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Koratala A, Chandra NC, Balasubramanian P, Yu Lee-Mateus A, Barrios-Ruiz A, Garza-Salas A, Bowman A, Grage R, Fernandez-Bussy S, Abia-Trujillo D. Diagnostic Accuracy of a Computed Tomography-Guided Transthoracic Needle Biopsy for Ground-Glass Opacities and Subsolid Pulmonary Nodules. Cureus 2024; 16:e57414. [PMID: 38694634 PMCID: PMC11061815 DOI: 10.7759/cureus.57414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Purpose The increasing use of computed tomography (CT) imaging has led to the detection of more ground-glass nodules (GGNs) and subsolid nodules (SSNs), which may be malignant and require a biopsy for proper diagnosis. Approximately 75% of persistent GGNs can be attributed to adenocarcinoma in situ or minimally invasive adenocarcinoma. A CT-guided biopsy has been proven to be a reliable procedure with high diagnostic performance. However, the diagnostic accuracy and safety of a CT-guided biopsy for GGNs and SSNs with solid components ≤6 mm are still uncertain. The aim of this study is to assess the diagnostic accuracy of a CT-guided core needle biopsy (CNB) for GGN and SSNs with solid components ≤6 mm. Methods This is a retrospective study of patients who underwent CT-guided CNB for the evaluation of GGNs and SSNs with solid components ≤6 mm between February 2020 and January 2023. Biopsy findings were compared to the final diagnosis determined by definite histopathologic examination and clinical course. Results A total of 22 patients were enrolled, with a median age of 74 years (IQR: 68-81). A total of 22 nodules were assessed, comprising 15 (68.2%) SSNs with a solid component measuring ≤6 mm and seven (31.8%) pure GGNs. The histopathological examination revealed that 12 (54.5%) were diagnosed as malignant, nine (40.9%) as benign, and one (4.5%) as non-diagnostic. The overall diagnostic accuracy and sensitivity for malignancy were 86.36% and 85.7%, respectively. Conclusion A CT-guided CNB for GGNs and SSNs with solid components measuring ≤6 mm appears to have a high diagnostic accuracy.
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Affiliation(s)
- Anoop Koratala
- Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, USA
| | - Nikitha C Chandra
- Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, USA
| | | | | | | | - Ana Garza-Salas
- Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, USA
| | | | - Rolf Grage
- Radiology, Mayo Clinic, Jacksonville, USA
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Zhang C, Pan Y, Li H, Zhang Y, Li B, Zhang Y, Luo X, Miao L, Ma L, Chen S, Hu H, Sun Y, Zhang Y, Xiang J, Wang S, Gu Y, Li Y, Shen X, Wang Z, Ye T, Chen H. Extent of surgical resection for radiologically subsolid T1N0 invasive lung adenocarcinoma: When is a wedge resection acceptable? J Thorac Cardiovasc Surg 2024; 167:797-809.e2. [PMID: 37385528 DOI: 10.1016/j.jtcvs.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To evaluate whether wedge resection (WR) was appropriate for the patients with peripheral T1 N0 solitary subsolid invasive lung adenocarcinoma. METHODS Patients with peripheral T1N0 solitary subsolid invasive lung adenocarcinoma who received sublobar resection were retrospectively reviewed. Clinicopathologic characteristics, 5-year recurrence-free survival, and 5-year lung cancer-specific overall survival were analyzed. Cox regression model was used to elucidate risk factors for recurrence. RESULTS Two hundred fifty-eight patients receiving WR and 1245 patients receiving segmentectomy were included. The mean follow-up time was 36.87 ± 16.21 months. Five-year recurrence-free survival following WR was 96.89% for patients with ground-glass nodule (GGN) ≤2 cm and 0.25< consolidation-to-tumor ratio (CTR) ≤0.5, not statistically different from 100% for those with GGN≤2 cm and CTR ≤0.25 (P = .231). The 5-year recurrence-free survival was 90.12% for patients with GGN between 2 and 3 cm and CTR ≤0.5, significantly lower than that of patients with GGN ≤2 cm and CTR ≤0.25 (P = .046). For patients with GGN≤2 cm and 0.25 CONCLUSIONS WR might be appropriate for patients with invasive lung adenocarcinoma appearing as peripheral GGN ≤2 cm and CTR ≤0.5, but inappropriate for those with invasive lung adenocarcinoma appearing as peripheral GGN between 2 and 3 cm and CTR ≤0.5.
