Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma

Moon, Youngkyu; Sung, Sook Whan; Lee, Kyo Young; Sim, Sung Bo; Park, Jae Kil

doi:10.21037/jtd.2016.06.34

Cited by 47 publications

(45 citation statements)

References 31 publications

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“…In our study, the maximum diameter greater than 16.1 mm indicated IA independently, and this was similar with previous study (5)(6)(7)(8)23,24). And when using a threshold of greater or equal to16.1 mm for size measurement and enhanced monochromatic CT number of 140 keV greater or equal to −476.4 HU together, the diagnostic capacity and sensitivity for IA increased.…”

Section: Discussionsupporting

confidence: 91%

“…Regarding the morphologic CT features of pGGNs, in previous study, an internal air bronchogram (5,8,24) or pleural retraction (6,7) are associated with invasiveness of GGNs or even pGGNs (5)(6)(7)(8). While another study (25) reported that no significant morphologic differences were observed in pGGNs, including bubble lucency, lobulation, spiculation and pleural retraction.…”

Section: Discussionmentioning

confidence: 93%

“…Analysis of pulmonary pure ground-glass nodule in enhanced dual energy CT imaging for predicting invasive adenocarcinoma: comparing with conventional thin-section CT imaging Several researches have used thin-section CT (TSCT) to distinguish IA from the preinvasive adenocarcinoma or MIA in terms of CT number and morphologic characteristics such as size, margin, bubble lucency, and solid proportion, and have indicated that the solid proportion has correlation with the degree of invasion of ground-glass nodules (GGNs) (4)(5)(6)(7)(8)(9).…”

Section: Original Articlementioning

confidence: 99%

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Analysis of pulmonary pure ground-glass nodule in enhanced dual energy CT imaging for predicting invasive adenocarcinoma: comparing with conventional thin-section CT imaging

Zhang

Tang

et al. 2017

J. Thorac. Dis.

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Background: To investigate the value of dual energy computed tomography (DECT) parameters (including iodine concentration and monochromatic CT numbers) for predicting pure ground-glass nodules (pGGNs) of invasive adenocarcinoma (IA).Methods: A total of 55 resected pGGNs evaluated with both unenhanced thin-section CT (TSCT) and enhanced DECT scans were included. Correlations between histopathology [adenocarcinoma in situ (AIS), minimally IA (MIA), and IA] and CT scan characteristics were examined. CT scan and clinicodemographic data were investigated by univariate and multivariate analysis to identify features that helped distinguish IA from AIS or MIA.Results: Both normalized iodine concentration (NIC) of IA and slope of spectral curve [slope(k)] were not significantly different between IA and AIS or MIA. Size, performance of pleural retraction and enhanced monochromatic CT attenuation values of 120-140 keV were significantly higher for IA. In multivariate regression analysis, size and enhanced monochromatic CT number of 140 keV were independent predictors for IA. Using the two parameters together, the diagnostic capacity of IA could be improved from 0.697 or 0.635 to 0.713.Conclusions: DECT could help demonstrate blood supply and indicate invasion extent of pGGNs, and monochromatic CT number of higher energy (especially 140 keV) would be better for diagnosing IA than lower energies. Together with size of pGGNs, the diagnostic capacity of IA could be better. Several researches have used thin-section CT (TSCT) to distinguish IA from the preinvasive adenocarcinoma or MIA in terms of CT number and morphologic characteristics such as size, margin, bubble lucency, and solid proportion, and have indicated that the solid proportion has correlation with the degree of invasion of ground-glass nodules (GGNs) (4-9).Sometimes, GGNs would have no solid component, which are named pure GGNs (pGGNs). Most pGGNs tend to be preinvasive (1), while approximately 20-40% of pGGNs are pathologically malignant (10). Because of the limited resolution (0.2-0.3 mm) of CT images, stromal or myofibroblastic invasion of 5 mm or smaller in MIA or even IA greater than 5 mm in size may manifest as pGGN on high resolution CT (5). It has been proved that CT attenuation of IA is higher than its precursors (11), but there is no consensus over the cutoff of CT attenuation to indicate pGGN of IA. One study suggests that pGGNs with mean CT attenuation >−472 Hounsfield unit (HU) are more likely to be IA, with sensitivity of 75% and specificity of 81% (12). Angiogenesis is a fundamental process in the development of tumors, but enhancement characteristics of GGNs are often very difficult to assess because of low cellularity, and there are few researches about the enhancement characteristics of GGNs. Li et al. (13) found that the solid proportion of some GGNs (mostly in MIA or IA) would increase after contrast enhancement, and it could help for diagnosis of GGNs.Gemstone spectral imaging (GSI) analysis software is a specific tool in dual energy computed...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 93%

