteria. The model's effectiveness for predicting invasive adenocarcinoma risk in pure ground glass nodules was validated using ROC curves, calibration curves, and decision analysis curves. RESULTS In this analysis, 17 studies were incorporated. Key variables included in the model were the largest diameter of the lesion, average CT value, presence of pleural traction, and spiculation. The derived formula from the meta-analysis was: 1.16×the largest lesion diameter + 0.01 × the average CT value + 0.66 × pleural traction + 0.44 × spiculation. This model underwent validation using an external set of 512 pure ground glass nodules, demonstrating good diagnostic performance with an ROC curve area of 0.880 (95% CI: 0.852-0.909). The calibration curve indicated accurate predictions, and the decision analysis curve suggested high clinical applicability of the model. CONCLUSION We established a predictive model for determining the invasiveness of pure ground-glass nodules, incorporating four key radiological indicators. This model is both straightforward and effective for identifying patients with a high likelihood of invasive adenocarcinoma.
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Affiliation(s)
- Yantao Yang
- Department of Thoracic and Cardiovascular Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming, China
| | - Libin Zhang
- Department of Thoracic Surgery, The First People's Hospital Of Yunnan Province, Kunming City, Yunnan Province, China
| | - Han Wang
- Department of Thoracic Surgery, The First People's Hospital Of Yunnan Province, Kunming City, Yunnan Province, China
| | - Jie Zhao
- Department of Thoracic and Cardiovascular Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming, China
| | - Jun Liu
- Department of Thoracic Surgery, The First People's Hospital Of Yunnan Province, Kunming City, Yunnan Province, China
| | - Yun Chen
- Department of Thoracic Surgery, The First People's Hospital Of Yunnan Province, Kunming City, Yunnan Province, China
| | - Jiagui Lu
- Department of Thoracic Surgery, The First People's Hospital Of Yunnan Province, Kunming City, Yunnan Province, China
| | - Yaowu Duan
- Department of Thoracic and Cardiovascular Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming, China
| | - Huilian Hu
- Department of Thoracic and Cardiovascular Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming, China
| | - Hao Peng
- Department of Thoracic Surgery, The First People's Hospital Of Yunnan Province, Kunming City, Yunnan Province, China.
| | - Lianhua Ye
- Department of Thoracic and Cardiovascular Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming, China.
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Xiong Z, Yang Z, Hu X, Yi M, Cai J. Individualised prediction of progression of solitary sub-solid pulmonary nodules based on CT semantic and clinical features: a 3-year follow-up study. Clin Radiol 2024; 79:e174-e181. [PMID: 37945437 DOI: 10.1016/j.crad.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023]
Abstract
AIM To develop and validate a progressive prediction model for estimating the time to progression (TTP) of sub-solid pulmonary nodules (SSNs). MATERIALS AND METHODS A total of 126 cases who met inclusion and exclusion criteria were included in the study. The primary endpoint of the study was TTP of SSNs. Baseline characteristics were assessed in terms of clinical and CT semantic features. Kaplan-Meier analysis and Cox regression analysis were performed to determine the relationship between SSNs TTP and factors from the entire data set. The nomogram was constructed based on the result of multivariate analysis and internal validation was performed using the bootstrapping. The nomogram's performance was assessed with the C-index, calibration curves, and decision curve analysis. RESULTS The median follow-up time of the population was 42.5 (21.5) months. On Kaplan-Meier analysis, patients with higher or positive values of the indices had higher cumulative progression rates (p<0.05). Multivariate Cox regression models identified diameter, consolidation tumour ratio (CTR), morphology, and vasodilation sign (VDS) as independent risk factors of TTP. These predictors were included in the final model to estimate individual probabilities of progression in the 3 years, which performed well in the discrimination (the C-index was 0.901 [95%CI: 0.830-0.981] and 0.875 [95%CI: 0.805-0.942] in the training and internally validation sets). CONCLUSION The radiological semantic features nomogram is a promising and favourable prognostic biomarker for predicting progression and may aid in clinical risk stratification and decision-making for SSNs.
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Affiliation(s)
- Z Xiong
- Department of Radiology, The Fifth People's Hospital of Chongqing, China; Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, China
| | - Z Yang
- Department of Radiology, Kaiyang County People's Hospital of Guizhou Province, China
| | - X Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, China
| | - M Yi
- Department of Radiology, The Fifth People's Hospital of Chongqing, China
| | - J Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, China.
