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Hu B, Ren W, Feng Z, Li M, Li X, Han R, Peng Z. Correlation between CT imaging characteristics and pathological diagnosis for subcentimeter pulmonary nodules. Thorac Cancer 2022; 13:1067-1075. [PMID: 35212152 PMCID: PMC8977167 DOI: 10.1111/1759-7714.14363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 01/15/2023] Open
Abstract
Background Advances in chest computed tomography (CT) have resulted in more frequent detection of subcentimeter pulmonary nodules (SCPNs), some of which are non‐benign and may represent invasive lung cancer. The present study aimed to explore the correlation between pathological diagnosis and the CT imaging manifestations of SCPNs. Methods This retrospective study included patients who underwent pulmonary resection for SCPNs at Shandong Provincial Hospital in China. Lesions were divided into five categories according to their morphological characteristics on CT: cotton ball, solid‐filled with spiculation, solid‐filled with smooth edges, mixed‐density ground‐glass, and vacuolar. We further analyzed lesion size, enhancement patterns, vascular aggregation, and SCPN traversing. Chi‐square tests, Fisher's exact tests, and Welch's one‐way analysis of variance were used to examine the correlation between CT imaging characteristics and pathological type. Results There were statistically significant differences in the morphological distributions of SCPNs with different pathological types, including benign lesions and malignant lesions at different stages (p < 0.01). The morphological distributions of the four subtypes of invasive lung adenocarcinoma also exhibited significant differences (p < 0.01). In addition, size and enhancement patterns differed significantly among different pathological types of SCPNs. Conclusion Different pathological types of SCPNs exhibit significant differences based on their morphological category, size, and enhancement pattern on CT imaging. These CT characteristics may assist in the qualitative diagnosis of SCPNs.
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Affiliation(s)
- Benchuang Hu
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Wangang Ren
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Zhen Feng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Meng Li
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Xiao Li
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Rui Han
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Zhongmin Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
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Qiu T, Ru X, Yin K, Yu J, Song Y, Wu J. Two nomograms based on CT features to predict tumor invasiveness of pulmonary adenocarcinoma and growth in pure GGN: a retrospective analysis. Jpn J Radiol 2020; 38:761-770. [PMID: 32356236 DOI: 10.1007/s11604-020-00957-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of the study is to construct two nomograms for predicting the invasive extent of pulmonary adenocarcinoma and nodule growth in patients with pulmonary pure ground-glass nodules (pGGN). METHOD Consecutive patients with pGGNs (n = 172) were retrospectively studied at one institution, formed the development cohort in predicting IPAs' nomogram. A separate cohort of patients with pGGNs (n = 116) from another institution was used for validation. For the predicting growth nomogram, the primary cohort of patients with pGGNs (n = 80) was from the former institution. We developed the nomogram for predicting IPA using binary logistic regression model, and a Cox multivariable model for the growth nomogram. We assessed nomogram model performance by calibration and discrimination (C-index). RESULTS The variables selected in binary logistic regression model (lesion size and shape) had a significant effect on identifying IPA from preinvasive lesion. The C-index of the development and validation cohort were 0.819 (95% CI 0.753-0.874) and 0.811 (95% CI 0.728-0.878), respectively. The risk variables (lesion size, blood vessel types) were selected in the multivariable Cox model. The C-index was 0.880 in the development cohort. CONCLUSION Our nomograms are reliable prognostic methods that can predict the invasiveness of pulmonary adenocarcinomas and the growth of pure GGN in preoperative.
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Affiliation(s)
- Taichun Qiu
- Rodiology Department, People's Hospital of Deyang City, No. 173, Taishan North Rd, Deyang, Sichuan, China.,Radiology Department, The Affiliated ZhongShan Hospital of Dalian University, Dalian University, No. 6, Jiefang Rd, Zhongshan District, Dalian, 116001, China
| | - Xiaoshuang Ru
- Radiology Department, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Medical University, No. 42, Xuegong Rd, Shahekou District, Dalian, China
| | - Ke Yin
- Radiology Department, The Affiliated ZhongShan Hospital of Dalian University, Dalian University, No. 6, Jiefang Rd, Zhongshan District, Dalian, 116001, China
| | - Jing Yu
- Radiology Department, The Affiliated ZhongShan Hospital of Dalian University, Dalian University, No. 6, Jiefang Rd, Zhongshan District, Dalian, 116001, China
| | - Yang Song
- Radiology Department, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Medical University, No. 42, Xuegong Rd, Shahekou District, Dalian, China
| | - Jianlin Wu
- Radiology Department, The Affiliated ZhongShan Hospital of Dalian University, Dalian University, No. 6, Jiefang Rd, Zhongshan District, Dalian, 116001, China.
