Quantitative CT analysis of pulmonary ground-glass opacity nodules for the distinction of invasive adenocarcinoma from pre-invasive or minimally invasive adenocarcinoma (original) (raw)
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Predictors of Invasive Adenocarcinomas among Pure Ground-Glass Nodules Less Than 2 cm in Diameter
Cancers, 2021
Benign lesions, atypical adenomatous hyperplasia (AAH), and malignancies such as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IA) may feature a pure ground-glass nodule (pGGN) on a thin-slide computed tomography (CT) image. According to the World Health Organization (WHO) classification for lung cancer, the prognosis of patients with IA is worse than those with AIS and MIA. It is relatively risky to perform a core needle biopsy of a pGGN less than 2 cm to obtain a reliable pathological diagnosis. The early and adequate management of patients with IA may provide a favorable prognosis. This study aimed to disclose suggestive signs of CT to accurately predict IA among the pGGNs. A total of 181 pGGNs of less than 2 cm, in 171 patients who had preoperative CT-guided localization for surgical excision of a lung nodule between December 2013 and August 2019, were enrolled. All had CT images of 0.625 mm slice thickness during CT-guided i...
Translational Cancer Research, 2021
Background: Invasive adenocarcinoma (IA) manifesting as pure ground-glass nodule is rare and not been well studied. Meanwhile, tumor size is considered as a predictor of invasiveness in lung adenocarcinoma. The present study aimed to investigate the radiological and pathological characteristics as well as prognosis of IA manifesting as pure ground-glass nodule with different sizes. Methods: Patients with solitary pure ground glass nodule (GGN) who underwent resection and were pathologically diagnosed as IA between July 2013 and July 2015 were included. Nodules were divided into four groups according to size: A, B, C, and D, corresponding to "≤1 cm," "1-2 cm," "2-3 cm," and ">3 cm," respectively. The correlations and differences in radiological and pathological characteristics as well as prognosis among these groups were analyzed. Results: The amounts of nodules in groups A, B, C, and D are 17, 148, 78, and 30, respectively. The average diameter of these 273 nodules is 1.9 (1.5-2.4) cm. A large tumor is likely to have low computed tomography (CT) value (P<0.001), irregular shape (P=0.001), spiculation appearance (P<0.001) and exhibit pleural indentation (P<0.001) and air bronchogram (P<0.001). The proportion of lepidic predominant adenocarcinoma (LPA) (n=239, 87.5%) is much higher than that of other subtypes (n=34, 12.5%). Currently, there is no case with lymphatic, pleural, or vessel invasion and lymph node involvement, and none died of recurrence or metastasis within 5 years after resection. Conclusions: For IA manifesting as pure ground-glass nodule, size is correlated to invasiveness, and large tumors tend to have lower CT value, an irregular shape, lobulation and spiculation appearance and exhibit pleural indentation and air bronchogram. Nevertheless, the prognosis is excellent with 100% 5-year diseasefree survival regardless of the size and pathological subtype.
Diagnostic and Interventional Radiology, 2016
ulmonary adenocarcinoma is the most common type of lung cancer, and it may present as a focal ground-glass opacity (GGO) on thin-section computed tomography (CT) (1). Focal GGOs are classified as part-solid or pure according to the presence or absence of a solid component within the lesion (1). A focal GGO is a complex diagnostic challenge because it may be the manifestation of a wide array of benign and malignant conditions, including inflammation, focal interstitial fibrosis, and neoplasm (2). Inflammation generally regresses in a short period of time (in weeks or a few months), either spontaneously or after proper therapy (2). Although benign, focal interstitial fibrosis may remain unchanged for a long time (2-5), while malignancies (most often pulmonary adenocarcinomas) tend to grow (6, 7). Pulmonary adenocarcinomas exhibiting GGO are typically slow-growing lesions (8, 9), and their growth rates are difficult to characterize, particularly when size variations are solely assessed as changes in two-dimensional (2D) diameters measured on an axial scan. The major limitation of this method is the asymmetric growth of lesions in the longitudinal plane. The high intra-and interobserver variabilities are additional drawbacks of 2D measurements (10-12). Therefore, three-dimensional (3D) measurements are the current method of choice in the assessment of the growth rate of pulmonary lesions by calculating volumetric changes and doubling time (DT) (13). Although the accuracy and reproducibility of volumetric analysis in solid lung nodules have been widely demonstrated in the literature (14, 15), the results in GGOs are less consistent (16). However, it has been reported that the reproducibility of computerized volumetric analysis is relatively high for GGOs ≥8 mm in diameter (17) and that CT
Journal of thoracic disease, 2015
To evaluate the information gain by the application of both non-contrast and contrast enhanced computed tomography (CT) with extended mediastinal display window settings in the evaluation of pure ground glass nodules (pGGNs) and or mixed ground glass nodules (mGGNs) in the context of pre-invasive or early stage lung adenocarcinoma. One hundred and fifty patients with ground glass nodules (GGNs) and mGGNs, with contrast enhanced CT scans within 2 weeks of thoracic surgery were included in the study. Quantitative evaluation of all nodules was performed in a conventional mediastinal window (CMW) and an extended mediastinal window (EMW) both on non-contrast images and contrast-enhanced images. Contrast-enhanced images with CMW demonstrated amplification of solid portion in 23 (43%), 41 (77%) with EMW out of 53 minimally invasive adenocarcinoma (MIA) nodules, and in 34 of 37 (91%) of invasive adenocarcinoma (IAC) nodules. Using the increase in size of solid portion of the nodule measured...
