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Yang Y, Xu J, Wang W, Ma M, Huang Q, Zhou C, Zhao J, Duan Y, Luo J, Jiang J, Ye L. A nomogram based on the quantitative and qualitative features of CT imaging for the prediction of the invasiveness of ground glass nodules in lung adenocarcinoma. BMC Cancer 2024; 24:438. [PMID: 38594670 PMCID: PMC11005224 DOI: 10.1186/s12885-024-12207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE Based on the quantitative and qualitative features of CT imaging, a model for predicting the invasiveness of ground-glass nodules (GGNs) was constructed, which could provide a reference value for preoperative planning of GGN patients. MATERIALS AND METHODS Altogether, 702 patients with GGNs (including 748 GGNs) were included in this study. The GGNs operated between September 2020 and July 2022 were classified into the training group (n = 555), and those operated between August 2022 and November 2022 were classified into the validation group (n = 193). Clinical data and the quantitative and qualitative features of CT imaging were harvested from these patients. In the training group, the quantitative and qualitative characteristics in CT imaging of GGNs were analyzed by using performing univariate and multivariate logistic regression analyses, followed by constructing a nomogram prediction model. The differentiation, calibration, and clinical practicability in both the training and validation groups were assessed by the nomogram models. RESULTS In the training group, multivariate logistic regression analysis disclosed that the maximum diameter (OR = 4.707, 95%CI: 2.06-10.758), consolidation/tumor ratio (CTR) (OR = 1.027, 95%CI: 1.011-1.043), maximum CT value (OR = 1.025, 95%CI: 1.004-1.047), mean CT value (OR = 1.035, 95%CI: 1.008-1.063; P = 0.012), spiculation sign (OR = 2.055, 95%CI: 1.148-3.679), and vascular convergence sign (OR = 2.508, 95%CI: 1.345-4.676) were independent risk parameters for invasive adenocarcinoma. Based on these findings, we established a nomogram model for predicting the invasiveness of GGN, and the AUC was 0.910 (95%CI: 0.885-0.934) and 0.902 (95%CI: 0.859-0.944) in the training group and the validation group, respectively. The internal validation of the Bootstrap method showed an AUC value of 0.905, indicating a good differentiation of the model. Hosmer-Lemeshow goodness of fit test for the training and validation groups indicated that the model had a good fitting effect (P > 0.05). Furthermore, the calibration curve and decision analysis curve of the training and validation groups reflected that the model had a good calibration degree and clinical practicability. CONCLUSION Combined with the quantitative and qualitative features of CT imaging, a nomogram prediction model can be created to forecast the invasiveness of GGNs. This model has good prediction efficacy for the invasiveness of GGNs and can provide help for the clinical management and decision-making of GGNs.
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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, Yunnan Province, Kunming, China
| | - Jing Xu
- Department of Dermatology and Venereal Diseases, Yan'an Hospital of Kunming City, Kunming, China
| | - Wei Wang
- Department of Thoracic and Cardiovascular Surgery, Shiyan Taihe Hospital (Hubei University of Medicine), Hubei, Shiyan, China
| | - Mingsheng Ma
- Department of Thoracic and Cardiovascular Surgery, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Yunnan Province, Kunming, China
| | - Qiubo Huang
- Department of Thoracic and Cardiovascular Surgery, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Yunnan Province, Kunming, China
| | - Chen Zhou
- Department of Thoracic and Cardiovascular Surgery, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, No. 519 Kunzhou Road, Xishan District, Yunnan Province, Kunming, 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, Yunnan Province, Kunming, 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, Yunnan Province, Kunming, China
| | - Jia Luo
- Department of Pathology, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiezhi Jiang
- Department of Radiology, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, Kunming, 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, Yunnan Province, Kunming, China.
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Gao S, Wu Y, Li H, Zhou Y, Du C, Yang R, Wu Y. The predictive value of computed tomography value on high-resolution images in differentiating invasive from indolent lung adenocarcinoma. Transl Cancer Res 2024; 13:268-277. [PMID: 38410205 PMCID: PMC10894351 DOI: 10.21037/tcr-23-1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
Background Invasive adenocarcinoma (IA) has a worse prognosis and different clinical management strategies compared to indolent lung adenocarcinoma including adenocarcinoma in situ (AIS) and minimally IA (MIA). The purpose of this study was to evaluate the predictive value of computed tomography (CT) value in differentiating invasive from indolent lung adenocarcinoma. Methods The pathological diagnoses and imaging data of confirmed lung adenocarcinomas manifested as lung nodules with homogeneous internal density which were surgically resected between August 2021 and July 2022 were retrospectively analyzed. Differences in CT values between invasive and indolent lung adenocarcinomas were compared in the primary cohort (n=766), and receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value. The predictive performance of the cut-off value was evaluated in the validation cohort (n=341). Results A total of 1,107 lung nodules from 1,014 patients were included in the total cohort. The CT values had a significant difference between invasive and indolent lung adenocarcinomas (P<0.001). Using the primary cohort, we determined the optimal cut-off value of -415 Hounsfield units (HU) of the CT value based on ROC curve, which showed good discrimination between IA and AIS/MIA in both the primary and validation cohorts (sensitivity, 85.98% and 87.42%, specificity, 87.67% and 84.74%, respectively). Conclusions The CT value of >-415 HU could be an effective predictor of invasive lung adenocarcinoma, thereby providing an appropriate clinical decision guide.