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3
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Cui X, Fan S, Heuvelmans MA, Han D, Zhao Y, Groen HJM, Dorrius MD, Oudkerk M, de Bock GH, Vliegenthart R, Ye Z. Optimization of CT windowing for diagnosing invasiveness of adenocarcinoma presenting as sub-solid nodules. Eur J Radiol 2020; 128:108981. [PMID: 32371183 DOI: 10.1016/j.ejrad.2020.108981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/06/2020] [Accepted: 03/28/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the optimal window setting to diagnose the invasiveness of lung adenocarcinoma in sub-solid nodules (SSNs). METHODS We retrospectively included 437 SSNs and randomly divided them 3:1 into a training group (327) and a testing group (110). The presence of a solid component was regarded as indicator of invasiveness. At fixed window level (WL) of 35 Hounsfield Units (HU), two readers adjusted the window width (WW) in the training group and recorded once a solid component appeared or disappeared on CT images acquired at 120 kVp. The optimal WW cut-off value to differentiate between invasive and pre-invasive lesions, based on the receiver operating characteristic (ROC) curve, was defined as "core" WW. The diagnostic performances of the mediastinal window setting (WW/WL, 350/35 HU) and core window setting were then compared in the testing group. RESULTS Of the 437 SSNs, 88 were pre-invasive [17 atypical adenomatous hyperplasia (AAH) and 71 adenocarcinoma in situ (AIS)], 349 were invasive [233 minimally invasive adenocarcinoma (MIA), 116 invasive adenocarcinoma (IA)]. In training group, the core WW of 1175 HU was the optimal cut-off to detect solid components of SSNs (AUC:0.79). In testing group, the sensitivity, specificity, positive, negative predictive value, and diagnostic accuracy for SSN invasiveness were 49.4%, 90.5%, 95.7%, 29.7%, and 57.3% for mediastinal window setting, and 87.6%, 76.2%, 91.6%, 76.2%, and 85.5% for core window setting. CONCLUSION At 120 kVp, core window setting (WW/WL, 1175/35 HU) outperformed the traditional mediastinal window setting to diagnose the invasiveness of SSNs.
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Affiliation(s)
- Xiaonan Cui
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Shuxuan Fan
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Marjolein A Heuvelmans
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; Medisch Spectrum Twente, Department of Pulmonology, Enschede, the Netherlands
| | - Daiwei Han
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Yingru Zhao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China
| | - Harry J M Groen
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - Monique D Dorrius
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy (iDNA) BV, Groningen, the Netherlands; University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Zhaoxiang Ye
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China.
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Sun Y, Li C, Jin L, Gao P, Zhao W, Ma W, Tan M, Wu W, Duan S, Shan Y, Li M. Radiomics for lung adenocarcinoma manifesting as pure ground-glass nodules: invasive prediction. Eur Radiol 2020; 30:3650-3659. [PMID: 32162003 PMCID: PMC7305264 DOI: 10.1007/s00330-020-06776-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/14/2019] [Accepted: 02/24/2020] [Indexed: 12/18/2022]
Abstract
Objectives To investigate the value of radiomics based on CT imaging in predicting invasive adenocarcinoma manifesting as pure ground-glass nodules (pGGNs). Methods This study enrolled 395 pGGNs with histopathology-confirmed benign nodules or adenocarcinoma. A total of 396 radiomic features were extracted from each labeled nodule. A Rad-score was constructed with the least absolute shrinkage and selection operator (LASSO) in the training set. Multivariate logistic regression analysis was conducted to establish the radiographic model and the combined radiographic–radiomics model. The predictive performance was validated by receiver operating characteristic (ROC) curve. Based on the multivariate logistic regression analysis, an individual prediction nomogram was developed and the clinical utility was assessed. Results Five radiomic features and four radiographic features were selected for predicting the invasive lesions. The combined radiographic–radiomics model (AUC 0.77; 95% CI, 0.69–0.86) performed better than the radiographic model (AUC 0.71; 95% CI, 0.62–0.81) and Rad-score (AUC 0.72; 95% CI, 0.63–0.81) in the validation set. The clinical utility of the individualized prediction nomogram developed using the Rad-score, margin, spiculation, and size was confirmed in the validation set. The decision curve analysis (DCA) indicated that using a model with Rad-score to predict the invasive lesion would be more beneficial than that without Rad-score and the clinical model. Conclusions The proposed radiomics-based nomogram that incorporated the Rad-score, margin, spiculation, and size may be utilized as a noninvasive biomarker for the assessment of invasive prediction in patients with pGGNs. Key Points • CT-based radiomics analysis helps invasive prediction manifested as pGGNs. • The combined radiographic–radiomics model may be utilized as a noninvasive biomarker for predicting invasive lesion for pGGNs. • Radiomics-based individual nomogram may serve as a vital decision support tool to identify invasive pGGNs, obviating further workup and blind follow-up. Electronic supplementary material The online version of this article (10.1007/s00330-020-06776-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yingli Sun