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Yang Y, Xu J, Wang W, Zhao J, Yang Y, Wang B, Ye L. Meta-analysis of the correlation between CT-based features and invasive properties of pure ground-glass nodules. Asian J Surg 2023; 46:3405-3416. [PMID: 37328382 DOI: 10.1016/j.asjsur.2023.04.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 06/18/2023] Open
Abstract
Several studies have revealed that computed tomography (CT) features can make a distinction in the invasive properties of pure ground-glass nodules (pGGNs). However, imaging parameters related to the invasive properties of pGGNs are unclear. This meta-analysis was designed to decipher the correlation between the invasiveness of pGGNs and CT-based features, and ultimately to be conducive to making rational clinical decisions. We searched a series of databases, including PubMed, Embase, Web of Science, Cochrane Library, Scopus, wanfang, CNKI, VIP, as well as CBM databases, until September 20, 2022, for the eligible publications only in Chinese or English. This meta-analysis was implemented with the Stata 16.0 software. Ultimately, 17 studies published between 2017 and 2022 were included. According to the meta-analysis, we observed a larger maximum size of lesions in invasive adenocarcinoma (IAC) versus that in preinvasive lesions (PIL) [SMD = 1.37, 95% CI (1.07-1.68), P < 0.05]. Meanwhile, there were also increased mean CT values of IAC [SMD = 0.71, 95% CI (0.35, 1.07), P < 0.05], the incidence of pleural traction sign [OR = 1.94, 95% CI (1.24, 3.03), P < 0.05], the incidence of IAC spiculation [OR = 1.55, 95% CI (1.05, 2.29), P < 0.05] in comparison to those of PIL. Nevertheless, IAC and PIL exhibited no significant differences in vacuole sign, air bronchogram, regular shape, lobulation and vascular convergence sign (all P > 0.05). Therefore, IAC and PIL manifested different CT features of pGGNs. The maximum diameter of lesions, mean CT value, pleural traction sign and spiculation are important indicators to distinguish IAC and PIL. Reasonable use of these features can be helpful to the treatment of pGGNs.
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Affiliation(s)
- Yantao Yang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Jing Xu
- Department of Dermatology and Venereal Diseases, Yan'an Hospital of Kunming City, No. 245, East Renmin Road, Kunming City, Yunnan Province, China
| | - Wei Wang
- Department of Thoracic and Cardiovascular Surgery, Shiyan Taihe Hospital (Hubei University of Medicine), Shiyan, China
| | - Jie Zhao
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Yichen Yang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Biying Wang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China
| | - Lianhua Ye
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Kunming City, Yunnan Province, China.
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Wu L, Gao C, Kong N, Lou X, Xu M. The long-term course of subsolid nodules and predictors of interval growth on chest CT: a systematic review and meta-analysis. Eur Radiol 2023; 33:2075-2088. [PMID: 36136107 PMCID: PMC9935651 DOI: 10.1007/s00330-022-09138-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/26/2022] [Accepted: 09/02/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To calculate the pooled incidence of interval growth after long-term follow-up and identify predictors of interval growth in subsolid nodules (SSNs) on chest CT. METHODS A search of MEDLINE (PubMed), Cochrane Library, Web of Science Core Collection, and Embase was performed on November 08, 2021, for relevant studies. Patient information, CT scanner, and SSN follow-up information were extracted from each included study. A random-effects model was applied along with subgroup and meta-regression analyses. Study quality was assessed by the Newcastle-Ottawa scale, and publication bias was assessed by Egger's test. RESULTS Of the 6802 retrieved articles, 16 articles were included and analyzed, providing a total of 2898 available SSNs. The pooled incidence of growth in the 2898 SSNs was 22% (95% confidence interval [CI], 15-29%). The pooled incidence of growth in the subgroup analysis of pure ground-glass nodules was 26% (95% CI: 12-39%). The incidence of SSN growth after 2 or more years of stability was only 5% (95% CI: 3-7%). An initially large SSN size was found to be the most frequent risk factor affecting the incidence of SSN growth and the time of growth. CONCLUSIONS The pooled incidence of SSN growth was as high as 22%, with a 26% incidence reported for pure ground-glass nodules. Although the incidence of growth was only 5% after 2 or more years of stability, long-term follow-up is needed in certain cases. Moreover, the initial size of the SSN was the most frequent risk factor for growth. KEY POINTS • Based on a meta-analysis of 2898 available subsolid nodules in the literature, the pooled incidence of growth was 22% for all subsolid nodules and 26% for pure ground-glass nodules. • After 2 or more years of stability on follow-up CT, the pooled incidence of subsolid nodule growth was only 5%. • Given the incidence of subsolid nodule growth, management of these lesions with long-term follow-up is preferred.