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Affiliation(s)
- Chao 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, Fudan University, Shanghai, China
| | - Yunjian Pan
- 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, Fudan University, Shanghai, China
| | - Hang Li
- 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, Fudan University, 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, Fudan University, Shanghai, China
| | - Bin Li
- 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, Fudan University, Shanghai, China
| | - Yiliang 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, Fudan University, Shanghai, China
| | - Xiaoyang Luo
- 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, Fudan University, Shanghai, China
| | - Longsheng Miao
- 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, Fudan University, Shanghai, China
| | - Longfei Ma
- 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, Fudan University, Shanghai, China
| | - Sufeng 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, Fudan University, Shanghai, China
| | - Hong Hu
- 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, Fudan University, Shanghai, China
| | - Yihua Sun
- 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, Fudan University, Shanghai, China
| | - Yawei 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, Fudan University, Shanghai, China
| | - Jiaqing Xiang
- 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, Fudan University, Shanghai, China
| | - Shengping Wang
- Department of Oncology, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yajia Gu
- Department of Oncology, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuan Li
- Department of Oncology, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xuxia Shen
- Department of Oncology, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zezhou Wang
- Department of Oncology, Fudan University, Shanghai, China; Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ting Ye
- 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, 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, Fudan University, Shanghai, China.
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Quanyang W, Lina Z, Yao H, Jiawei W, Wei T, Linlin Q, Zewei Z, Donghui H, Hongjia L, Shuluan C, Jiaxing Z, Shijun Z. Application of computer-aided detection for NCCN-based follow-up recommendation in subsolid nodules: Effect on inter-observer agreement. Cancer Med 2024; 13:e6967. [PMID: 38348960 PMCID: PMC10832308 DOI: 10.1002/cam4.6967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
RATIONALE AND OBJECTIVES Computer-aided detection (CAD) of pulmonary nodules reduces the impact of observer variability, improving the reliability and reproducibility of nodule assessments in clinical practice. Therefore, this study aimed to assess the impact of CAD on inter-observer agreement in the follow-up management of subsolid nodules. MATERIALS AND METHODS A dataset comprising 60 subsolid nodule cases was constructed based on the National Cancer Center lung cancer screening data. Five observers independently assessed all low-dose computed tomography scans and assigned follow-up management strategies to each case according to the National Comprehensive Cancer Network (NCCN) guidelines, using both manual measurements and CAD assistance. The linearly weighted Cohen's kappa test was used to measure agreement between paired observers. Agreement among multiple observers was evaluated using the Fleiss kappa statistic. RESULTS The agreement of the five observers for NCCN follow-up management categorization was moderate when measured manually, with a Fleiss kappa score of 0.437. Utilizing CAD led to a notable enhancement in agreement, achieving a substantial consensus with a Fleiss kappa value of 0.623. After using CAD, the proportion of major and substantial management discrepancies decreased from 27.5% to 15.8% and 4.8% to 1.5%, respectively (p < 0.01). In 23 lung cancer cases presenting as part-solid nodules, CAD significantly elevates the average sensitivity in detecting lung cancer cases presenting as part-solid nodules (overall sensitivity, 82.6% vs. 92.2%; p < 0.05). CONCLUSION The application of CAD significantly improves inter-observer agreement in the follow-up management strategy for subsolid nodules. It also demonstrates the potential to reduce substantial management discrepancies and increase detection sensitivity in lung cancer cases presenting as part-solid nodules.