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Cheng Li
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Liang Jin
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Pan Gao
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Wei Zhao
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.,Diagnosis and Treatment Center of Small Lung Nodules, Huadong Hospital, Shanghai, China
| | - Weiling Ma
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Mingyu Tan
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Weilan Wu
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | | | - Yuqing Shan
- Department of Radiology, The People's Hospital of Rizhao, Rizhao City, 276800, China
| | - Ming Li
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China. .,Diagnosis and Treatment Center of Small Lung Nodules, Huadong Hospital, Shanghai, China. .,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
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A Subsolid Nodules Imaging Reporting System (SSN-IRS) for Classifying 3 Subtypes of Pulmonary Adenocarcinoma. Clin Lung Cancer 2020; 21:314-325.e4. [PMID: 32273256 DOI: 10.1016/j.cllc.2020.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To develop an imaging reporting system for the classification of 3 adenocarcinoma subtypes of computed tomography (CT)-detected subsolid pulmonary nodules (SSNs) in clinical patients. METHODS Between November 2011 and October 2017, 437 pathologically confirmed SSNs were retrospectively identified. SSNs were randomly divided 2:1 into a training group (291 cases) and a testing group (146 cases). CT-imaging characteristics were analyzed using multinomial univariable and multivariable logistic regression analysis to identify discriminating factors for the 3 adenocarcinoma subtypes (pre-invasive lesions, minimally invasive adenocarcinoma, and invasive adenocarcinoma). These factors were used to develop a classification and regression tree model. Finally, an SSN Imaging Reporting System (SSN-IRS) was constructed based on the optimized classification model. For validation, the classification performance was evaluated in the testing group. RESULTS Of the CT-derived characteristics of SSNs, qualitative density (nonsolid or part-solid), core (non-core or core), semantic features (pleural indentation, vacuole sign, vascular invasion), and diameter of solid component (≤6 mm or >6 mm), were the most important factors for the SSN-IRS. The total sensitivity, specificity, and diagnostic accuracy of the SSN-IRS was 89.0% (95% confidence interval [CI], 84.8%-92.4%), 74.6% (95% CI, 70.8%-78.1%), and 79.4% (95% CI, 76.5%-82.0%) in the training group and 84.9% (95% CI, 78.1%-90.3%), 68.5% (95% CI, 62.8%-73.8%), and 74.0% (95% CI, 69.6%-78.0%) in the testing group, respectively. CONCLUSIONS The SSN-IRS can classify 3 adenocarcinoma subtypes using CT-based characteristics of subsolid pulmonary nodules. This classification tool can help clinicians to make follow-up recommendations or decisions for surgery in clinical patients with SSNs.
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Huang C, Wang C, Wang Y, Liu J, Bie F, Wang Y, Du J. The Prognostic Significance of Pure Ground Glass Opacities in Lung Cancer Computed Tomographic Images. J Cancer 2019; 10:6888-6895. [PMID: 31839823 PMCID: PMC6909955 DOI: 10.7150/jca.33132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/02/2019] [Indexed: 11/14/2022] Open
Abstract
Objective: Pure ground-glass opacity (GGO) nodules have been detected with increasing frequency using computed tomography (CT). We performed a retrospective study to clarify whether lung cancer patient prognoses correlated with pure GGO nodules. We also analyzed the clinical characters of patients with pure GGO nodules to provide diagnostic guidance on lung cancer identification and treatment of patients in clinical practice. Methods: We enrolled 39 of 1422 patients with pure GGO nodules who accepted surgical treatment of the lung cancer nodules, and reviewed materials from 404 patients to verify our conclusions. To discover which factors were prognostically significant, we used the Kaplan-Meier method to estimate the overall survival (OS) and progression-free survival (PFS) curves. Age, gender, smoking history, histology, tumor size, and stage were the factors examined in our study. We also performed subgroup and matching group analyses to clarify the correlation between the presence of pure GGO nodules and prognoses. Results: Pure GGO nodules were associated with non-smoking females that had adenocarcinoma. The prognoses of patients in the pure GGO nodule group was better than those in the non-pure GGO nodule group (p = 0.046). Age, grade, and stage (including tumor size and lymph node metastases) were had prognostic significance. In the matching group stage assessments, although patient prognoses were not significantly different among patients of the GGO group compared with thoses of the other group in long-term, while in the short term, patients with pure GGO nodules had longer PFS. Non-smoking female patients with lung cancer were more likely to have adenocarcinoma. Conclusions: As a subgroup of GGO nodules, pure GGO nodules predict a better prognosis in all lung cancer patients. Wheras our study showed that lung patients with pure GGO nodules in similar stages were not significantly different in long-term prognoses, in the short term; patients with pure GGO nodules had longer PFS.
