Using the CT features to differentiate invasive pulmonary adenocarcinoma from pre-invasive lesion appearing as pure or mixed ground-glass nodules

Abstract

The authors Jing Liang and Xiao-quan Xu contributed equally to this article.Objective: To differentiate pre-invasive lesion from invasive pulmonary adenocarcinoma (IPA) appearing as ground-glass nodules (GGNs) using CT features. Methods: 149 GGNs were enrolled in this study, with 74 pure GGNs (p-GGNs) and 75 mixed GGNs (m-GGNs). Firstly, univariate analysis was used to analyse the difference of CT features between pre-invasive lesion and IPA. Then, multivariate analysis was conducted to identify variables that could independently differentiate pre-invasive lesion from IPA. Receiver operating characteristic curve analysis was performed to evaluate the differentiating value of identified variables. Results: In the p-GGNs, multivariate analysis showed that the amount of blood vessels was an independent risk factor. Using the amount of blood vessels "$1" as the diagnostic criterion, we could diagnose IPA with a sensitivity of 100%. Using the amount of blood vessels "50" as the diagnostic criterion, we could diagnose pre-invasive lesions with a specificity of 100%. In the m-GGNs, multivariate analysis showed that the volume of solid portion (V Solid ) and pleural indentation were two independent risk factors. One further model was constructed using these two variables: model 5 2.508 3 (V Solid 1 1.407) 3 (pleural indentation 2 1.016). Using the new model, improved diagnostic ability was achieved compared with using V Solid or pleural indentation alone. Conclusion: The amount of blood vessels through the p-GGNs would be an important criterion during clinical management, while V Solid and pleural indentation seemed important for m-GGNs. Moreover, the new model could further improve the differentiating value for m-GGNs. Advances in knowledge: CT features are useful in differentiating pre-invasive lesion from IPA appearing as GGNs. INTRODUCTIONAccording to the new pathological classification constituted in 2011, lung adenocarcinoma was divided into the preinvasive lesion group and the invasive pulmonary adenocarcinoma (IPA) group.1,2 Significant difference existed between these two groups regarding the surgical method and the scope of lymph node dissection.2-5 Sublobar resection could be acceptable for pre-invasive lesion, while the standard surgical treatment for IPA should be lobectomy.2-5 Skip metastases involving mediastinal lymph nodes, without hilar lymph nodes appeared mostly in the IPA group, thus the scope of lymph node dissection for the IPA group should be larger than for the pre-invasive lesion group.2-5 Therefore, accurate differentiation between preinvasive and IPA lesions before surgery was crucial, particularly for surgery planning, prognosis assessment and doctor-patient communication.

Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study

“…Furthermore, the foci of fibrosis would become larger with the increased invasive grade of tumor. This mechanism suggests that pleural indentation is significantly associated with invasive extent., which is consistent with the findings of Takashima et al [18] and Liang et al [19] on mixed GGN.…”

“…In a similar study performed by Lee et al [10], they found that lesion size was the sole predictor of invasive extent. Moreover, Liang et al [19] demonstrated that the amount of blood vessels ( n ≥ 1) was also an independent risk factor able to differentiate IPAs from preinvasive lesions. Based on these results, we incorporated more variables compared to previous prediction models.…”

Development and validation of a nomogram to estimate the pretest probability of cancer in Chinese patients with solid solitary pulmonary nodules: A multi‐institutional study

“…In addition, central fibrosis and the resultant tissue contraction could cause fibrotic strands around the tumor, which were recognized on CT as pleural indentations . Moreover, the foci of fibrosis would become larger when the malignancy probability of a nodule increased . Furthermore, serum tumor markers are associated with malignancy, and CEA has been demonstrated as an effective marker for a wide range of malignancies .…”

“…21 Moreover, the foci of fibrosis would become larger when the malignancy probability of a nodule increased. 22 Furthermore, serum tumor markers are associated with malignancy, 23 and CEA has been demonstrated as an effective marker for a wide range of malignancies. 24 Although the serum CEA level was associated with smoking and age, 25 the multivariate analysis indicated serum CEA as a significant rather than the confounding factor.…”

Malignancy estimation of Lung-RADS criteria for subsolid nodules on CT: accuracy of low and high risk spectrum when using NLST nodules

“…AIS and MIA have a (near) 100% disease-free survival after resection and usually grow slowly [ 27 ]. Several studies have investigated which morphological features would allow for differentiating pre-invasive from invasive nonsolid lesions [ 15 , 28 ]. More research would be beneficial to reveal more insight in predictive morphological features of pre-invasive and invasive nonsolid nodules.…”