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Background: Computed tomography (CT) can reveal small pulmonary nodules of 2 cm. Nodules with a consolidation-to-tumor ratio (C/T ratio) 0.5 on thinsection chest CT are generally recognized as noninvasive lung cancer. However, estimations of C/T ratios on CT may vary between observers. Three-dimensional (3D) imaging can provide more accurate information than 2D-CT for distinguishing noninvasive lung cancers. The aims of this study were to determine the 3D-C/T ratios of small pulmonary nodules on 3D-CT images and explore the relationship between 3D-C/T ratios and the histopathological invasiveness of lung cancers. Methods: This was a retrospective analysis of a total of 82 patients with lung adenocarcinoma who had a ground glass opacity (GGO) on CT and underwent surgery from April 2013 to March 2016. We constructed 3D tumor images and calculated the 3D-C/T ratios of GGOs using a 3D analysis system (SYNAPSE VINCENT ® ; Fuji Film). The relationships between 3D-C/T ratio and histopathological indicators of invasiveness were evaluated. Pathological noninvasive cancer was defined as follows: no lymph node metastasis (n[-]), no lymphatic invasion (ly[-]), no vascular invasion (v[-]), and no pleural invasion (pl[-]). Results: 10 (12%) of 82 tumors were found to be invasive by histopathology, with the following positive indicators: n(+) in 5 (6%), ly(+) in 3 (4%), v(+) in 2 (2%), and pl(+) in 6 (7%). The median 3D-C/T ratio was 0.39. The mean 3D-C/T ratios by pathological findings were as follows: n(+) 0.74 vs n(-) 0.35 (p < 0.01), ly(+) 0.74 vs ly(-) 0.36 (p ¼ 0.06), v(+) 0.58 vs v(-) 0.37 (p ¼ 0.27), and pl(+) 0.57 vs pl(-) 0.35 (p ¼ 0.04). The 3D-C/T ratios of invasive cancer vs noninvasive cancer were 0.71 and 0.34, respectively (p < 0.01). By ROC curve analysis, a 3D-C/T ratio cutoff value of 0.43 provided a sensitivity and specificity of 100% and 61%, respectively, for the diagnosis of invasive cancer. Conclusion: This was a pilot study that evaluated the usefulness of 3D-CT imaging for assessing the invasiveness of small lung adenocarcinomas. A prospective observational study of 3D-CT imaging for diagnosing invasive lung adenocarcinoma is warranted.
lobectomy in 5 patients, anatomical segmentectomy in 3 patients, wedge resection in 3 patients. Morbidity 2 % and mortality in one patient Conclusion: Diagnosis and management of AVMs by surgical therapy resection was with very good results and with limited morbidity and low mortality and no recurrence during early follow-up.
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