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Affiliation(s)
- Wu Quanyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhou Lina
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Huang Yao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wang Jiawei
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Tang Wei
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qi Linlin
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhang Zewei
- PET‐CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hou Donghui
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Li Hongjia
- PET‐CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Chen Shuluan
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhang Jiaxing
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhao Shijun
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Wu FZ, Wu YJ, Chen CS, Tang EK. Prediction of Interval Growth of Lung Adenocarcinomas Manifesting as Persistent Subsolid Nodules ≤3 cm Based on Radiomic Features. Acad Radiol 2023; 30:2856-2869. [PMID: 37080884 DOI: 10.1016/j.acra.2023.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 04/22/2023]
Abstract
RATIONALES AND OBJECTIVES To investigate the prognostic value of the radiomic-based prediction model in predicting the interval growth rate of persistent subsolid nodules (SSNs) with an initial size of ≤ 3 cm manifesting as lung adenocarcinomas. MATERIALS AND METHODS A total of 133 patients (mean age, 59.02 years; male, 37.6%) with 133 SSNs who underwent a series of CT examinations at our hospital between 2012 and 2022 were included in this study. Forty-one radiomic features were extracted from each volumetric region of interest. Radiomic features combined with conventional clinical and semantic parameters were then selected for radiomic-based model building. To investigate the model performance in terms of substantial SSN growth and stage shift growth, the model performance was compared by the area under the curve (AUC) obtained by receiver operating characteristic analysis. RESULTS The mean follow-up period was 3.62 years. For substantial SSN growth, a radiomic-based model (Model 2) based on clinical characteristics, CT semantic features, and radiomic features yielded an AUCs of 0.869 (95% CI: 0.799-0.922). In comparison with Model 1 (clinical characteristics and CT semantic features), Model 2 performed better than Model 1 for substantial SSN growth (AUC model 1:0.793 versus AUC model 2:0.869, p = 0.028). A radiomic-based nomogram combining sex, follow-up period, and three radiomic features was built for substantial SSN growth prediction. For the stage shift growth, a radiomic-based model (Model 4) based on clinical characteristics, CT semantic features, and radiomic features yielded an AUCs of 0.883 (95% CI: 0.815-0.933). Compared with Model 3 (clinical characteristics and CT semantic features), Model 4 performed better than the model 3 for stage shift growth (AUC model 1: 0.769 versus AUC model 2: 0.883, p = 0.006). A radiomic-based nomogram combining the initial nodule size, SSN classification, follow-up period, and three radiomic features was built to predict the stage shift growth. CONCLUSION Radiomic-based models have superior utility in estimating the prognostic interval growth of patients with early lung adenocarcinomas (≤ 3 cm) than conventional clinical-semantic models in terms of substantial interval growth and stage shift growth, potentially guiding clinical decision-making with follow-up strategies of SSNs in personalized precision medicine.
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Affiliation(s)
- Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, 70, Lien-hai Road, Kaohsiung 80424, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yun-Ju Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Software Engineering and Management, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Chi-Shen Chen
- Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - En-Kuei Tang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Xiao R, Ma Y, Li H, Li X, Sun Z, Qi Q, Yin P, Yang F, Qiu M. Lung adenocarcinoma manifesting as subsolid nodule potentially represents tumour in the equilibrium phase of immunoediting. Immunology 2023; 168:290-301. [PMID: 35503794 DOI: 10.1111/imm.13489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/09/2022] [Indexed: 01/17/2023] Open
Abstract
Lung adenocarcinomas manifesting as subsolid nodules (SSN-LUADs) possess distinct dormant behaviour. This study was designed to compare the immune landscapes of normal lungs (nLungs), SSN-LUADs and LUADs manifesting as solid nodules (SN-LUADs) so as to better understand the status of anti-tumour immunity in SSN-LUADs. Mass cytometry by time-of-flight analysis was performed on 299, 570 single cells from nLung, SSN-LUAD and SN-LUAD tissues. The immune cells were identified by phenotype, and the percentages of different immune cell subclusters were compared between SSN-LUADs, SN-LUADs and nLungs. Elevated percentage of CD8+ T cells were identified in SSN-LUADs compared with in nLungs and SN-LUADs. Elevated CD56bright NK cells and decreased CD56dim NK cells were identified in both SSN-LUADs and SN-LUADs compared with in nLungs. The immune landscape of SSN-LUAD fits the theory of equilibrium phase of immunoediting, thus functional adaptive anti-tumour immunity but impaired innate anti-tumour immunity potentially contributes to the maintaining of its dormant behaviour.