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Affiliation(s)
- Shenhu Gao
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxuan Wu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haoyang Li
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuwei Zhou
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengli Du
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rong Yang
- Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yihe Wu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Deng C, Chen Z, Bai J, Fu F, Wang S, Li Y, Zhang Y, Chen H. Clinical characteristics and progression of pre-/minimally invasive lung adenocarcinoma harboring ALK or RET rearrangements: a retrospective cohort study. Transl Lung Cancer Res 2023; 12:2440-2447. [PMID: 38205201 PMCID: PMC10775003 DOI: 10.21037/tlcr-23-517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
Background Patients harboring anaplastic lymphoma kinase (ALK) or rearranged during transfection (RET) rearrangements are usually diagnosed at a relatively late stage with nodal and distant metastasis, and rapid progression course of ALK/RET fusion-positive lung cancer were well-known. However, clinical characteristics and course of pre-/minimally invasive lung adenocarcinoma harboring ALK or RET fusions are poorly described. Identifying patients with gene fusions at early stage may offer surgical options that could cure those patients. Methods We retrospectively included patients with surgically resected pre-/minimally invasive lung adenocarcinomas harboring epidermal growth factor receptor (EGFR) mutations or ALK/RET rearrangements, and further compared the patient clinical characteristics, nodule natural course, and survival outcomes. Radiological characteristics including ground-glass component, cystic airspace, pleural attachment, etc. were specially assessed for this study. EGFR (exons 18-22) was detected by Sanger sequencing and quantitative real-time polymerase chain reaction (qRT-PCR) was used to analyze the ALK/RET rearrangements. Lung cancer-specific survival (LCSS), relapse-free survival (RFS), and overall survival (OS) were all evaluated. Results Of 238 patients with pre-/minimally invasive lung adenocarcinomas, 226 patients had EGFR mutations, 7 patients had ALK fusions, and 5 patients had RET fusions. Average age at surgery was 45.3 years for ALK/RET-positive group and 52.6 years for EGFR-positive group (P=0.049). Radiologically, among the 12 patients with ALK/RET fusions, the majority of lesions (10/12) manifested as mixed ground-glass opacities (mGGOs), which was significantly more prevalent when compared with patients with EGFR mutations (83.4% vs. 24.3%, P<0.001). Moreover, a substantial proportion of cystic airspace was found in ALK/RET-positive group but not in EGFR-positive group (66.7% vs. 14.2%, P<0.001). Among four patients with ALK/RET fusions undergoing surveillance over 1 year before surgery, two of them developed rapid radiologic progression. The 5-year LCSS and RFS were 100%, 100% for ALK/RET-positive group, and 100%, 100% for EGFR-positive group, respectively. Conclusions ALK/RET-positive pre-/minimally invasive lung adenocarcinomas were mostly characterized as mGGOs with cystic airspace developing rapid nodule progression, and no recurrence occurred during long-term follow-up after resection. This provides insights into proper curative surgery timing in the management of patients with gene fusions. However, these findings must be treated with caution and validated in future multi-center studies with larger sample size.