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Affiliation(s)
- Cuicui Huang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Chao Wang
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Yadong Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Jichang Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Fenglong Bie
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Yu Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China.,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, 250021, China
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Whole-Lesion Computed Tomography-Based Entropy Parameters for the Differentiation of Minimally Invasive and Invasive Adenocarcinomas Appearing as Pulmonary Subsolid Nodules. J Comput Assist Tomogr 2019; 43:817-824. [PMID: 31343995 DOI: 10.1097/rct.0000000000000889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the differentiation of computed tomography (CT)-based entropy parameters between minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) lesions appearing as pulmonary subsolid nodules (SSNs). METHODS This study was approved by the institutional review board in our hospital. From July 2015 to November 2018, 186 consecutive patients with solitary peripheral pulmonary SSNs that were pathologically confirmed as pulmonary adenocarcinomas (74 MIA and 112 IAC lesions) were included and subdivided into the training data set and the validation data set. Chest CT scans without contrast enhancement were performed in all patients preoperatively. The subjective CT features of the SSNs were reviewed and compared between the MIA and IAC groups. Each SSN was semisegmented with our in-house software, and entropy-related parameters were quantitatively extracted using another in-house software developed in the MATLAB platform. Logistic regression analysis and receiver operating characteristic analysis were performed to evaluate the diagnostic performances. Three diagnostic models including subjective model, entropy model, and combined model were built and analyzed using area under the curve (AUC) analysis. RESULTS There were 119 nonsolid nodules and 67 part-solid nodules. Significant differences were found in the subjective CT features among nodule type, lesion size, lobulated shape, and irregular margin between the MIA and IAC groups. Multivariate analysis revealed that part-solid type and lobulated shape were significant independent factors for IAC (P < 0.0001 and P < 0.0001, respectively). Three entropy parameters including Entropy-0.8, Entropy-2.0-32, and Entropy-2.0-64 were identified as independent risk factors for the differentiation of MIA and IAC lesions. The median entropy model value of the MIA group was 0.266 (range, 0.174-0.590), which was significantly lower than the IAC group with value 0.815 (range, 0.623-0.901) (P < 0.0001). Multivariate analysis revealed that the combined model had an excellent diagnostic performance with sensitivity of 88.2%, specificity of 73.0%, and accuracy of 82.1%. The AUC value of the combined model was significantly higher (AUC, 0.869) than that of the subjective model (AUC, 0.809) or the entropy model alone (AUC, 0.836) (P < 0.0001). CONCLUSIONS The CT-based entropy parameters could help assess the aggressiveness of pulmonary adenocarcinoma via quantitative analysis of intratumoral heterogeneity. The MIA can be differentiated from IAC accurately by using entropy-related parameters in peripheral pulmonary SSNs.
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Gao F, Li M, Zhang Z, Xiao L, Zhang G, Zheng X, Hua Y, Li J. Morphological classification of pre-invasive lesions and early-stage lung adenocarcinoma based on CT images. Eur Radiol 2019; 29:5423-5430. [PMID: 30903336 DOI: 10.1007/s00330-019-06149-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/18/2019] [Accepted: 03/08/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To retrospectively analyze the computed tomography (CT) features in patients with pre-invasive lesions and early-stage lung adenocarcinoma and to explore the correlation between tumor morphological changes and pathological diagnoses. MATERIALS AND METHODS CT morphological characteristics in 2106 patients with pre-invasive (stage 0) and early-stage (stage I) lung adenocarcinoma were analyzed; lesions were confirmed by surgical pathology. Based on the morphological characteristics, the lesions were divided into eight types: I (cotton ball, ground-glass nodules), II (solid fill), III (granular), IV (dendriform), V (bubble-like lucencies), VI (alveolate or honeycomb), VII (scar-like), and VIII (notched or umbilication). The different distributions of eight morphological types in pathological types of the lesions and subtypes of invasive adenocarcinoma were analyzed by chi-squared or Fisher's exact test. Correlation between the percentage of ground-glass opacity in the lesions and pathology types were analyzed by two-tailed Pearson's test. RESULTS A negative correlation was observed between the pathological types and proportion of ground-glass component in the lesions (p < 0.001 and r = - 0.583). Significant differences in morphological characteristics among various pathological types of pre-invasive lesions and early lung adenocarcinomas were observed (p < 0.05). Furthermore, among the different pathological subtypes of stage I invasive adenocarcinoma, the differences in their manifestation as morphological types I, II, III, and VI were statistically significant (p < 0.05). CONCLUSION The eight types of morphological classification of pre-invasive lesions and early-stage (stage 0 or stage I) lung adenocarcinoma has different pathological bases, and morphological classification may be useful for the diagnosis and differential diagnosis of lung adenocarcinoma. KEY POINTS • CT morphological classification of pre-invasive lesions and lung adenocarcinoma is intuitive. • CT morphological classification characterizes morphological changes of the entire lesion. • Different pathological types of lung adenocarcinoma have different morphological features.