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Affiliation(s)
- Rongxin Xiao
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yi Ma
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Hao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Zewen Sun
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Qingyi Qi
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Ping Yin
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Mantang Qiu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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Yan J, Xue X, Gao C, Guo Y, Wu L, Zhou C, Chen F, Xu M. Predicting the Ki-67 proliferation index in pulmonary adenocarcinoma patients presenting with subsolid nodules: construction of a nomogram based on CT images. Quant Imaging Med Surg 2022; 12:642-652. [PMID: 34993108 DOI: 10.21037/qims-20-1385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Ki-67 proliferation index (PI) reflects the proliferation of cells. However, the conventional methods for the acquisition of the Ki-67 PI, such as surgery and biopsy, are generally invasive. This study investigated a potential noninvasive method of predicting the Ki-67 PI in patients with lung adenocarcinoma presenting with subsolid nodules. METHODS This retrospective study enrolled 153 patients who presented with pulmonary adenocarcinoma appearing as subsolid nodules (SSNs) on computed tomography (CT) images between January 2015 and December 2018. Presence of LUAD with SSNs was confirmed by histopathology. Of these participants, 107 patients were from institution 1 and were divided into a training cohort and an internal validation cohort in a 7:3 ratio. The other 46 patients were from institution 2 and were enrolled as an external validation cohort. All patients underwent conventional CT scans with thin-slice (≤1.25 mm) reconstruction, and 1,316 quantitative radiomic features were extracted from the CT images for each nodule. The minimum redundancy maximum relevance and the least absolute shrinkage and selection operator were used for feature selection, and the radiomics signature was constructed based on these selected features. Clinical features were examined using univariate logistic regression analysis. The nomogram was developed based on the radiomics signature and the independent clinical risk factors. The Delong test and t test were employed for statistical analysis. The performance of different models was assessed by the receiver operating characteristic (ROC) curve. RESULTS The diameter of the nodules [odds ratio (OR) =1.17; P=0.003] was identified as an independent predictive parameter. Both the radiomics signature and the nomogram suggested a good predictive probability for Ki-67 expression. For the radiomics signature, the area under the ROC curve (AUC) for the training cohort, the internal validation cohort, and the external validation cohort was 0.86 [95% confidence interval (CI): 0.77 to 0.95], 0.81 (95% CI: 0.64 to 0.98), and 0.77 (95% CI: 0.62 to 0.91), respectively. For the nomogram, the AUC for the training cohort, the internal validation cohort, and the external validation cohort was 0.86 (95% CI: 0.77 to 0.95), 0.80 (95% CI: 0.64 to 0.97), and 0.79 (95% CI: 0.65 to 0.94), respectively. There were no statistical differences in the AUCs between the radiomics signature and the radiomic nomogram in the training cohort or the validation cohorts (all P>0.05). CONCLUSIONS The nomogram provides a novel strategy for determining the Ki-67 PI in predicting the proliferation of subsolid nodules, which may be beneficial for the management of patients with SSNs.
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Affiliation(s)
- Jing Yan
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xing Xue
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen Gao
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yifan Guo
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Linyu Wu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Changyu Zhou
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Feng Chen
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Maosheng Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Im DJ, Lee SM, Han K, Park CH, Lee JW, Hwang SH, Seo JS, Kwon W, Lee KH, Hur J. Predictive factors of recurrence after resection of subsolid clinical stage IA lung adenocarcinoma. Thorac Cancer 2021; 12:941-948. [PMID: 33554473 PMCID: PMC7952811 DOI: 10.1111/1759-7714.13876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ongoing studies are currently investigating the extent of surgical resection required for subsolid cancers. This study aimed to investigate the predictive factors related to recurrence in patients with clinical stage IA subsolid cancer who underwent either lobectomy or sublobar resection. METHODS This was a prospective multicenter observational study conducted in eight qualifying university teaching hospitals between April 2014 and December 2016. A total of 173 patients with subsolid nodules pathologically confirmed to have primary lung adenocarcinoma and stage IA disease were included in the final analysis. All patients underwent lobectomy, segmentectomy, or wedge resection performed by experienced thoracoscopic surgeons at each site. The surgical procedure was chosen based on the decision of the surgeons involved. The primary endpoint was time to recurrence (TTR). RESULTS The study population was 43.9% (76 of 173) male with a mean age of 60.7 years. During the median follow-up period of 5.01 years, nine patients (5%) experienced disease recurrence. In the multivariable analysis, tumor size (size ≥2 cm) (hazard ratio: 73.717, 95% confidence interval [CI]: 3.635-895.036; p < 0.001) and stage IA3 (hazard ratio: 62.010, 95% CI: 2.837-855.185; p < 0.001) were independent predictors of tumor recurrence. When analyzing the recurrence outcome in patients according to surgical procedure, no significant difference was found in TTR among the three groups (i.e., lobectomy, segmentectomy, and wedge resection; p = 0.99). CONCLUSIONS Patients with radiologically subsolid lung adenocarcinoma measuring <3 cm could be candidates for sublobar resection instead of lobectomy.