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Affiliation(s)
- Linyu Wu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), 54 Youdian Road, Hangzhou, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chen Gao
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), 54 Youdian Road, Hangzhou, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ning Kong
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), 54 Youdian Road, Hangzhou, China
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xinjing Lou
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China
| | - Maosheng Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), 54 Youdian Road, Hangzhou, China.
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China.
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A Nomogram Incorporating Tumor-Related Vessels for Differentiating Adenocarcinoma In Situ from Minimally Invasive and Invasive Adenocarcinoma Appearing as Subsolid Nodules. Acad Radiol 2022; 30:928-939. [PMID: 36150965 DOI: 10.1016/j.acra.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop a nomogram incorporating the quantity of tumor-related vessels (TRVs) and conventional CT features (CCTFs) for the preoperative differentiation of adenocarcinoma in situ (AIS) from minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) appearing as subsolid nodules. METHODS High-resolution CT target scans of 274 subsolid nodules from 268 patients were included in this study and randomly assigned to the training and validation groups at a ratio of 7:3. A nomogram incorporating CCTFs with the category of TRVs (CTRVs, using TRVs as categorical variables) and a final nomogram combining the number of TRVs (QTRVs) and CCTFs were constructed using multivariable logistic regression analysis. The performance levels of the two nomograms were evaluated and validated on the training and validation datasets and then compared. RESULTS The CCTF-QTRV nomogram incorporating abnormal air bronchogram, density, number of dilated and distorted vessels and number of adherent vessels showed more favorable predictive efficacy than the CCTF-CTRV nomogram (training cohort: area under the curve (AUC) = 0.893 vs. 0.844, validation cohort: AUC = 0.871 vs. 0.807). The net reclassification index (training cohort: 0.188, validation cohort: 0.326) and the integrated discrimination improvement values (training cohort: 0.091, validation cohort: 0.125) indicated that the CCTF-QTRV nomogram performed significantly better discriminative ability than the CCTF-CTRV nomogram (all p-value < 0.05). CONCLUSIONS The nomogram incorporating the QTRVs and CCTFs showed favorable predictive efficacy for differentiating AIS from MIA-IAC appearing as subsolid nodules and may serve as a potential tool to provide individual care for these patients.
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Sheng A, Zhou P, Ye Y, Sun K, Yang Z. Diagnostic Efficacy of CT Radiomic Features in Pulmonary Invasive Mucinous Adenocarcinoma. SCANNING 2022; 2022:5314225. [PMID: 35832299 PMCID: PMC9252846 DOI: 10.1155/2022/5314225] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 05/14/2023]
Abstract
In order to solve the problem of the effect of CT images on the diagnosis of lungs, the authors proposed a method for the diagnosis of invasive mucinous adenocarcinoma of the lungs based on CT radiomic features, and the modified method is found by reviewing past cases: among the 34 cases of primary pulmonary lymphoma, 12 cases were nodular mass type, 19 cases were nonnodular mass type, and 3 cases were mixed type; 13 cases involved bilateral lung lobes, 7 cases involved right lung, and 4 cases involved left lung example. There were 17 cases of tumor consolidation density shadow, 17 cases of mixed density shadow, the average CT value was about 32HU, 15 cases of cavitation sign, 6 cases of cavity, 9 cases of angiography sign, 30 cases of air bronchus sign, 22 cases of bronchiectasis, bronchial stenosis or amputation in 8 cases, pleural effusion in 12 cases, lymph node enlargement in 15 cases, and pleural metastasis in 2 cases. The final pathological results included 24 cases of membrane-associated lymphoid tissue (MALT) lymphoma, 9 cases of diffuse large B-cell lymphoma (DLBCL), and 1 case of T-cell lymphoma. The CT manifestations of primary pulmonary lymphoma (PPL) are diverse and do not have obvious specificity, the imaging manifestations are correlated with pathological types, and air bronchial signs, bronchiectasis, angiography signs, and other signs are used for the diagnosis of PPL. This is of great significance for the diagnosis of PPL.