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Affiliation(s)
- Chaoqiang Deng
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zongwei Chen
- Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Shanghai, China
| | - Jinsong Bai
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shengping Wang
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuan Li
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Thoracic Oncology, Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Jian HU, Jun CHEN, Chang CHEN, Wenzhao ZHONG, Qing GENG. [Wedge Resection of Pulmonary Nodules (≤2 cm):
A Consensus Statement by Specialists of Thoracic Surgery (2023 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2023; 26:338-347. [PMID: 37316443 PMCID: PMC10273154 DOI: 10.3779/j.issn.1009-3419.2023.102.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Indexed: 06/16/2023]
Abstract
Lung cancer is the highest cancer-related mortality rate in the world, and is one of the most common malignancies. The standard treatment for early-stage non-small cell lung cancer (NSCLC) is radical lobectomy, while recent studies have found that sub-lobectomy of pulmonary nodules (≤2 cm) is not inferior to lobectomy and even improve the prognosis of the patients. These important findings will effectively and positively promote the formation of consensus and principles of wedge resection of pulmonary nodules (≤2 cm) in the field of thoracic surgery. The purpose of this study is to present a national expert consensus on wedge resection of pulmonary nodules (≤2 cm) in the field of thoracic surgery. The experts from Editorial Committee of Consensus on Wedge Resection of Lung Nodules (≤2 cm) (2023 Edition) jointly participated in the revision work. According to the clinical progress about the wedge resection of pulmonary nodules (≤2 cm) at home and abroad during recent years, experts jointly wrote Wedge Resection of Pulmonary Nodules (≤2 cm): a Consensus Statement by Specialists of Thoracic Surgery (2023 Edition), in combination with the homogeneous treatment principles of wedge resection in the field of thoracic surgery in China. This consensus was summarized from the following aspects: (1) Indications of wedge resection of pulmonary nodules (≤2 cm); (2) Resection range of pulmonary nodules (≤2 cm) required for wedge resection; (3) Excisable pulmonary nodules (≤2 cm) for wedge resection. This consensus finally put forward 8 recommended opinions, and sorted out 5 opinions which were still controversial and needed more evidence. The integrated opinions were generated through the discussion held among the experts of thoracic surgery from all over the country, making wedge resection of pulmonary nodules (≤2 cm) more appropriate for China and more standardized and homogeneous for clinical practice. In the future, more relevant researches should be accumulated based on the characteristics of lung cancer and its diagnosis and treatment in China, optimizing the treatment of pulmonary nodules (≤2 cm).
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Chen C, Geng Q, Song G, Zhang Q, Wang Y, Sun D, Zeng Q, Dai Z, Wang G. A comprehensive nomogram combining CT-based radiomics with clinical features for differentiation of benign and malignant lung subcentimeter solid nodules. Front Oncol 2023; 13:1066360. [PMID: 37007065 PMCID: PMC10064794 DOI: 10.3389/fonc.2023.1066360] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
ObjectiveTo establish a nomogram based on non-enhanced computed tomography(CT) imaging radiomics and clinical features for use in predicting the malignancy of sub-centimeter solid nodules (SCSNs).Materials and methodsRetrospective analysis was performed of records for 198 patients with SCSNs that were surgically resected and examined pathologically at two medical institutions between January 2020 and June 2021. Patients from Center 1 were included in the training cohort (n = 147), and patients from Center 2 were included in the external validation cohort (n = 52). Radiomic features were extracted from chest CT images. The least absolute shrinkage and selection operator (LASSO) regression model was used for radiomic feature extraction and computation of radiomic scores. Clinical features, subjective CT findings, and radiomic scores were used to build multiple predictive models. Model performance was examined by evaluating the area under the receiver operating characteristic curve (AUC). The best model was selected for efficacy evaluation in a validation cohort, and column line plots were created.ResultsPulmonary malignant nodules were significantly associated with vascular alterations in both the training (p < 0.001) and external validation (p < 0.001) cohorts. Eleven radiomic features were selected after a dimensionality reduction to calculate the radiomic scores. Based on these findings, three prediction models were constructed: subjective model (Model 1), radiomic score model (Model 2), and comprehensive model (Model 3), with AUCs of 0.672, 0.888, and 0.930, respectively. The optimal model with an AUC of 0.905 was applied to the validation cohort, and decision curve analysis indicated that the comprehensive model column line plot was clinically useful.ConclusionPredictive models constructed based on CT-based radiomics with clinical features can help clinicians diagnose pulmonary nodules and guide clinical decision making.
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Affiliation(s)
- Chengyu Chen
- Department of Thoracic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Qun Geng
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Gesheng Song
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical Unversity, Jinan, China
| | - Qian Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Youruo Wang
- Elite Class of 2017, Shandong First Medical University, Jinan, China
| | - Dongfeng Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Qingshi Zeng
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical Unversity, Jinan, China
| | - Zhengjun Dai
- Scientific Research Department, Huiying Medical Technology Co., Ltd, Beijing, China
| | - Gongchao Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Gongchao Wang,
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Chen X, Li P, Zhang M, Wang X, Wang D. Value of preoperative 18F-FDG PET/CT and HRCT in predicting the differentiation degree of lung adenocarcinoma dominated by solid density. PeerJ 2023; 11:e15242. [PMID: 37138817 PMCID: PMC10150717 DOI: 10.7717/peerj.15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Purpose To evaluate the value of positron emission tomography/computed tomography (PET/CT) combined with high-resolution CT (HRCT) in determining the degree of differentiation of lung adenocarcinoma. Methods From January 2018 to January 2022, 88 patients with solid density nodules that are lung adenocarcinoma were surgically treated. All patients were examined using HRCT and PET/CT before surgery. During HRCT, two independent observers assessed the presence of lobulation, spiculation, pleural indentation, vascular convergence, and air bronchial signs (bronchial distortion and bronchial disruption). The diameter and CT value of the nodules were measured simultaneously. During PET/CT, the maximum standard uptake value (SUVmax), mean standard uptake value (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the nodules were measured. The risk factors of pathological classification were predicted by logistic regression analysis. Results All 88 patients (mean age 60 ± 8 years; 44 males and 44 females) were evaluated. The average nodule size was 2.6 ± 1.1 cm. The univariate analysis showed that carcinoembryonic antigen (CEA), pleural indentation, vascular convergence, bronchial distortion, and higher SUVmax were more common in poor differentiated lung adenocarcinoma, and in the multivariate analysis, pleural indentation, vascular convergence, and SUVmax were predictive factors. The combined diagnosis using these three factors showed that the area under the curve (AUC) was 0.735. Conclusion SUVmax >6.99 combined with HRCT (pleural indentation sign and vascular convergence sign) is helpful to predict the differentiation degree of lung adenocarcinoma dominated by solid density.