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Affiliation(s)
- Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Seo
- Department of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, G Sam Hospital, Gunpo-si, Gyeonggi Province, Republic of Korea
| | - Woocheol Kwon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Kye Ho Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, Dankook University Hospital, Cheonan, Chungnam Province, Republic of Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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8
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Zhang R, Tian P, Chen B, Zhou Y, Li W. Predicting Lung Cancer Risk of Incidental Solid and Subsolid Pulmonary Nodules in Different Sizes. Cancer Manag Res 2020; 12:8057-8066. [PMID: 32943938 PMCID: PMC7481308 DOI: 10.2147/cmar.s256719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/13/2020] [Indexed: 02/05/2023] Open
Abstract
Objective Malignancy prediction models for pulmonary nodules are most accurate when used within nodules similar to those in which they were developed. This study was to establish models that respectively predict malignancy risk of incidental solid and subsolid pulmonary nodules of different size. Materials and Methods This retrospective study enrolled patients with 5-30 mm pulmonary nodules who had a histopathologic diagnosis of benign or malignant. The median time to lung cancer diagnosis was 25 days. Four training/validation datasets were assembled based on nodule texture and size: subsolid nodules (SSNs) ≤15 mm, SSNs between 15 and 30 mm, solid nodules ≤15 mm and those between 15 and 30 mm. Univariate logistic regression was used to identify potential predictors, and multivariate analysis was used to build four models. Results The study identified 1008 benign and 1813 malignant nodules from a single hospital, and by random selection 1008 malignant nodules were enrolled for further analysis. There was a much higher malignancy rate among SSNs than solid nodules (rate, 75% vs 39%, P<0.001). Four distinguishing models were respectively developed and the areas under the curve (AUC) in training sets and validation sets were 0.83 (0.78-0.88) and 0.70 (0.61-0.80) for SSNs ≤15 mm, 0.84 (0.74-0.93) and 0.72 (0.57-0.87) for SSNs between 15 and 30 mm, 0.82 (0.77-0.87) and 0.71 (0.61-0.80) for solid nodules ≤15 mm, 0.82 (0.79-0.85) and 0.81 (0.76-0.86) for solid nodules between 15 and 30 mm. Each model showed good calibration and potential clinical applications. Different independent predictors were identified for solid nodules and SSNs of different size. Conclusion We developed four models to help characterize subsolid and solid pulmonary nodules of different sizes. The established models may provide decision-making information for thoracic radiologists and clinicians.
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Affiliation(s)
- Rui Zhang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Panwen Tian
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Department of Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bojiang Chen
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yongzhao Zhou
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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9
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Gao C, Li J, Wu L, Kong D, Xu M, Zhou C. The Natural Growth of Subsolid Nodules Predicted by Quantitative Initial CT Features: A Systematic Review. Front Oncol 2020; 10:318. [PMID: 32292716 PMCID: PMC7119340 DOI: 10.3389/fonc.2020.00318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The detection rate for pulmonary nodules, particularly subsolid nodules (SSNs), has been significantly improved. The purpose of this review is to summarize the relationship between quantitative features of initial CT imaging and the subsequent natural growth of SSNs to explore potential reasons for these findings. Methods: Relevant studies were collected from a literature search of PubMed, Embase, Web of Science, and Cochrane. Data extraction was performed on the patients' basic information, CT methods, and acquisition methods, including quantitative CT features, and statistical methods. Results: A total of 10 relevant articles were included in our review, which included 850 patients with 1,026 SSNs. Overall, the results were variable, and the key findings were as follows. Seven studies looked at the relationship between the diameter and growth of SSNs, showing that SSNs with larger diameters were associated with increased growth. An additional three studies which focused on the relationship between CT attenuation and the growth of SSNs showed that SSNs with a high CT attenuation were associated with increased growth. Conclusion: CT attenuation may be useful in predicting the natural growth of SSNs, and mean CT attenuation may be more useful in predicting the natural growth of pure ground glass nodules (GGNs) than part-solid GGNs. While evaluation by diameter did have some limitations, it demonstrates value in predicting the growth of SSNs.