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Affiliation(s)
- Aizhu Sheng
- Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Zhejiang 315000, China
| | - Pengfei Zhou
- Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Zhejiang 315000, China
| | - Yizhai Ye
- Department of Radiology, Ninghai First Hospital, Ningbo, Zhejiang 315600, China
| | - Keda Sun
- Department of Radiology, No. 2 Hospital of Yinzhou District, Ningbo, Zhejiang 315100, China
| | - Zhenhua Yang
- Department of Thoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Zhejiang 315000, China
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Multivariate Analysis on Development of Lung Adenocarcinoma Lesion from Solitary Pulmonary Nodule. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8330111. [PMID: 35795880 PMCID: PMC9155859 DOI: 10.1155/2022/8330111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 12/01/2022]
Abstract
Objective To analyze multiple factors developing lung adenocarcinoma lesion from solitary pulmonary nodule (SPN). Methods A total of 70 patients diagnosed with lung adenocarcinoma after finding SPN by chest CT and treated in our hospital (01, 2018–01, 2021) were selected as the malignant lesion group, and another 70 patients diagnosed with benign lesion after finding SPN by CT in the same period were included in the benign lesion group. All patients had complete medical records. With univariate analysis and multivariate logistic regression, the independent risk factors for developing lung adenocarcinoma lesions from SPN were analyzed. Results By conducting univariate analysis of patients' general information (age, course of disease, BMI, nodule diameter, and gender), smoking status (smoking history and number of cigarettes smoked per year), medical history (family history of lung cancer, history of extrapulmonary malignant tumor, and history of autoimmune diseases), basic complications (hypertension and diabetes), and laboratory examinations (CEA, NSE, CYFRA21-1, SCC-Ag, and CA125), it was concluded that age, course of disease, nodule diameter, CEA positive, CYFRA21-1 positive, and CA125 positive were significantly different between the two groups (P < 0.05); the logistic regression results showed that high age, increased nodule diameter, and CYFRA21-1 positive were the independent risk factors developing lung adenocarcinoma from SPN (P < 0.05). Conclusion In patients with SPN, higher age, longer course of disease, greater nodule diameter, and CYFRA21-1 positive imply increased risk for triggering lung adenocarcinoma lesion. Therefore, high attention should be paid in the clinic to such SPN patients for early diagnosis and treatment.
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Song X, Zhao Q, Zhang H, Xue W, Xin Z, Xie J, Zhang X. Development and Validation of a Preoperative CT-Based Nomogram to Differentiate Invasive from Non-Invasive Pulmonary Adenocarcinoma in Solitary Pulmonary Nodules. Cancer Manag Res 2022; 14:1195-1208. [PMID: 35342306 PMCID: PMC8948523 DOI: 10.2147/cmar.s357385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Xin Song
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- North China University of Science and Technology, Tangshan, People’s Republic of China
| | - Qingtao Zhao
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Hua Zhang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Wenfei Xue
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Zhifei Xin
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Jianhua Xie
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- North China University of Science and Technology, Tangshan, People’s Republic of China
| | - Xiaopeng Zhang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Correspondence: Xiaopeng Zhang, Hebei General Hospital, No. 348, Heping Western Road, Xinhua District, Shijiazhuang, 050000, People’s Republic of China, Tel +8613722865878, Email
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Predicting lung adenocarcinoma invasiveness by measurement of pure ground-glass nodule roundness by using multiplanar reformation: a retrospective analysis. Clin Radiol 2021; 77:e20-e26. [PMID: 34772486 DOI: 10.1016/j.crad.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/07/2021] [Indexed: 01/11/2023]
Abstract
AIM To explore the value of roundness measurement based on thin-section axial, coronal, and sagittal section computed tomography (CT) images for predicting pure ground-glass nodule (pGGN) invasiveness. MATERIALS AND METHODS A total of 168 pGGNs in 155 patients (44 male, 111 females; mean age, 55.74 ± 10.57 years), and confirmed by surgery and histopathology, were analysed retrospectively and divided into pre-invasive (n=72) and invasive (n=96) groups. Photoshop (CS6) software was used to measure pGGN roundness based on conventional axial section, as well as coronal and sagittal sections generated by multiplanar reformation, from thin-section (1-mm-thick) CT lung images. RESULTS pGGN roundness values, measured in axial, coronal, and sagittal thin-section CT sections from the pre-invasive group were 0.8 ± 0.049, 0.816 ± 0.05, and 0.818 ± 0.043, respectively, while those in the invasive group were 0.745 ± 0.077, 0.684 ± 0.106, and 0.678 ± 0.106; differences between the two groups were significant (all p<0.001). Binary logistic regression analysis showed that roundness values based on coronal and sagittal sections (p<0.001) were better than those from axial sections (p>0.05) in predicting pGGN invasiveness, with odds ratio (OR) values of 14.858 and 23.315, respectively. ROC analysis showed that evaluation of roundness measured in sagittal sections was better at predicting pGGN invasiveness than when coronal sections were used (AUC 0.870 versus 0.832). CONCLUSION Roundness is useful for predicting pGGN invasiveness, with measurements from coronal and sagittal sections better than those from conventional axial sections, with sagittal section images having the best predictive value.