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Affiliation(s)
- Feng Gao
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, 200040, China
| | - Ming Li
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, 200040, China. .,Diagnostic and Treatment Center of Small Lung Nodules, Huadong Hospital Fudan University, 221#, West Yanan Road, Shanghai, 200040, China. .,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, 200040, China.
| | - Ziwei Zhang
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Li Xiao
- Department of Pathology, Huadong Hospital Fudan University, Shanghai, 200040, China
| | - Guozhen Zhang
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, 200040, China
| | - Xiangpeng Zheng
- Diagnostic and Treatment Center of Small Lung Nodules, Huadong Hospital Fudan University, 221#, West Yanan Road, Shanghai, 200040, China
| | - Yanqing Hua
- Department of Radiology, Huadong Hospital Fudan University, Shanghai, 200040, China
| | - Jianying Li
- CT Research Center, GE Healthcare China, Shanghai, 200040, China
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Development and validation of a radiomics nomogram for identifying invasiveness of pulmonary adenocarcinomas appearing as subcentimeter ground-glass opacity nodules. Eur J Radiol 2019; 112:161-168. [PMID: 30777206 DOI: 10.1016/j.ejrad.2019.01.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/20/2022]
Abstract
The aim of the present study was to develop and validate a radiomics-based nomogram for differentiation of pre-invasive lesions from invasive lesions that appearing as ground-glass opacity nodules (GGNs) ≤10 mm (sub-centimeter) in diameter at CT. A total of 542 consecutive patients with 626 pathologically confirmed pulmonary subcentimeter GGNs were retrospectively studied from October 2011 to September 2017. All the GGNs were divided into a training set (n = 334) and a validation set (n = 292). Researchers extracted 475 radiomics features from the plain CT images; a radiomics signature was constructed with the least absolute shrinkage and selection operator (LASSO) based on multivariable regression in the training set. Based on the multivariable logistic regression model, a radiomics nomogram was developed in the training set. The performance of the nomogram was evaluated with respect to its calibration, discrimination, and clinical-utility and this was assessed in the validation set. The constructed radiomics signature, which consisted of 15 radiomics features, was significantly associated with the invasiveness of subcentimeter GGNs (P < 0.0001 for both training set and validation set). To build the nomogram model, radiomics signature and mean CT value were used. The nomogram model demonstrated good discrimination and calibration in both training set (C-index, 0.716 [95% CI, 0.632 to 0.801]) and validation set (C-index, 0.707 [95% CI, 0.625 to 0.788]). Decision curve analysis (DCA) indicated that radiomics-based nomogram was clinically useful. A radiomics-based nomogram that incorporates both radiomics signature and mean CT value is constructed in the study, which can be conveniently used to facilitate the preoperative individualized prediction of the invasiveness in patients with subcentimeter GGNs.
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Ahn H, Lee KH, Kim J, Kim J, Kim J, Lee KW. Diameter of the Solid Component in Subsolid Nodules on Low-Dose Unenhanced Chest Computed Tomography: Measurement Accuracy for the Prediction of Invasive Component in Lung Adenocarcinoma. Korean J Radiol 2018; 19:508-515. [PMID: 29713229 PMCID: PMC5904478 DOI: 10.3348/kjr.2018.19.3.508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/24/2017] [Indexed: 01/15/2023] Open
Abstract
Objective To determine if measurement of the diameter of the solid component in subsolid nodules (SSNs) on low-dose unenhanced chest computed tomography (CT) is as accurate as on standard-dose enhanced CT in prediction of pathological size of invasive component of lung adenocarcinoma. Materials and Methods From February 2012 to October 2015, 114 SSNs were identified in 105 patients that underwent low-dose unenhanced and standard-dose enhanced CT pre-operatively. Three radiologists independently measured the largest diameter of the solid component. Intraclass correlation coefficients (ICCs) were used to assess inter-reader agreement. We estimated measurement differences between the size of solid component and that of invasive component. We measured diagnostic accuracy of the prediction of invasive adenocarcinoma using a size criterion of a solid component ≥ 6 mm, and compared them using a generalized linear mixed model. Results Inter-reader agreement was excellent (ICC, 0.84.0.89). The mean ± standard deviation of absolute measurement differences between the solid component and invasive component was 4 ± 4 mm in low-dose unenhanced CT and 5 ± 4 mm in standard-dose enhanced CT. Diagnostic accuracy was 81.3% (95% confidence interval, 76.7.85.3%) in low-dose unenhanced CT and 76.6% (71.8.81.0%) in standard-dose enhanced CT, with no statistically significant difference (p = 0.130). Conclusion Measurement of the diameter of the solid component of SSNs on low-dose unenhanced chest CT was as accurate as on standard-dose enhanced CT for predicting the invasive component. Thus, low-dose unenhanced CT may be used safely in the evaluation of patients with SSNs.