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Affiliation(s)
- Chen Gao
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaying Li
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Linyu Wu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Maosheng Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Changyu Zhou
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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10
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Borghesi A, Michelini S, Golemi S, Scrimieri A, Maroldi R. What's New on Quantitative CT Analysis as a Tool to Predict Growth in Persistent Pulmonary Subsolid Nodules? A Literature Review. Diagnostics (Basel) 2020; 10:E55. [PMID: 31973010 PMCID: PMC7168253 DOI: 10.3390/diagnostics10020055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 12/23/2022] Open
Abstract
Pulmonary subsolid nodules (SSNs) are observed not infrequently on thin-section chest computed tomography (CT) images. SSNs persisting after a follow-up period of three to six months have a high likelihood of being pre-malignant or malignant lesions. Malignant SSNs usually represent the histologic spectrum of pulmonary adenocarcinomas, and pulmonary adenocarcinomas presenting as SSNs exhibit quite heterogeneous behavior. In fact, while most lesions show an indolent course and may grow very slowly or remain stable for many years, others may exhibit significant growth in a relatively short time. Therefore, it is not yet clear which persistent SSNs should be surgically removed and for how many years stable SSNs should be monitored. In order to solve these two open issues, the use of quantitative analysis has been proposed to define the "tailored" management of persistent SSNs. The main purpose of this review was to summarize recent results about quantitative CT analysis as a diagnostic tool for predicting the behavior of persistent SSNs. Thus, a literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science databases to find original articles published from January 2014 to October 2019. The results of the selected studies are presented and compared in a narrative way.
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Affiliation(s)
- Andrea Borghesi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
| | - Silvia Michelini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124 Brescia, Italy;
| | - Salvatore Golemi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
| | - Alessandra Scrimieri
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
| | - Roberto Maroldi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
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11
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Suh YJ, Park CM, Han K, Jeon SK, Kim H, Hwang EJ, Lee JH, Paeng JC, Lee CH, Kim YT, Goo JM. Utility of FDG PET/CT for Preoperative Staging of Non-Small Cell Lung Cancers Manifesting as Subsolid Nodules With a Solid Portion of 3 cm or Smaller. AJR Am J Roentgenol 2020; 214:514-23. [PMID: 31846374 DOI: 10.2214/AJR.19.21811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE. The objective of our study was to investigate the utility of FDG PET/CT for the preoperative staging of subsolid non-small cell lung cancers (NSCLCs) with a solid portion size of 3 cm or smaller. MATERIALS AND METHODS. We retrospectively enrolled 855 patients with pathologically proven NSCLCs manifesting as subsolid nodules with a solid portion of 3 cm or smaller on CT. We then compared the diagnostic performances of FDG PET/CT and chest CT for detecting lymph node (LN), intrathoracic, or distant metastases in patients who underwent preoperative chest CT and FDG PET/CT. After propensity score matching, we compared the diagnostic performance of FDG PET/CT in the group who underwent both chest CT and FDG PET/CT with that of chest CT in patients who did not undergo FDG PET/CT. RESULTS. There were LN metastases in 25 of 765 patients (3.3%) who underwent surgical LN dissection or biopsy and intrathoracic or distant metastasis in two of 855 patients (0.2%). For LN staging, FDG PET/CT showed a sensitivity of 44.0%, specificity of 81.5%, positive predictive value of 9.6%, negative predictive value of 97.0%, and accuracy of 79.9%, which were lower than those of chest CT for accuracy (p < 0.0001). FDG PET/CT could not accurately detect any intrathoracic or distant metastasis. After propensity score matching, the diagnostic accuracy for LN staging of FDG PET/CT in the group who underwent both CT and FDG PET/CT was lower than that of chest CT in the group who did not undergo FDG PET/CT (p = 0.002), and the diagnostic accuracy for intrathoracic and distant metastases was not different (p > 0.999). CONCLUSION. FDG PET/CT has limited utility in preoperatively detecting LN or distant metastasis in patients with subsolid NSCLCs with a solid portion size of 3 cm or smaller.
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12
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Lee HJ, Seo H, Cha SI, Park TI, Kim CH, Lee J. Sarcoidosis presenting pulmonary subsolid nodules that mimic lung adenocarcinoma in a patient with history of uveitis and arrhythmia: a case report. Ann Transl Med 2019; 7:496. [PMID: 31700932 DOI: 10.21037/atm.2019.08.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sarcoidosis is an idiopathic systemic granulomatous disorder that can involve any organ, although the lung is the most commonly affected site; moreover, it may affect multiple organs simultaneously or serially over a long time span. Diagnosing sarcoidosis can be a challenge in cases presenting an isolated extra-thoracic lesion at the early stage of disease. Pulmonary nodular lesion, a rare radiologic finding, may also lead to delayed diagnosis of sarcoidosis. We reported a case of atypical pulmonary nodular sarcoidosis that was suspected as lung adenocarcinoma, which was diagnosed about 20 years after initial isolated extra-thoracic manifestation occurred.
