Background Different pathological subtypes of invasive pulmonary adenocarcinoma (IPA) have different surgical methods and heterogeneous prognosis. It is essential to clarify IPA subtypes before operation and high-resolution computed tomography (HRCT) plays a very important role in this regard. We aimed to investigate the HRCT features of lepidic-predominant type and other pathological subtypes of early-stage (T1N0M0) IPA appearing as a ground-glass nodule (GGN). Methods We performed a retrospective analysis on clinical data and HRCT features of 630 lesions in 589 patients with pathologically confirmed IPA (invasive foci > 5 mm) appearing as pure GGN (pGGN) and mixed GGN (mGGN) with consolidation-to-tumor ratio (CTR) ≤0.5 from January to December 2019. All GGNs were classified as lepidic-predominant adenocarcinoma (LPA) and nonlepidic-predominant adenocarcinoma (n-LPA) groups. Univariate analysis was performed to analyze the differences of clinical data and HRCT features between the LPA and n-LPA groups. Multivariate analysis was conducted to determine the variables to distinguish the LPA from n-LPA group independently. The diagnostic performance of different parameters was compared using receiver operating characteristic curves. Results In total, 367 GGNs in the LPA group and 263 GGNs in the n-LPA group were identified. In the univariate analysis, the CTR, mean CT values, and mean diameters as well as mixed GGN, deep lobulation, spiculation, vascular change, bronchial change, and tumor–lung interface were smaller in the LPA group than in the n-LPA group (P < 0.05). Logistic regression model was reconstructed including the mean CT value, CTR, deep lobulation, spiculation, vascular change, and bronchial change (P < 0.05). Area under the curve of the logistic regression model for differentiating LPA and n-LPA was 0.840 (76.4% sensitivity, 78.7% specificity), which was significantly higher than that of the mean CT value or CTR. Conclusions Deep lobulation, spiculation, vascular change, and bronchial change, CT value > − 472.5 HU and CTR > 27.4% may indicate nonlepidic predominant invasive pulmonary adenocarcinoma in GGNs.
Background: Imaging manifestations of active pulmonary tuberculosis (APTB) on CT described in previous studies did not cover a variety of imaging appearances of bronchogenic spread of pulmonary tuberculosis (PTB) and could overlap with many other diseases.Purpose: To propose a CT imaging sign-“fireworks sign” to demonstrate the bronchogenic spread of active pulmonary tuberculosis and correlate with histopathology. Methods: A total of 679 patients with confirmed PTB were enrolled in this study. The histological proof of APTB was obtained by means of sputum smear in 429 patients, bronchoalveolar lavage in 167 patients, biopsy or surgical histopathology in 83 patients. The clinical and imaging data were retrospectively reviewed. The “fireworks sign” on CT which was a focal conglomeration (clusters) of multiple nodules could be classified into three patterns: pistil pattern (consolidation or more nodules in the central region and fewer nodules in the peripheral region), dandelion pattern (fewer nodules in the central region and more nodules in the peripheral region) and peony pattern (nodules evenly distributed in the affected region). Imaging assessment included the pattern, number, site of fireworks sign and other associated imaging features. The histopathological comparison of fireworks sign was also performed in the biopsy or surgical specimens. Results: A total of 180 lesions with fireworks sign were found in 106 patients (106/679, 15.6%), including 71 pistil patterns, 21 dandelion patterns and 88 peony patterns, respectively. More than two patterns of fireworks sign presented in 68 patients. Histopathological proof was achieved in 83 patients and the fireworks sign was composed of centrilobular nodules which corresponded pathologically to caseous necrotic granulomas in bronchioles and alveolar ducts. Single lobe, multiple lobes of unilateral lung, and bilateral lungs involvement was presented in 66.0% (70/106), 6.6% (7/106), and 27.4% of patients (29/106), respectively. The fireworks sign decreased in density or turned into ground-glass opacity during or after anti-tuberculosis treatment in 34 patients in a series of follow-up CT scans. Other imaging features including tree-in-bud sign (21.7%), consolidation (18%), cavity (24%), bronchiectasis (21.7%), pleural effusion (2.8%), pneumothorax (1.9%), pleural thickening (35.9%) and mediastinal lymph node enlargement (13.2%) were also found.Conclusion: The fireworks sign is a CT feature of bronchogenic dissemination of active pulmonary tuberculosis and histopathologically corresponds to a comglomeration of caseous necrotic granulomas in the bronchiole and alveolar ducts.
Background: We aimed to investigate the high-resolution computed tomography (HRCT) features of lepidic-predominant type and other pathological subtypes of early-stage (T1N0M0) invasive pulmonary adenocarcinoma appearing as a ground-glass nodule (GGN). Methods: We performed a retrospective analysis on clinical data and HRCT features of 630 lesions in 589 patients with pathologically confirmed invasive pulmonary adenocarcinomas presenting as pure GGN and mixed GGN [consolidation-to-tumor ratio (CTR), <0.5] from January to December 2019. All GGNs were classified as lepidic-predominant adenocarcinoma (LPA) and nonlepidic-predominant adenocarcinoma (n-LPA) groups. Univariate analysis was performed to analyze the difference of clinical data and HRCT features between the LPA and n-LPA groups. Multivariate analysis was conducted to determine the variables to distinguish the LPA from n-LPA group independently. The diagnostic performance of different parameters was compared using receiver operating characteristic curves. Results: In total, 367 GGNs in the LPA group and 263 GGNs in the n-LPA group were identified. In the univariate analysis, the CTR, mean computed tomography (CT) values, and mean diameters as well as mixed GGN, deep lobulation, spiculation, vascular change, bronchial change, and tumor–lung interface were smaller in the LPA group than in the n-LPA group (P < 0.05). Logistic regression model was reconstructed including the mean CT value, deep lobulation, and vascular change (P < 0.001), as well as CTR, spiculation, and bronchial change (P < 0.05). Area under the curve of the logistic regression model for differentiating LPA and n-LPA was 0.840 (76.4% sensitivity, 78.7% specificity), which was significantly higher than that of the mean CT value or CTR (both P < 0.05). Conclusions: HRCT features were helpful in differentiating lepidic-predominant type from other subtypes in early-stage GGN invasive pulmonary adenocarcinoma. The mean CT value of <−472.5 HU and CTR of <27.4% were highly suspected in lepidic-predominant invasive pulmonary adenocarcinoma.
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