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Affiliation(s)
- Hyungwoo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jeongjae Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Wang L, Shen W, Xi Y, Liu S, Zheng D, Jin C. Nomogram for Predicting the Risk of Invasive Pulmonary Adenocarcinoma for Pure Ground-Glass Nodules. Ann Thorac Surg 2018; 105:1058-1064. [DOI: 10.1016/j.athoracsur.2017.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/02/2017] [Accepted: 11/05/2017] [Indexed: 12/17/2022]
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12
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Li W, Wang X, Zhang Y, Li X, Li Q, Ye Z. Radiomic analysis of pulmonary ground-glass opacity nodules for distinction of preinvasive lesions, invasive pulmonary adenocarcinoma and minimally invasive adenocarcinoma based on quantitative texture analysis of CT. Chin J Cancer Res 2018; 30:415-424. [PMID: 30210221 PMCID: PMC6129571 DOI: 10.21147/j.issn.1000-9604.2018.04.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To identify the differences among preinvasive lesions, minimally invasive adenocarcinomas (MIAs) and invasive pulmonary adenocarcinomas (IPAs) based on radiomic feature analysis with computed tomography (CT). Methods A total of 109 patients with ground-glass opacity lesions (GGOs) in the lungs determined by CT examinations were enrolled, all of whom had received a pathologic diagnosis. After the manual delineation and segmentation of the GGOs as regions of interest (ROIs), the patients were subdivided into three groups based on pathologic analyses: the preinvasive lesions (including atypical adenomatous hyperplasia and adenocarcinoma in situ) subgroup, the MIA subgroup and the IPA subgroup. Next, we obtained the texture features of the GGOs. The data analysis was aimed at finding both the differences between each pair of the groups and predictors to distinguish any two pathologic subtypes using logistic regression. Finally, a receiver operating characteristic (ROC) curve was applied to accurately evaluate the performances of the regression models.
Results We found that the voxel count feature (P<0.001) could be used as a predictor for distinguishing IPAs from preinvasive lesions. However, the surface area feature (P=0.040) and the extruded surface area feature (P=0.013) could be predictors of IPAs compared with MIAs. In addition, the correlation feature (P=0.046) could distinguish preinvasive lesions from MIAs better. Conclusions Preinvasive lesions, MIAs and IPAs can be discriminated based on texture features within CT images, although the three diseases could all appear as GGOs on CT images. The diagnoses of these three diseases are very important for clinical surgery.
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Affiliation(s)
- Wei Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xuexiang Wang
- Department of Radiology, Tianjin Hongqiao Hospital, Tianjin 300130, China
| | - Yuwei Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xubin Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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Fukui M, Suzuki K, Matsunaga T, Oh S, Takamochi K. Surgical intervention for ground glass dominant lesions: observation or outright resection? Jpn J Clin Oncol 2017; 47:749-754. [PMID: 28431123 DOI: 10.1093/jjco/hyx053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/03/2017] [Indexed: 11/12/2022] Open
Abstract
Background The management of ground glass opacity (GGO) on computed tomography (CT) remains controversial. Information of the relationship between clinical behavior and pathological invasiveness of GGO is valuable for management. We conducted this retrospective study to establish differences in the pathological invasiveness between GGO with and without changes. Methods Among 1762 patients, the following criteria was used: (1) maximum tumor diameter of 3 cm or less, (2) tumor having 50% or more GGO and (3) resection after at least three months of follow up. A change of CT findings was defined as an increase in the diameter or consolidation compared with the initial CT. The relationship between preoperative changes and ratio of invasive adenocarcinoma was investigated. Predictors of GGO growth were also examined. Results There were 250 patients: pure GGO without changes (G-N group; n = 118), pure GGO with changes (G-C group; n = 35), part-solid GGO without changes (S-N group; n = 78), and part-solid GGO with changes (S-C group; n = 20). The ratio of invasive adenocarcinoma in each group was 0.54, 0.89, 0.8, and 0.90. There was a significant difference between the G-N and G-C group (P < 0.001). However, there was no significant difference between the G-C, S-N and S-C group. Multivariate analysis indicated age was a predictor of preoperative changes (OR = 1.953, P = 0.049). Conclusions The pathological results of part-solid GGO with changes were not different from those without changes. Therefore surgery can be deferred until those lesions demonstrate changes. The pathological results of pure GGO with changes were equivalent to those of part-solid GGO. Therefore, even for pure GGO, follow up is necessary especially in elderly patients.