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Affiliation(s)
- Xiaolin Chen
- Department of PET/CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Ping Li
- Department of PET/CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Minghui Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xuewei Wang
- Department of PET/CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Dalong Wang
- Department of PET/CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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Zuo Z, Wang P, Zeng W, Qi W, Zhang W. Measuring pure ground-glass nodules on computed tomography: assessing agreement between a commercially available deep learning algorithm and radiologists’ readings. Acta Radiol 2022; 64:1422-1430. [PMID: 36317301 DOI: 10.1177/02841851221135406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Deep learning algorithms (DLAs) could enable automatic measurements of solid portions of mixed ground-glass nodules (mGGNs) in agreement with the invasive component sizes measured during pathologic examinations. However, the measurement of pure ground-glass nodules (pGGNs) based on DLAs has rarely been reported in the literature. Purpose To evaluate the use of a commercially available DLA for the automatic measurement of pGGNs on computed tomography (CT). Material and Methods In this retrospective study, we included 68 patients with 81 pGGNs. The maximum diameter of the nodules was manually measured by senior radiologists and automatically segmented and measured by the DLA. Agreement between the measurements by the radiologist and DLA was assessed using Bland–Altman plots, and correlations were analyzed using Pearson correlation. Finally, we evaluated the association between the radiologist and DLA measurements and the invasiveness of lung adenocarcinoma in patients with pGGNs on preoperative CT. Results The radiologist and DLA measurements exhibited good agreement with a Bland–Altman bias of 3.0%, which were clinically acceptable. The correlation between both sets of maximum diameters was also strong, with a Pearson correlation coefficient of 0.968 ( P < 0.001). In addition, both sets of maximum diameters were larger in the invasive adenocarcinoma group than in the non-invasive adenocarcinoma group ( P < 0.001). Conclusion Automatic pGGNs measurements by the DLA were comparable with those measured manually and were closely associated with the invasiveness of lung adenocarcinoma.
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Affiliation(s)
- Zhichao Zuo
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, PR China
| | - Peng Wang
- Department of Radiology, WuHan No.1 Hospital, WuHan, PR China
| | - Weihua Zeng
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, PR China
| | - Wanyin Qi
- Department of Radiology, the Affiliated Hospital of Southwest Medical University, Luzhou, PR China
| | - Wei Zhang
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, PR China
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Xie M, Gao J, Ma X, Wu C, Zang X, Wang Y, Deng H, Yao J, Sun T, Yu Z, Liu S, Zhuang G, Xue X, Wu J, Wang J. Consolidation radiographic morphology can be an indicator of the pathological basis and prognosis of partially solid nodules. BMC Pulm Med 2022; 22:369. [PMID: 36171571 PMCID: PMC9520850 DOI: 10.1186/s12890-022-02165-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Part-solid nodules (PSNs) have gradually shifted to defining special clinical subtypes. Commonly, the solid portions of PSNs show various radiological morphologies, of which the corresponding pathological basis and prognosis are unclear. We conducted a radiological–pathological evaluation to determine the histopathologic basis of different consolidation radiographic morphologies related to prognosis. Materials and methods A cohort of 275 patients with a surgical pathological diagnosis of lung adenocarcinoma were enrolled. Preoperative computed tomography (CT) images of the PSNs were recorded and assessed. A panel of 103 patients with complete pathological specimens was selected to examine the radiological–pathological associations, and follow-up was performed to identify the prognosis. Results Of the 275 patients, punctate consolidation was observed radiologically in 43/275 (15.7%), stripe consolidation in 68/275 (24.7%), and irregular consolidation in 164/275 (59.6%) patients. The radiological morphology of the solid components was significantly associated with the histopathological subtypes (P < 0.001). Visual punctate solid components on CT correlated with tertiary lymphoid structures, stripe solid components on CT correlated with fibrotic scar, and irregular solid components on CT correlated with invasion. PSNs with regular consolidation had a better prognosis than those with irregular consolidation. Conclusion Radiological morphology of solid components in PSNs can indicate the pathological basis and is valuable for prognosis. In particular, irregular solid components in PSNs usually indicate serious invasive growth, which should be taken with caution during assessment.