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Xue LM, Li Y, Zhang Y, Wang SC, Zhang RY, Ye JD, Yu H, Qiang JW. A predictive nomogram for two-year growth of CT-indeterminate small pulmonary nodules. Eur Radiol 2021; 32:2672-2682. [PMID: 34677668 DOI: 10.1007/s00330-021-08343-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Lung cancer is the most common cancer and the leading cause of cancer-related death worldwide. The optimal management of computed tomography (CT)-indeterminate pulmonary nodules is important. To optimize individualized follow-up strategies, we developed a radiomics nomogram for predicting 2-year growth in case of indeterminate small pulmonary nodules. METHODS A total of 215 histopathology-confirmed small pulmonary nodules (21 benign and 194 malignant) in 205 patients with ultra-high-resolution CT (U-HRCT) were divided into growth and nongrowth nodules and were randomly allocated to the primary (n = 151) or validation (n = 64) group. The least absolute shrinkage and selection operator (LASSO) method was used for radiomics feature selection and radiomics signature determination. Multivariable logistic regression analysis was used to develop a radiomics nomogram that integrated the radiomics signature with significant clinical parameters (sex and nodule type). The area under the curve (AUC) was applied to assess the predictive performance of the radiomics nomogram. The net benefit of the radiomics nomogram was assessed using a clinical decision curve. RESULTS The radiomics signature and nomogram yielded AUCs of 0.892 (95% confidence interval [CI]: 0.843-0.940) and 0.911 (95% CI: 0.867-0.955), respectively, in the primary group and 0.826 (95% CI: 0.727-0.926) and 0.843 (95% CI: 0.749-0.937), respectively, in the validation group. The clinical usefulness of the nomogram was demonstrated by decision curve analysis. CONCLUSIONS A radiomics nomogram was developed by integrating the radiomics signature with clinical parameters and was easily used for the individualized prediction of two-year growth in case of CT-indeterminate small pulmonary nodules. KEY POINTS • A radiomics nomogram was developed for predicting the two-year growth of CT-indeterminate small pulmonary nodules. • The nomogram integrated a CT-based radiomics signature with clinical parameters and was valuable in developing an individualized follow-up strategy for patients with indeterminate small pulmonary nodules.
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Affiliation(s)
- Li Min Xue
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China
| | - Yu Zhang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai Road, Shanghai, 200032, China
| | - Shu Chao Wang
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China
| | - Ran Ying Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University, 108 Fenglin Road, Shanghai, 200032, China
| | - Jian Ding Ye
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai Road, Shanghai, 200032, China
| | - Hong Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai Road, Shanghai, 200032, China.
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, China.