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Affiliation(s)
- Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Ahn H, Lee KW, Lee KH, Kim J, Kim K, Chung JH, Lee CT. Effect of computed tomography window settings and reconstruction plane on 8th edition T-stage classification in patients with lung adenocarcinoma manifesting as a subsolid nodule. Eur J Radiol 2017; 98:130-135. [PMID: 29279151 DOI: 10.1016/j.ejrad.2017.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/17/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the effect of window settings and reconstruction plane on clinical T-stage determined by solid portion size within subsolid nodules (SSNs), based on 8th-edition TNM standards. MATERIALS AND METHODS This retrospective study included 247 SSNs from 221 patients who underwent surgery for lung adenocarcinomas between Feb 2012 and Oct 2015. Two radiologists independently measured the diameter of the solid portion on axial, coronal, and sagittal planes using lung- and mediastinal-window. The largest diameter among the measurements on the three planes was referred to as multiplanar measurement. Inter-reader agreement as well as the correlation between the CT and pathologic measurements were calculated using intra-class correlation coefficients (ICCs). The proportions of disagreement in clinical T-stage on different measurement methods were measured. The κ values for agreement between clinical- and pathological T-stage were measured. RESULTS Inter-reader agreement was moderate-to-excellent (ICC confidence interval [CI] range, 0.51-0.92) in lung-window, while it was good-to-excellent (0.77-0.95) in mediastinal-window. The correlation between the CT and pathologic measurements was good-to-excellent (ICC CI range, 0.63-0.82) in lung-window and fair-to-good (0.25-0.78) in mediastinal-window. The proportions of disagreement between clinical T-stages using mediastinal- and lung-window were 32.0%-41.7% and 33.6%-49.0% with axial and multiplanar measurement, respectively. Multiplanar measurement resulted in upstaging in 12.6%-15.8% and 19.0%-24.3% of cases with mediastinal- and lung-window, respectively, when compared with axial measurement alone. The κ values for agreement between clinical T-stage and pathological T-stage ranged from 0.53 to 0.69. CONCLUSIONS Mediastinal-window was a more stable method in the aspect of the inter-reader agreement, but the correlation between the CT and pathologic measurement was better in lung-window. The clinical T-stage varied in up to one-half of the cases according to the window setting, and multiplanar measurement resulted in upstaging in up to one-fourth of the cases.
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Affiliation(s)
- Hyungwoo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Kwhanmien Kim
- Department of Thoracic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Choon-Taek Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
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Nemec U, Heidinger BH, Anderson KR, Westmore MS, VanderLaan PA, Bankier AA. Software-based risk stratification of pulmonary adenocarcinomas manifesting as pure ground glass nodules on computed tomography. Eur Radiol 2017; 28:235-242. [PMID: 28710575 PMCID: PMC5717124 DOI: 10.1007/s00330-017-4937-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/08/2017] [Accepted: 06/08/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the performance of the "Computer-Aided Nodule Assessment and Risk Yield" (CANARY) software in the differentiation and risk assessment of histological subtypes of lung adenocarcinomas manifesting as pure ground glass nodules on computed tomography (CT). METHODS 64 surgically resected and histologically proven adenocarcinomas manifesting as pure ground-glass nodules on CT were assessed using CANARY software, which classifies voxel-densities into three risk components (low, intermediate, and high risk). Differences in risk components between histological adenocarcinoma subtypes were analysed. To determine the optimal threshold reflecting the presence of an invasive focus, sensitivity, specificity, negative predictive value, and positive predictive value were calculated. RESULTS 28/64 (44%) were adenocarcinomas in situ (AIS); 26/64 (41%) were minimally invasive adenocarcinomas (MIA); and 10/64 (16%) were invasive ACs (IAC). The software showed significant differences in risk components between histological subtypes (P<0.001-0.003). A relative volume of 45% or less of low-risk components was associated with histological invasiveness (specificity 100%, positive predictive value 100%). CONCLUSIONS CANARY-based risk assessment of ACs manifesting as pure ground glass nodules on CT allows the differentiation of their histological subtypes. A threshold of 45% of low-risk components reflects invasiveness in these groups. KEY POINTS • CANARY-based risk assessment allows the differentiation of their histological subtypes. • 45% or less of low-risk component reflects histological invasiveness. • CANARY has potential role in suspected adenocarcinomas manifesting as pure ground-glass nodules.
