Abstract
Thin-section computed tomography (TSCT) imaging biomarkers are uncertain to distinguish progressive adenocarcinoma from benign lesions in pGGNs. The purpose of this study was to evaluate the usefulness of TSCT characteristics for differentiating among transient (TRA) lesions, atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) presenting as pure ground-glass nodules (pGGNs). Between January 2016 and January 2018, 255 pGGNs, including 64 TRA, 22 AAH, 37 AIS, 108 MIA and 24 IAC cases, were reviewed on TSCT images. Differences in TSCT characteristics were compared among these five subtypes of pGGNs. Logistic analysis was performed to identify significant factors for predicting MIA and IAC. Progressive pGGNs were more likely to be round or oval in shape, with clear margins, air bronchograms, vascular and pleural changes, creep growth, and bubble-like lucency than were non-progressive pGGNs. The optimal cut-off values of the maximum diameter for differentiating non-progressive from progressive pGGNs and IAC from non-IAC were 6.5 mm and 11.5 mm, respectively. For the prediction of IAC vs. non-IAC and non-progressive vs. progressive adenocarcinoma, the areas under the receiver operating characteristics curves were 0.865 and 0.783 for maximum diameter and 0.784 and 0.722 for maximum CT attenuation, respectively. The optimal cut-off values of maximum CT attenuation were −532 HU and −574 HU for differentiating non-progressive from progressive pGGNs and IAC from non-IAC, respectively. Maximum diameter, maximum attenuation and morphological characteristics could help distinguish TRA lesions from MIA and IAC but not from AAH. So, CT morphologic characteristics, diameter and attenuation parameters are useful for differentiating among pGGNs of different subtypes.
Highlights
The Fleischner Society Guidelines issued in 2013 proposed substantive changes in the follow-up and management of sub-solid nodules
The 2015 World Health Organization Classification of Lung Tumours suggests that on Thin-section computed tomography (TSCT), pure ground-glass nodules (pGGNs) typically indicate the presence of preinvasive lesions, while invasive adenocarcinoma usually manifests as part-solid GGNs and solid nodules[2]
The results of our study demonstrated that middle and peripheral location, large maximum diameter and attenuation, bubble-like lucency, round or oval shape, clear margin, air bronchogram, vascular and pleural changes and creep growth were predictive of malignancy in pGGNs, while smaller diameter and maximum attenuation were associated with benignity
Summary
The Fleischner Society Guidelines issued in 2013 proposed substantive changes in the follow-up and management of sub-solid nodules. PGGNs equal to or less than 5 mm in diameter do not need routine follow-up. Five-year follow-up scanning is recommended for pGGNs with diameters equal or greater than 6 mm[1]. The 2015 World Health Organization Classification of Lung Tumours suggests that on TSCT, pGGNs typically indicate the presence of preinvasive lesions, while invasive adenocarcinoma usually manifests as part-solid GGNs and solid nodules[2]. With the widespread use of clinical TSCT screening, a growing number of pGGNs have been detected, and MIA and IAC are usually pathologically found in pGGNs4–6.
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