Predictive factors for invasive adenocarcinoma in patients with clinical non-invasive or minimally invasive lung cancer

Abstract

Background: Pure ground glass opacity (GGO) or part-solid GGO with small solid component (≤5 mm) are likely to be non-invasive or minimally invasive lung cancer. However, those lesions sometimes are diagnosed as invasive adenocarcinoma postoperatively. The aim of this study was to determine the predictors of invasive adenocarcinoma in clinical non-or minimally invasive lung cancer. Methods: From January 2010 to December 2017, 203 patients were diagnosed as clinical adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) identified on chest computed tomography (CT) and they underwent surgical resection. A retrospective study was performed to analyze the prediction of invasive adenocarcinoma in clinical non-or minimally invasive lung cancer. Results: Of all clinical AIS or MIA patients, invasive adenocarcinoma was diagnosed in 55 patients (27.1%).In clinical AIS, invasive adenocarcinoma was diagnosed in 19 patients (17.9%) and 36 patients (37.1%) were diagnosed as invasive adenocarcinoma in clinical MIA (P=0.002). Tumor diameter and the presence of solid component were confirmed to be significant predictive factors for invasive adenocarcinoma in a multivariate analysis [hazard ratio (HR) 1.071, P=0.037; HR 2.573, P=0.005; respectively]. Conclusions: Large tumor size and the presence of solid component in clinical AIS or MIA are predictive factors for invasive adenocarcinoma. Therefore, early surgical intervention is recommended for those lesions.

Invasiveness and surgical timing evaluation by clinical features of ground‐glass opacity nodules in lung cancers

“…Previous studies have also revealed that all the IA presented in pure GGO nodules were larger than 1 cm. 16 Our study revealed that a nodule diameter larger than 1 cm was a significant factor to predict invasiveness in the part-solid group. Quantitative analysis of attenuation of the GGO nodule by histogram distribution has offered physicians a way to distinguish preinvasiveness from invasiveness and the report by Li et al showed that the tumor volume and mean attenuation could be a predictive factor for the invasiveness.…”

“…Previous reports have revealed that pure GGO nodules could be diagnosed as IA ultimately after surgical resection 14,15 and IA could also be misdiagnosed as a clinically noninvasive tumor on a preoperative CT scan just according to the CT features. 16 In this study, we found that the part-solid GGO nodules were significantly different in the invasiveness compared to the pure GGO nodules. A solid component is a risk factor for invasiveness and could be considered as the surgical indication when physicians encounter a new diagnosed of GGO nodule.…”

“…Hence, the surgical timing for the GGO nodules should be considered at the MIA stage. Previous reports have revealed that pure GGO nodules could be diagnosed as IA ultimately after surgical resection and IA could also be misdiagnosed as a clinically noninvasive tumor on a preoperative CT scan just according to the CT features . In this study, we found that the part‐solid GGO nodules were significantly different in the invasiveness compared to the pure GGO nodules.…”

“…Until now, there has been no definitive surgical policy for pure GGO nodules and generally, a pure GGO nodule larger than 1 cm should be considered indicative for surgery. Previous studies have also revealed that all the IA presented in pure GGO nodules were larger than 1 cm . Our study revealed that a nodule diameter larger than 1 cm was a significant factor to predict invasiveness in the part‐solid group.…”

Clinical and Radiomic Factors for Predicting Invasiveness in Pulmonary Ground-Glass Opacity.

“…The CTR (consolidation/tumour ratio) of pure GGO alone was 0, while that of solid nodules was 1. A nodule that is part-solid had a CTR between 0 and 1 [21]. The nal result is the average of the two radiologists.…”