Factors distinguishing invasive from pre-invasive adenocarcinoma presenting as pure ground glass pulmonary nodules

Huan-Huan Yang,Xiu-Chun Xu,Yi-Lv Lv,Bo Ye,Ding-Zhong Hu,Xing-Hai Fan,Zhi-Yong Ai

doi:10.1186/s13014-020-01628-x

Huan-Huan Yang, Xiu-Chun Xu + Show 5 more

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https://doi.org/10.1186/s13014-020-01628-x

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Abstract

BackgroundTo investigate predictors of pathological invasiveness and prognosis of lung adenocarcinoma in patients with pure ground-glass nodules (pGGNs).MethodsClinical and computed tomography (CT) features of invasive adenocarcinomas (IACs) and pre-IACs were retrospectively compared in 641 consecutive patients with pGGNs and confirmed lung adenocarcinomas who had undergone postoperative CT follow-up. Potential predictors of prognosis were investigated in these patients.ResultsOf 659 pGGNs in 641 patients, 258 (39.1%) were adenocarcinomas in situ, 265 (40.2%) were minimally invasive adenocarcinomas, and 136 (20.6%) were IACs. Respective optimal cutoffs for age, serum carcinoembryonic antigen concentration, maximal diameter, mean diameter, and CT density for distinguishing pre-IACs from IACs were 53 years, 2.19 ng/mL, 10.78 mm, 10.09 mm, and − 582.28 Hounsfield units (HU). Univariable analysis indicated that sex, age, maximal diameter, mean diameter, CT density, and spiculation were significant predictors of lung IAC. In multivariable analysis age, maximal diameter, and CT density were significant predictors of lung IAC. During a median follow-up of 41 months no pGGN IACs recurred.ConclusionspGGNs may be lung IACs, especially in patients aged > 55 years with lesions that are > 1 cm in diameter and exhibit CT density > − 600 HU. pGGN IACs of < 3 cm in diameter have good post-resection prognoses.

Highlights

To investigate predictors of pathological invasiveness and prognosis of lung adenocarcinoma in patients with pure ground-glass nodules
The use of computed tomography (CT) to screen for lung cancer has resulted in detection of an increasing number of pure ground-glass nodules (pGGNs) [1], which are consistently found to constitute precursors of lung invasive adenocarcinomas (IACs). pGGNs include atypical adenomatous hyperplasia
There were no significant differences in carcinoembryonic antigen (CEA) concentration (p = 0.792), or the frequencies of pleural retraction (p = 0.857), air bronchogram signs (p = 1.000), or bubble lucency signs (p = 0.598) between the pre-IAC and IAC groups

Summary

Introduction

To investigate predictors of pathological invasiveness and prognosis of lung adenocarcinoma in patients with pure ground-glass nodules (pGGNs). In computed tomography (CT) images pure groundglass nodules (pGGNs) are visualized as homogeneous hazy lesions of the lung in which the vascular and bronchial components are preserved and there is no solid component. The use of CT to screen for lung cancer has resulted in detection of an increasing number of pGGNs [1], which are consistently found to constitute precursors of lung invasive adenocarcinomas (IACs). PGGNs include atypical adenomatous hyperplasia, Yang et al Radiation Oncology (2020) 15:186 The use of CT to screen for lung cancer has resulted in detection of an increasing number of pGGNs [1], which are consistently found to constitute precursors of lung invasive adenocarcinomas (IACs). pGGNs include atypical adenomatous hyperplasia, Yang et al Radiation Oncology (2020) 15:186

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