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Affiliation(s)
- Hye Jin Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Tae In Park
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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13
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Lim JK, Shin KM, Lee SY, Lee H, Hahm MH, Lee J, Kim CH, Cha SI, Jeong JY. Can emphysema influence size discrepancy between radiologic and pathologic size measurement in subsolid lung adenocarcinomas? Thorac Cancer 2019; 10:1919-1927. [PMID: 31407521 PMCID: PMC6775004 DOI: 10.1111/1759-7714.13165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 12/25/2022] Open
Abstract
Background To investigate the difference in the measured diameter of subsolid lung adenocarcinomas of thin‐section computed tomography (TSCT) and pathology according to presence of emphysema. Methods A total of 268 surgically resected pathologic T1 or T2 adenocarcinomas visualized as subsolid nodules (SSNs) on TSCT were analyzed in 252 patients. Two observers measured the greatest diameters of the whole tumor (WTsize) and solid tumor (STsize) on TSCT in lung windows, classified nodules as part‐solid or nonsolid, and recorded the presence of regional emphysema. Interobserver variability was determined with intraclass correlation coefficients (ICC). CT measurements were compared to pathologic size (Psize) and invasive size (PIsize) using the Wilcoxon signed‐rank test. Results The interobserver agreement between the diameters measured by the two observers was strong for WTsize (ICC = 0.968 [95% confidence interval, 0.960–0.975]) and STsize (ICC = 0.966 [95% CI, 0.950–0.969]). Radiologic WTsize was significantly greater than Psize (P < 0.001), while STsize was less than PIsize. The WTsize of the emphysema group was better correlated with Psize than WTsize of the normal lung group (P = 0.001), while the STsize of the normal lung group was better correlated with PIsize than STsize of the emphysema group. The concordance rate in T staging between CT and pathologic analysis was better correlated in patients with normal lungs than in those with emphysema (P = 0.023). Conclusion STsize on TSCT was underestimated in patients with emphysema, resulting in higher discordance in T staging between TSCT and pathologic analysis for subsolid lung adenocarcinomas.
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Affiliation(s)
- Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyung Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hoseok Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Myong Hun Hahm
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Chang Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ji Yun Jeong
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, South Korea
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14
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Abstract
Pulmonary ground-glass nodules (GGNs) are hazy radiological findings on computed tomography (CT). GGNs are detected more often in never-smokers. Retrospective and prospective studies have revealed that approximately 20% of pure GGNs and 40% of part-solid GGNs gradually grow or increase their solid components, whereas others remain stable for years. Most persistent or growing GGNs are lung adenocarcinomas or their preinvasive lesions. To distinguish GGNs with growth from those without growth, GGNs should be followed for at least 5 years. Lesion size and smoking history are predictors of GGN growth. Genetic analyses of resected GGNs have suggested that EGFR mutations are also predictors for growth but a subset of KRAS- or BRAF-mutated GGNs may undergo spontaneous regression because the frequencies of KRAS or BRAF mutations decrease with the advance of pathological invasiveness. Although lobectomy is the standard surgical procedure for lung cancer, limited surgery such as wedge resection or segmentectomy for lung cancers ≤2 cm with consolidation/tumor ratio ≤0.25 can be a viable alternative based on the recent clinical trial. Further genetic analyses and clinical trials can contribute to elucidation of the biological aspects of preinvasive adenocarcinoma and the development of less invasive management strategies for patients with GGNs.
