Diagnosis of the invasiveness of lung adenocarcinoma manifesting as ground glass opacities on high‐resolution computed tomography

Abstract

BackgroundTo explore the diagnostic method in assessing the malignancy of pulmonary adenocarcinoma characterized by ground glass opacities (GGO) on computed tomography (CT).MethodsPreoperative CT data for preinvasive and invasive lung adenocarcinomas were analyzed retrospectively. GGO lesions that were detected on lung windows but absent using the mediastinal window were subject to adjustment of the window width, which was reduced with the fixed interval of 100 HU until the lesions were no longer evident, with a fixed mediastinal window level of 40 HU. The shape, smoking habits, size of the lesion on the lung window, and window width at which lesions disappeared were compared and receiver operating characteristic curves were used to determine the optimal cut‐off of the lesion size and window width to differentiate between these invasive and preinvasive lesions.ResultsOf the 209 lung adenocarcinomas, 102 were preinvasive (25 atypical adenomatous hyperplasia and 77 adenocarcinoma in situ), while 107 were invasive (78 minimally invasive adenocarcinoma and 29 invasive adenocarcinoma). The shape, lesion size, and window width at which lesions were no longer evident differed significantly between the two groups (P < 0.05). The size of 8.9 mm and a window width of 1250 HU were the optimal cut‐off to differentiate between preinvasive and invasive lesions.ConclusionThe shape, size of the lesion, and window width on high‐resolution CT may be useful in assessing the invasiveness of lung adenocarcinoma that manifests as GGO. Irregular lesions that disappear at window width <1250 HU, with a diameter of > 8.9 mm are more likely to be invasive.

Radiomic analysis of pulmonary ground-glass opacity nodules for distinction of preinvasive lesions, invasive pulmonary adenocarcinoma and minimally invasive adenocarcinoma based on quantitative texture analysis of CT

“…For a long time, the study of the assessment of GGOs using CT particularly used visual features such as lesion size and the presence of pleural retraction ( 25 ), the proportion of the solid component, the shape and size of the lesion, and the window width ( 26 ). However, it was not an easy or accurate method for identifying the different diseases.…”

Software-based risk stratification of pulmonary adenocarcinomas manifesting as pure ground glass nodules on computed tomography

“…Previous studies reported lesion size to be an important predictor for invasiveness in ACs manifesting as pure ground glass nodules [ 19 , 20 ]. Lee et al showed that an overall lesion size of < 10 mm can be used to differentiate between pre-invasive and invasive lesions [ 21 ].…”

Surgical intervention for ground glass dominant lesions: observation or outright resection?

“…GGO dominant tumors have been increasingly observed due to widespread use of high resolution CT imaging, and many studies have reported a relationship between radiological prognostic factors and pathological invasiveness (9,14,15). The specificity of pathological invasiveness, which is defined as the presence of vascular and lymphatic invasion and lymph node metastasis, was reported to be 100% when the cut-off value was set as a consolidation/maximum tumor ratio of ≤0.5 for lesions ≤3 cm (16).…”