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Affiliation(s)
- Mei Xie
- Department of Respiratory and Critical Care, Chinese PLA General Hospital, the First Medical Centre, Beijing, 100835, People's Republic of China.,Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, People's Republic of China
| | - Jie Gao
- Department of Pathology, Chinese PLA General Hospital, Beijing, 100835, People's Republic of China
| | - Xidong Ma
- Department of Respiratory and Critical Care, Chinese PLA General Hospital, the First Medical Centre, Beijing, 100835, People's Republic of China
| | - Chongchong Wu
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100835, People's Republic of China
| | - Xuelei Zang
- Center of Clinical Laboratory Medicine, First Medical Centre, Chinese PLA General Hospital, 100835, Beijing, People's Republic of China
| | - Yuanyong Wang
- Department of Thoracic Surgery, Tangdu Hospital of Air Force Military Medical University, Xi'an, 710038, Shanxi, People's Republic of China
| | - Hui Deng
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, 100038, Beijing, People's Republic of China
| | - Jie Yao
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, 100038, Beijing, People's Republic of China
| | - Tingting Sun
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, People's Republic of China
| | - Zhaofeng Yu
- School of Medicine, Peking University, Beijing, 100871, People's Republic of China
| | - Sanhong Liu
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Guanglei Zhuang
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200000, Shanghai, People's Republic of China.
| | - Xinying Xue
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, 100038, Beijing, People's Republic of China.
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, People's Republic of China.
| | - Jianxin Wang
- Department of Respiratory and Critical Care, Chinese PLA General Hospital, the First Medical Centre, Beijing, 100835, People's Republic of China.
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Zhang T, Zhang C, Zhong Y, Sun Y, Wang H, Li H, Yang G, Zhu Q, Yuan M. A radiomics nomogram for invasiveness prediction in lung adenocarcinoma manifesting as part-solid nodules with solid components smaller than 6 mm. Front Oncol 2022; 12:900049. [PMID: 36033463 PMCID: PMC9406823 DOI: 10.3389/fonc.2022.900049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate whether radiomics can help radiologists and thoracic surgeons accurately predict invasive adenocarcinoma (IAC) manifesting as part-solid nodules (PSNs) with solid components <6 mm and provide a basis for rational clinical decision-making. Materials and Methods In total, 1,210 patients (mean age ± standard deviation: 54.28 ± 11.38 years, 374 men and 836 women) from our hospital and another hospital with 1,248 PSNs pathologically diagnosed with adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), or IAC were enrolled in this study. Among them, 1,050 cases from our hospital were randomly divided into a derivation set (n = 735) and an internal validation set (n = 315), 198 cases from another hospital were used for external validation. Each labeled nodule was segmented, and 105 radiomics features were extracted. Least absolute shrinkage and selection operator (LASSO) was used to calculate Rad-score and build the radiomics model. Multivariable logistic regression was conducted to identify the clinicoradiological predictors and establish the clinical-radiographic model. The combined model and predictive nomogram were developed based on identified clinicoradiological independent predictors and Rad-score using multivariable logistic regression analysis. The predictive performances of the three models were compared via receiver operating characteristic (ROC) curve analysis. Decision curve analysis (DCA) was performed on both the internal and external validation sets to evaluate the clinical utility of the nomogram. Results The radiomics model showed superior predictive performance than the clinical-radiographic model in both internal and external validation sets (Az values, 0.884 vs. 0.810, p = 0.001; 0.924 vs. 0.855, p < 0.001, respectively). The combined model showed comparable predictive performance to the radiomics model (Az values, 0.887 vs. 0.884, p = 0.398; 0.917 vs. 0.924, p = 0.271, respectively). The clinical application value of the nomogram developed based on the Rad-score, maximum diameter, and lesion shape was confirmed, and DCA demonstrated that application of the Rad-score would be beneficial for radiologists predicting invasive lesions. Conclusions Radiomics has the potential as an independent diagnostic tool to predict the invasiveness of PSNs with solid components <6 mm.