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Affiliation(s)
- Yoshihisa Kobayashi
- Department of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Chiara Ambrogio
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Tetsuya Mitsudomi
- Department of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
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15
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Kim H, Park CM, Jeon S, Lee JH, Ahn SY, Yoo RE, Lim HJ, Park J, Lim WH, Hwang EJ, Lee SM, Goo JM. Validation of prediction models for risk stratification of incidentally detected pulmonary subsolid nodules: a retrospective cohort study in a Korean tertiary medical centre. BMJ Open 2018; 8:e019996. [PMID: 29794091 PMCID: PMC5988095 DOI: 10.1136/bmjopen-2017-019996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To validate the performances of two prediction models (Brock and Lee models) for the differentiation of minimally invasive adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IPA) from preinvasive lesions among subsolid nodules (SSNs). DESIGN A retrospective cohort study. SETTING A tertiary university hospital in South Korea. PARTICIPANTS 410 patients with 410 incidentally detected SSNs who underwent surgical resection for the pulmonary adenocarcinoma spectrum between 2011 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Using clinical and radiological variables, the predicted probability of MIA/IPA was calculated from pre-existing logistic models (Brock and Lee models). Areas under the receiver operating characteristic curve (AUCs) were calculated and compared between models. Performance metrics including sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were also obtained. RESULTS For pure ground-glass nodules (n=101), the AUC of the Brock model in differentiating MIA/IPA (59/101) from preinvasive lesions (42/101) was 0.671. Sensitivity, specificity, accuracy, PPV and NPV based on the optimal cut-off value were 64.4%, 64.3%, 64.4%, 71.7% and 56.3%, respectively. Sensitivity, specificity, accuracy, PPV and NPV according to the Lee criteria were 76.3%, 42.9%, 62.4%, 65.2% and 56.3%, respectively. AUC was not obtained for the Lee model as a single cut-off of nodule size (≥10 mm) was suggested by this model for the assessment of pure ground-glass nodules. For part-solid nodules (n=309; 26 preinvasive lesions and 283 MIA/IPAs), the AUC was 0.746 for the Brock model and 0.771 for the Lee model (p=0.574). Sensitivity, specificity, accuracy, PPV and NPV were 82.3%, 53.8%, 79.9%, 95.1% and 21.9%, respectively, for the Brock model and 77.0%, 69.2%, 76.4%, 96.5% and 21.7%, respectively, for the Lee model. CONCLUSIONS The performance of prediction models for the incidentally detected SSNs in differentiating MIA/IPA from preinvasive lesions might be suboptimal. Thus, an alternative risk calculation model is required for the incidentally detected SSNs.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Sunkyung Jeon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Su Yeon Ahn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Hyun-Ju Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Juil Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Cancer Research Institute, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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16
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Zhou QJ, Zheng ZC, Zhu YQ, Lu PJ, Huang J, Ye JD, Zhang J, Lu S, Luo QQ. Tumor invasiveness defined by IASLC/ATS/ERS classification of ground-glass nodules can be predicted by quantitative CT parameters. J Thorac Dis 2017; 9:1190-1200. [PMID: 28616268 DOI: 10.21037/jtd.2017.03.170] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND To investigate the potential value of CT parameters to differentiate ground-glass nodules between noninvasive adenocarcinoma and invasive pulmonary adenocarcinoma (IPA) as defined by IASLC/ATS/ERS classification. METHODS We retrospectively reviewed 211 patients with pathologically proved stage 0-IA lung adenocarcinoma which appeared as subsolid nodules, from January 2012 to January 2013 including 137 pure ground glass nodules (pGGNs) and 74 part-solid nodules (PSNs). Pathological data was classified under the 2011 IASLC/ATS/ERS classification. Both quantitative and qualitative CT parameters were used to determine the tumor invasiveness between noninvasive adenocarcinomas and IPAs. RESULTS There were 154 noninvasive adenocarcinomas and 57 IPAs. In pGGNs, CT size and area, one-dimensional mean CT value and bubble lucency were significantly different between noninvasive adenocarcinomas and IPAs on univariate analysis. Multivariate regression and ROC analysis revealed that CT size and one-dimensional mean CT value were predictive of noninvasive adenocarcinomas compared to IPAs. Optimal cutoff value was 13.60 mm (sensitivity, 75.0%; specificity, 99.6%), and -583.60 HU (sensitivity, 68.8%; specificity, 66.9%). In PSNs, there were significant differences in CT size and area, solid component area, solid proportion, one-dimensional mean and maximum CT value, three-dimensional (3D) mean CT value between noninvasive adenocarcinomas and IPAs on univariate analysis. Multivariate and ROC analysis showed that CT size and 3D mean CT value were significantly differentiators. Optimal cutoff value was 19.64 mm (sensitivity, 53.7%; specificity, 93.9%), -571.63 HU (sensitivity, 85.4%; specificity, 75.8%). CONCLUSIONS For pGGNs, CT size and one-dimensional mean CT value are determinants for tumor invasiveness. For PSNs, tumor invasiveness can be predicted by CT size and 3D mean CT value.
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Affiliation(s)
- Qian-Jun Zhou
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Zhi-Chun Zheng
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Yong-Qiao Zhu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Pei-Ji Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jia Huang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jian-Ding Ye
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Qing-Quan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
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