Oncotarget, 2016
Purpose: To construct a preoperative nomogram to differentiate invasive pulmonary adenocarcinomas (IPAs) from preinvasive lesions in patients with solitary pure ground-glass nodules (GGN). Methods: A primary cohort of patients with pathologically confirmed pulmonary solitary pure GGN after surgery were retrospectively studied at five institutions from January 2009 to September 2015. Half of the patients were randomly selected and assigned to a model-development cohort, and the remaining patients were assigned to a validation cohort. A nomogram predicting the invasive extent of the solitary GGNs was constructed based on the independent risk factors. Predictive performance was evaluated by concordance index (C-index) and calibration curve. Results: Out of 898 cases included in the study, 501 (55.8%) were preinvasive lesions and 397 (44.2%) were IPAs. In the univariate analysis, lesion size (p < 0.001), lesion margin (p = 0.041), lesion shape (p < 0.001), mean computed tomography (CT) value (p = 0.018), presence of pleural indentation (p = 0.017), and smoking status (p = 0.014) were significantly associated with invasive extent. In multivariate analysis, lesion size (p < 0.001), lesion margin (p = 0.042), lesion shape (p < 0.001), mean CT value (p = 0.014), presence of pleural indentation (p = 0.026), and smoking status (p = 0.004) remained the predictive factors of invasive extent. A nomogram was developed and validation results showed a C-index of 0.94, demonstrating excellent concordance between predicted and observed results. Conclusions: We established and validated a novel nomogram that can identify IPAs from preinvasive lesions in patients with solitary pure GGN.
The Journal of Thoracic and Cardiovascular Surgery, 2013
This study aimed to compare malignant behavior and prognosis between solid tumors and mixed tumors with a ground-glass opacity component on high-resolution computed tomography. Methods: We examined 436 of 502 consecutive patients with clinical stage IA adenocarcinoma who had undergone preoperative high-resolution computed tomography and F-18-fluorodeoxyglucose positron emission tomography/ computed tomography; 66 patients with tumors with pure ground-glass opacity components were excluded. Tumor type (solid, n ¼ 137; mixed, n ¼ 299) and surgical results were analyzed for all patients and their matched pairs. Results: In all patients, solid tumors showed a significantly greater association (P<.001) with lymphatic, vascular, and pleural invasion and lymph node metastasis compared with mixed tumors. The disease-free survival was also worse in patients with solid tumors (P ¼ .0006). Analysis of 97 pairs matched for solid component size confirmed that solid tumors were significantly associated with lymphatic, vascular, and pleural invasion (P ¼ .008, P ¼ .029, P ¼ .003, respectively) and poor prognosis. When maximum standardized uptake value and solid component size were matched (n ¼ 79), the differences in pathologic prognostic parameters and disease-free survivals between patients with solid and mixed tumors disappeared. Conclusions: Solid tumors exhibit more malignant behavior and have a poorer prognosis compared with mixed tumors, even when the solid component size is the same in both tumor types. However, differences in malignant behavior can be identified using maximum standardized uptake values determined by F-18-fluorodeoxyglucose positron emission tomography/computed tomography.
2020
Background Multiple synchronous ground glass nodules (GGNs) are known to be malignant but progress slowly. Multiple synchronous lesions in the same patient show independent characteristics and must be treated individually. Methods This was a retrospective review of 34 lung adenocarcinoma patients with multiple synchronous GGNs in an Asian population. One hundred twenty-seven single lung adenocarcinoma patients were included for comparison. The follow-up period was 5 years for all patients. Results The 5-year overall survival (OS) patients with multiples did not differ from that of patients with single lesion to a statistically significant extent (Single: 81.8% vs. Multiple: 88.2%, P = 0.3602). Dominant tumors (DTs) with a ground glass component and consolidation were divided into three categories based on the consolidation-to-tumor ratio on radiological imaging. No significant differences were observed among the three DT categories. Twenty-four patients had unresected GGNs, progress...