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Affiliation(s)
- Teng Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chengxiu Zhang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Yan Zhong
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yingli Sun
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Haijie Wang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Hai Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Quan Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Quan Zhu, ; Mei Yuan,
| | - Mei Yuan
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Quan Zhu, ; Mei Yuan,
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Song Y, Chen D, Lian D, Xu S, Xiao H. Study on the Correlation Between CT Features and Vascular Tumor Thrombus Together With Nerve Invasion in Surgically Resected Lung Adenocarcinoma. Front Surg 2022; 9:931568. [PMID: 35836602 PMCID: PMC9273926 DOI: 10.3389/fsurg.2022.931568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background We aimed to analyze the relationship between pulmonary adenocarcinoma patients with vascular tumor thrombus and nerve invasion and different CT features. Methods The preoperative CT scanning data of 86 patients with lung adenocarcinoma who underwent surgical resection in our hospital from January 2020 to January 2022 were analyzed in the form of retrospective analysis. The CT images of all patients were observed, and the relationship between them and vascular tumor thrombus and nerve invasion of lung adenocarcinoma was analyzed. At the same time, the sensitivity, specificity, and accuracy of enhanced CT and plain CT were compared to evaluate the diagnostic efficacy of both. Results The results showed that the vascular tumor thrombus of lung adenocarcinoma was mainly related to the solid components and lobulated and calcified tumors in CT images, and the nerve invasion of lung adenocarcinoma was mainly related to the tumors with bronchial inflation sign in CT images (P < 0.05). The sensitivity, specificity, and accuracy of enhanced CT in the diagnosis of vascular tumor thrombus were 78.26%, 96.83%, and 91.86%, respectively, and the sensitivity, specificity, and accuracy in the diagnosis of nerve invasion were 75.00%, 98.72%, and 96.51%, respectively. The sensitivity, specificity, and accuracy of plain CT in the diagnosis of vascular tumor thrombus were 43.48%, 92.06%, and 79.07%, respectively, and the sensitivity, specificity, and accuracy in the diagnosis of nerve invasion were 25.00%, 94.87%, and 88.37%, respectively. The contrast showed that the sensitivity and accuracy of enhanced CT were higher than those of plain CT (P < 0.05), but the difference of specificity was not obvious (P > 0.05). Conclusions Solid components and lobulated and calcified tumors in CT signs are closely related to vascular tumor thrombus of lung adenocarcinoma, while patients with bronchial inflation sign are related to nerve invasion.
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Affiliation(s)
- Yu Song
- Department of Diagnostic Radiology, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Daiwen Chen
- Department of Diagnostic Radiology, 900 Hospital of the Joint Logistics Team, Fuzhou, China
- Correspondence: Daiwen Chen
| | - Duohuang Lian
- Department of Cardiothoracic Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Shangwen Xu
- Department of Diagnostic Radiology, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Hui Xiao
- Department of Diagnostic Radiology, 900 Hospital of the Joint Logistics Team, Fuzhou, China
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11
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Zhou S, Cai D, Chen C, Luo J, Wang R. Preoperative Changes of Lung Nodule on Computed Tomography and Their Relationship With Pathological Outcomes. Front Surg 2022; 9:836924. [PMID: 35372466 PMCID: PMC8965753 DOI: 10.3389/fsurg.2022.836924] [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: 12/16/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWhether changes of lung nodules on computed tomography could bring us helpful information related to their pathological outcomes remained unclear.Materials and MethodsThis retrospective study was carried out among 1,185 cases of lung nodules in Shanghai Chest Hospital from January 2015 to April 2017, which did not shrink or disappear after preoperative follow-up over three months. Their imaging features, changes, and clinical characteristics were collected. A separate analysis was performed in nodules with or without growth in long-axis diameter after follow-up, searching significant changes related to nodule malignancy and the median interval of follow-up for reference. Further study was performed similarly in malignant nodules for discrimination of malignant grading.ResultsMost nodules were stable (n = 885, 75%), whereas others grew (n = 300, 25%). For predicting nodule malignancy, increase in density (>10 Hounsfield units, median follow-up of 549 days) played an important role in growing group whereas it failed in stable group, and the increase in size was less significant in growing group. For discrimination of malignant grading, increase in density (>70 Hounsfield units, median follow-up of 366 days) showed its significance in stable group, and so did increase in size in growing group (maximum diameter growth >3.3 mm, median follow-up of 549 days, or average diameter growth >3.1 mm, median follow-up of 625 days).ConclusionsThere were significant changes of lung nodules by follow-up on computed tomography, related to their pathological outcomes. The predictive power of increase in density or size varied in different situations, whereas all referred to a long-time preoperative follow-up.
