Differential value of thin-slice CT features of lung mixed ground glass nodules between minimally invasive adenocarcinomas and invasive adenocarcinoma
YE Shengli1, XU Shunliang2, ZHENG Xiaoping3, HU Wenchao1, JIANG Jiakang3, YANG Li4
1.Department of Radiology, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, China; 2.Department of Radiology, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China; 3.Department of Pathology, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, China; 4.Department of Respiratory Medicine, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, China
YE Shengli,XU Shunliang,ZHENG Xiaoping, et al. Differential value of thin-slice CT features of lung mixed ground glass nodules between minimally invasive adenocarcinomas and invasive adenocarcinoma[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2020, 50(7): 547-552.
Abstract：Objective: To explore the differential value between lung minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) manifesting as mixed ground-glass nodule (MGGN) by analyzing the imaging features of thin section computed tomography (TSCT), so as to help thoracic surgeons to choose a reasonable surgical method for patients. Methods: There were 200 patients with 216 pathologically diagnosed MGGN (107 MIA and 109 IAC) from the First Affiliated Hospital of Zhejiang University School of Medicine included in this study. By comparing the imaging features of the two groups, the invasive risk factors were analyzed by multivariate logistic regression, and the diagnostic efficiency of the imaging features was analyzed by ROC curve. Results: There were statistical differences between MIA group and IAC group in clear border, lobulation sign, nodule diameter, the diameter of the solid component, the CT values of nodule and ground-glass components (P<0.05). The results of multivariate logistic regression analysis showed clear border (OR=0.063, 95%CI=0.008-0.507, P=0.009) and lobulation sign (OR=0.383, 95%CI=0.147-0.993, P=0.048) were the risk factors for their invasion. However, the greater the CT values of nodule (OR=1.007, 95%CI=1.001-1.014, P= 0.029), the CT values of ground-glass components (OR=1.007, 95%CI=1.001-1.013, P=0.030), the diameter of the solid component (OR=337.004, 95%CI=17.431-6 515.57, P<0.001) and the diameter of the nodule (OR= 3.528, 95%CI=1.146-10.862, P=0.028), the more likely it was for MGGN to be pathologically confirmed as IAC. The corresponding diagnostic sensitivity, specificity, areas under the ROC curve (AUC) of clear border were 9.35%, 97.85% and 0.536, respectively; lobulation sign was 58.88%, 59.63% and 0.593, respectively. The corresponding diagnostic cut-off value, sensitivity, specificity, AUC of CT values of nodule were -408 Hu, 77.57%, 84.40% and 0.881%, respectively; CT values of ground-glass components were: -496 Hu, 86.92%, 71.56% and 0.835, respectively; the solid component was 0.4 cm, 89.72%, 99.08% and 0.954% respectively in diameter; the nodule was 1.1 cm, 57.94%, 82.57% and 0.756 respectively in diameter. Conclusion: The MIA were significantly associated with less clear border, less lobulation sign, a smaller diameter of the solid component (≤4 mm)and nodule diameter (≤11 mm), and lower CT values of nodule (≤-408 Hu) and ground-glass components (≤-496 Hu) in the MGGN. Thin-slice CT imaging features can be helpful for the differential diagnosis of MIA and IAC manifesting as MGGN.