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Affiliation(s)
- Ursula Nemec
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
| | - Benedikt H Heidinger
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kevin R Anderson
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Paul A VanderLaan
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexander A Bankier
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Wu F, Tian SP, Jin X, Jing R, Yang YQ, Jin M, Zhao SH. CT and histopathologic characteristics of lung adenocarcinoma with pure ground-glass nodules 10 mm or less in diameter. Eur Radiol 2017; 27:4037-4043. [PMID: 28386719 DOI: 10.1007/s00330-017-4829-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/26/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate CT and histopathologic features of lung adenocarcinoma with pure ground-glass nodule (pGGN) ≤10 mm in diameter. METHODS CT appearances of 148 patients (150 lesions) who underwent curative resection of lung adenocarcinoma with pGGN ≤10 mm (25 atypical adenomatous hyperplasias, 42 adenocarcinoma in situs, 38 minimally invasive adenocarcinomas, and 45 invasive pulmonary adenocarcinomas) were analyzed for lesion size, density, bubble-like sign, air bronchogram, vessel changes, margin, and tumour-lung interface. CT characteristics were compared among different histopathologic subtypes. Univariate and multivariate analysis were used to assess the relationship between CT characteristics of pGGN and lesion invasiveness, respectively. RESULTS There were statistically significant differences among histopathologic subtypes in lesion size, vessel changes, and tumour-lung interface (P<0.05). Univariate analysis revealed significant differences of vessel changes, margin and tumour-lung interface between preinvasive and invasive lesions (P<0.05). Logistic regression analysis showed that the vessel changes, unsmooth margin and clear tumour-lung interface were significant predictive factors for lesion invasiveness, with odds ratios (95% CI) of 2.57 (1.17-5.62), 1.83 (1.25-2.68) and 4.25 (1.78-10.14), respectively. CONCLUSION Invasive lesions are found in 55.3% of subcentimeter pGGNs in our cohort. Vessel changes, unsmooth margin, and clear lung-tumour interface may indicate the invasiveness of lung adenocarcinoma with subcentimeter pGGN. KEY POINTS • Invasive lesions were found in 55.3% of lung adenocarcinomas with subcentimeter pGGNs • Lesion size, vessel changes, and tumour-lung interface showed different among histopathologic subtypes • Vessel changes, unsmooth margin and clear tumour-lung interface were predictors for lesion invasiveness.
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Affiliation(s)
- Fang Wu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Department of Radiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Shu-Ping Tian
- Department of Radiology, Navy General Hospital, 28 Fucheng Road, Beijing, 100048, China
| | - Xin Jin
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Rui Jing
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yue-Qing Yang
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Mei Jin
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shao-Hong Zhao
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Identification of Factors for the Preoperative Prediction of Tumour Subtype and Prognosis in Patients with T1 Lung Adenocarcinoma. DISEASE MARKERS 2017; 2016:9354680. [PMID: 28115792 PMCID: PMC5220495 DOI: 10.1155/2016/9354680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/26/2016] [Accepted: 11/15/2016] [Indexed: 12/21/2022]
Abstract
Aims. Identification of factors that can predict the subtypes of lung adenocarcinoma preoperatively is important for selecting the appropriate surgical procedure and for predicting postoperative survival. Methods. We retrospectively evaluated 87 patients with lung adenocarcinomas ≤30 mm. Results. Preoperative radiological findings, serum CEA level, serum microRNA-183 (miR-183) level, and tumour size differed significantly between patients with adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) and those with invasive adenocarcinoma (IAC). Receiver operating characteristic curves and univariate analysis revealed that patients who were older than 57 years or had a pure solid nodule or a tumour with mixed ground-glass opacity (mGGO), a tumour >11 mm, a serum CEA level >2.12 ng/mL, or a serum miR-183 level >1.233 (2-ΔΔCt) were more likely to be diagnosed with IAC than with AIS or MIA. The combination of all five factors had an area under the curve of 0.946, with a sensitivity of 89.13% and a specificity of 95.12%. Moreover, patients with a cut-off value >0.499 for the five-factor combination had poor overall survival. Conclusions. The five-factor combination enables clinicians to distinguish AIS or MIA from IAC, thereby aiding in selecting the appropriate treatment, and to predict the prognosis of lung adenocarcinoma patients.
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