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12
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Identification of pathological subtypes of early lung adenocarcinoma based on artificial intelligence parameters and CT signs. Biosci Rep 2022; 42:230629. [PMID: 35005775 PMCID: PMC8766821 DOI: 10.1042/bsr20212416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 12/05/2022] Open
Abstract
Objective: To explore the value of quantitative parameters of artificial intelligence (AI) and computed tomography (CT) signs in identifying pathological subtypes of lung adenocarcinoma appearing as ground-glass nodules (GGNs). Methods: CT images of 224 GGNs from 210 individuals were collected retrospectively and classified into atypical adenomatous hyperplasia (AAH)/adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC) groups. AI was used to identify GGNs and to obtain quantitative parameters, and CT signs were recognized manually. The mixed predictive model based on logistic multivariate regression was built and evaluated. Results: Of the 224 GGNs, 55, 93, and 76 were AAH/AIS, MIA, and IAC, respectively. In terms of AI parameters, from AAH/AIS to MIA, and IAC, there was a gradual increase in two-dimensional mean diameter, three-dimensional mean diameter, mean CT value, maximum CT value, and volume of GGNs (all P<0.0001). Except for the CT signs of the location, and the tumor–lung interface, there were significant differences among the three groups in the density, shape, vacuolar signs, air bronchogram, lobulation, spiculation, pleural indentation, and vascular convergence signs (all P<0.05). The areas under the curve (AUC) of predictive model 1 for identifying the AAH/AIS and MIA and model 2 for identifying MIA and IAC were 0.779 and 0.918, respectively, which were greater than the quantitative parameters independently (all P<0.05). Conclusion: AI parameters are valuable for identifying subtypes of early lung adenocarcinoma and have improved diagnostic efficacy when combined with CT signs.
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Zuo Z, Li Y, Peng K, Li X, Tan Q, Mo Y, Lan Y, Zeng W, Qi W. CT texture analysis-based nomogram for the preoperative prediction of visceral pleural invasion in cT1N0M0 lung adenocarcinoma: an external validation cohort study. Clin Radiol 2021; 77:e215-e221. [PMID: 34916048 DOI: 10.1016/j.crad.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/12/2021] [Indexed: 12/29/2022]
Abstract
AIM To develop a nomogram based on computed tomography (CT) texture analysis for the preoperative prediction of visceral pleural invasion in patients with cT1N0M0 lung adenocarcinoma. MATERIALS AND METHODS A dataset of chest CT containing lung nodules was collected from two institutions, and all surgically resected nodules were classified pathologically based on the presence of visceral pleural invasion. Each nodule on the CT image was segmented automatically by artificial-intelligence software and its CT texture features were extracted. The dataset was divided into training and external validation cohorts according to the institution, and a nomogram for predicting visceral pleural invasion was developed and validated. RESULTS Of a total of 313 patients enrolled from two independent institutions, 63 were diagnosed with visceral pleural invasion. Three-dimensional (3D) CT long diameter, skewness, and sphericity, and chronic obstructive pulmonary disease were identified as independent predictors for visceral pleural invasion by multivariable logistic regression. The nomogram based on multivariable logistic regression showed great discriminative ability, as indicated by a C-index of 0.890 (95% confidence interval [CI]: 0.867-0.914) and 0.864 (95% CI: 0.817-0.911) for the training and external validation cohorts, respectively. Additionally, calibration of the nomogram revealed good predictive ability, as indicated by the Brier score (0.108 and 0.100 for the training and external validation cohorts, respectively). CONCLUSIONS A nomogram was developed that could compute the probability of visceral pleural invasion in patients with cT1N0M0 lung adenocarcinoma with good calibration and discrimination. The nomogram has potential as a reliable tool for clinical evaluation and decision-making.
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Affiliation(s)
- Z Zuo
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Y Li
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - K Peng
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - X Li
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Q Tan
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Y Mo
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Y Lan
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - W Zeng
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - W Qi
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
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14
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Minato H, Katayanagi K, Kurumaya H, Tanaka N, Fujimori H, Tsunezuka Y, Kobayashi T. Verification of the eighth edition of the UICC-TNM classification on surgically resected lung adenocarcinoma: Comparison with previous classification in a local center. Cancer Rep (Hoboken) 2021; 5:e1422. [PMID: 34169671 PMCID: PMC8789611 DOI: 10.1002/cnr2.1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The UICC 8th TNM classification of lung cancer has been changed dramatically, especially in measuring methods of T-desriptors. Different from squamous- or small-cell carcinomas, in which the solid- and the invasive-diameter mostly agree with each other, the diameter of the radiological solid part and that of pathological invasive part in adenocarcinomas often does not match. AIM We aimed to determine radiological and pathological tumor diameters of pulmonary adenocarcinomas with clinicopathological factors and evaluate the validity of the 8th edition in comparison with the 7th edition. METHODS AND RESULTS We retrospectively analyzed clinicopathological factors of 429 patients with surgically resected pulmonary adenocarcinomas. The maximum tumor and their solid-part diameters were measured using thin-sectioned computed tomography and compared with pathological tumor and invasive diameters. Overall survival (OS) rate was determined using the Kaplan-Meier method for different subgroups of clinicopathological factors. Akaike's information criteria (AIC) was used as a discriminative measure for the univariate Cox model for the 7th and 8th editions. Multivariate Cox regression analysis was performed to explore independent prognostic factors. Correlation coefficients between radiological and pathological diameters in the 7th and 8th editions were 0.911 and 0.888, respectively, without a significant difference. The major reasons for the difference in the 8th edition were the presence of intratumoral fibrosis and papillary growth pattern. The weighted kappa coefficients in the 8th edition were superior those in the 7th edition for both the T and Stage classifications. In the univariate Cox model, AIC levels were the lowest in the 8th edition. Multivariate analysis revealed that age, lymphovascular invasion, pT(8th), and stage were the most important determinants for OS. CONCLUSION The UICC 8th edition is a more discriminative classification than the 7th edition. For subsolid nodules, continuous efforts are necessary to increase the universality of the measurement of solid and invasive diameters.