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Wang Z, Zhu W, Lu Z, Li W, Shi J. Invasive adenocarcinoma manifesting as pure ground glass nodule with different size: radiological characteristics differ while prognosis remains the same. Transl Cancer Res 2021; 10:2755-2766. [PMID: 35116586 PMCID: PMC8799266 DOI: 10.21037/tcr-21-78] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Invasive adenocarcinoma (IA) manifesting as pure ground-glass nodule is rare and not been well studied. Meanwhile, tumor size is considered as a predictor of invasiveness in lung adenocarcinoma. The present study aimed to investigate the radiological and pathological characteristics as well as prognosis of IA manifesting as pure ground-glass nodule with different sizes. METHODS Patients with solitary pure ground glass nodule (GGN) who underwent resection and were pathologically diagnosed as IA between July 2013 and July 2015 were included. Nodules were divided into four groups according to size: A, B, C, and D, corresponding to "≤1 cm," "1-2 cm," "2-3 cm," and ">3 cm," respectively. The correlations and differences in radiological and pathological characteristics as well as prognosis among these groups were analyzed. RESULTS The amounts of nodules in groups A, B, C, and D are 17, 148, 78, and 30, respectively. The average diameter of these 273 nodules is 1.9 (1.5-2.4) cm. A large tumor is likely to have low computed tomography (CT) value (P<0.001), irregular shape (P=0.001), spiculation appearance (P<0.001) and exhibit pleural indentation (P<0.001) and air bronchogram (P<0.001). The proportion of lepidic predominant adenocarcinoma (LPA) (n=239, 87.5%) is much higher than that of other subtypes (n=34, 12.5%). Currently, there is no case with lymphatic, pleural, or vessel invasion and lymph node involvement, and none died of recurrence or metastasis within 5 years after resection. CONCLUSIONS For IA manifesting as pure ground-glass nodule, size is correlated to invasiveness, and large tumors tend to have lower CT value, an irregular shape, lobulation and spiculation appearance and exhibit pleural indentation and air bronchogram. Nevertheless, the prognosis is excellent with 100% 5-year disease-free survival regardless of the size and pathological subtype.
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Affiliation(s)
- Zijian Wang
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Zhu
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenzhen Lu
- Clinical Research Unit, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Li
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Radiomic signature based on CT imaging to distinguish invasive adenocarcinoma from minimally invasive adenocarcinoma in pure ground-glass nodules with pleural contact. Cancer Imaging 2021; 21:1. [PMID: 33407884 PMCID: PMC7788838 DOI: 10.1186/s40644-020-00376-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022] Open
Abstract
Background Pure ground-glass nodules (pGGNs) with pleural contact (P-pGGNs) comprise not only invasive adenocarcinoma (IAC), but also minimally invasive adenocarcinoma (MIA). Radiomics recognizes complex patterns in imaging data by extracting high-throughput features of intra-tumor heterogeneity in a non-invasive manner. In this study, we sought to develop and validate a radiomics signature to identify IAC and MIA presented as P-pGGNs. Methods In total, 100 patients with P-pGGNs (69 training samples and 31 testing samples) were retrospectively enrolled from December 2012 to May 2018. Imaging and clinical findings were also analyzed. In total, 106 radiomics features were extracted from the 3D region of interest (ROI) using computed tomography (CT) imaging. Univariate analyses were used to identify independent risk factors for IAC. The least absolute shrinkage and selection operator (LASSO) method with 10-fold cross-validation was used to generate predictive features to build a radiomics signature. Receiver-operator characteristic (ROC) curves and calibration curves were used to evaluate the predictive accuracy of the radiomics signature. Decision curve analyses (DCA) were also conducted to evaluate whether the radiomics signature was sufficiently robust for clinical practice. Results Univariate analysis showed significant differences between MIA (N = 47) and IAC (N = 53) groups in terms of patient age, lobulation signs, spiculate margins, tumor size, CT values and relative CT values (all P < 0.05). ROC curve analysis showed, when MIA was identified from IAC, that the critical value of tumor length diameter (TLD) was1.39 cm and the area under the ROC curve (AUC) was 0.724 (sensitivity = 0.792, specificity = 0.553). The critical CT value on the largest axial plane (CT-LAP) was − 597.45 HU, and the AUC was 0.666 (sensitivity = 0.698, specificity= 0.638). The radiomics signature consisted of seven features and exhibited a good discriminative performance between IAC and MIA, with an AUC of 0.892 (sensitivity = 0.811, specificity 0.719), and 0.862 (sensitivity = 0.625, specificity = 0.800) in training and testing samples, respectively. Conclusions Our radiomics signature exhibited good discriminative performance in differentiating IAC from MIA in P-pGGNs, and may offer a crucial reference point for follow-up and selective surgical management. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-020-00376-1.
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