Section: Original Articlementioning

confidence: 99%

See 1 more Smart Citation

Analysis of pulmonary pure ground-glass nodule in enhanced dual energy CT imaging for predicting invasive adenocarcinoma: comparing with conventional thin-section CT imaging

Zhang

Tang

et al. 2017

J. Thorac. Dis.

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“…In this study, the acinar component and papillary components were related with GGO on chest CT. Our previous study showed that pure GGO tumours are not always composed of a lepidic component (7). Instead, acinar and papillary components may also present as GGO on chest CT. Other studies also support our results that pure GGOs consist of acinar or papillary components as well as lepidic component (11)(12)(13).…”

Section: Discussionmentioning

confidence: 94%

“…Indeed, in some cases, GGO nodules have been associated with invasive adenocarcinoma (7). Moreover, we have had experience with a pure GGO that was pathologically diagnosed as invasive adenocarcinoma after sublobar resection.…”

Section: Original Articlementioning

confidence: 99%

The prognosis of invasive adenocarcinoma presenting as ground-glass opacity on chest computed tomography after sublobar resection

Moon¹,

Lee²,

Park³

2017

J. Thorac. Dis.

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Background: Ground-glass opacity (GGO) on chest computed tomography (CT) is generally associated with non-invasive or minimally invasive adenocarcinoma (MIA). However, many instances of GGO are diagnosed as invasive adenocarcinoma. The purpose of this study is to analyse the histopathologic characteristics of invasive adenocarcinoma presenting as GGO and the prognosis after sublobar resection. Methods: We conducted a retrospective chart review of 191 patients who were treated for stage I nonsmall cell lung cancer presenting as a GGO-predominant tumour upon CT and who underwent curative resection. We analysed the histologic subtypes and components of invasive adenocarcinomas presenting as GGO-predominant tumours. We also compared the 5-year recurrence-free survival (RFS) of invasive adenocarcinomas presenting as GGO-predominant in patients undergoing sublobar resection or lobectomy. Results: Of 191 GGO-predominant tumour patients, 97 patients had adenocarcinoma in situ (AIS) or MIA, and 94 patients had invasive adenocarcinoma. In the analysis of the histologic component of invasive adenocarcinoma presenting as GGO, the mean rate of the lepidic component was 47.4%, that of the acinar component was 42.1%, and that of the papillary component was 7.3%. Micropapillary and solid components were nearly absent. The 5-year RFS rates of sublobar resection and lobectomy were both 100%. Conclusions: Invasive components such as acinar and papillary components can also be seen as GGO tumours on chest CT. After the sublobar resection of GGO-predominant tumours, a good prognosis can be expected, even if the tumour is an invasive adenocarcinoma such as the acinar or papillary subtypes.

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Margin Width of Resected Lepidic Lung Cancer Does Not Affect Recurrence After Sublobar Resection

2017

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Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma

Cited by 47 publications

References 31 publications

Analysis of pulmonary pure ground-glass nodule in enhanced dual energy CT imaging for predicting invasive adenocarcinoma: comparing with conventional thin-section CT imaging

Analysis of pulmonary pure ground-glass nodule in enhanced dual energy CT imaging for predicting invasive adenocarcinoma: comparing with conventional thin-section CT imaging

The prognosis of invasive adenocarcinoma presenting as ground-glass opacity on chest computed tomography after sublobar resection

Margin Width of Resected Lepidic Lung Cancer Does Not Affect Recurrence After Sublobar Resection

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