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Affiliation(s)
- Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroshi Kurumaya
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Nobuhiro Tanaka
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hideki Fujimori
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Yoshio Tsunezuka
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Takeshi Kobayashi
- Department of Diagnostic and Interventional Radiology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
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15
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Qi LL, Wang JW, Yang L, Huang Y, Zhao SJ, Tang W, Jin YJ, Zhang ZW, Zhou Z, Yu YZ, Wang YZ, Wu N. Natural history of pathologically confirmed pulmonary subsolid nodules with deep learning-assisted nodule segmentation. Eur Radiol 2020; 31:3884-3897. [PMID: 33219848 DOI: 10.1007/s00330-020-07450-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/29/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore the natural history of pulmonary subsolid nodules (SSNs) with different pathological types by deep learning-assisted nodule segmentation. METHODS Between June 2012 and June 2019, 95 resected SSNs with preoperative long-term follow-up were enrolled in this retrospective study. SSN detection and segmentation were performed on preoperative follow-up CTs using the deep learning-based Dr. Wise system. SSNs were categorized into invasive adenocarcinoma (IAC, n = 47) and non-IAC (n = 48) groups; according to the interval change during the preoperative follow-up, SSNs were divided into growth (n = 68), nongrowth (n = 22), and new emergence (n = 5) groups. We analyzed the cumulative percentages and pattern of SSN growth and identified significant factors for IAC diagnosis and SSN growth. RESULTS The mean preoperative follow-up was 42.1 ± 17.0 months. More SSNs showed growth or new emergence in the IAC than in the non-IAC group (89.4% vs. 64.6%, p = 0.009). Volume doubling time was non-significantly shorter for IACs than for non-IACs (1436.0 ± 1188.2 vs. 2087.5 ± 1799.7 days, p = 0.077). Median mass doubling time was significantly shorter for IACs than for non-IACs (821.7 vs. 1944.1 days, p = 0.001). Lobulated sign (p = 0.002) and SSN mass (p = 0.004) were significant factors for differentiating IACs. IACs showed significantly higher cumulative growth percentages than non-IACs in the first 70 months of follow-up. The growth pattern of SSNs may conform to the exponential model. The initial volume (p = 0.042) was a predictor for SSN growth. CONCLUSIONS IACs appearing as SSNs showed an indolent course. The mean growth rate was larger for IACs than for non-IACs. SSNs with larger initial volume are more likely to grow. KEY POINTS • Invasive adenocarcinomas (IACs) appearing as subsolid nodules (SSNs), with a mean volume doubling time (VDT) of 1436.0 ± 1188.2 days and median mass doubling time (MDT) of 821.7 days, showed an indolent course. • The VDT was shorter for IACs than for non-IACs (1436.0 ± 1188.2 vs. 2087.5 ± 1799.7 days), but the difference was not significant (p = 0.077). The median MDT was significantly shorter for IACs than for non-IACs (821.7 vs. 1944.1 days, p = 0.001). • SSNs with lobulated sign and larger mass (> 390.5 mg) may very likely be IACs. SSNs with larger initial volume are more likely to grow.
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Affiliation(s)
- Lin-Lin Qi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jian-Wei Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Lin Yang
- Department of Diagnostic Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yao Huang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Shi-Jun Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Wei Tang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yu-Jing Jin
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Ze-Wei Zhang
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Zhen Zhou
- School of Electronic Engineering and Computer Science, Peking University, No. 5 Yiheyuan Rd., Haidian District, Beijing, 100871, China
| | - Yi-Zhou Yu
- Deepwise AI Lab, Deepwise Inc., No. 8 Haidian avenue, Sinosteel International Plaza, Beijing, 100080, China
| | - Yi-Zhou Wang
- Center on Frontiers of Computing Studies, Department of Computer Science, Peking University, No. 5 Yiheyuan Rd., Haidian District, Beijing, 100871, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China. .,PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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