Abstract

BackgroundDifferent pathological subtypes of invasive pulmonary adenocarcinoma (IPA) have different surgical methods and heterogeneous prognosis. It is essential to clarify IPA subtypes before operation and high-resolution computed tomography (HRCT) plays a very important role in this regard. We aimed to investigate the HRCT features of lepidic-predominant type and other pathological subtypes of early-stage (T1N0M0) IPA appearing as a ground-glass nodule (GGN).MethodsWe performed a retrospective analysis on clinical data and HRCT features of 630 lesions in 589 patients with pathologically confirmed IPA (invasive foci > 5 mm) appearing as pure GGN (pGGN) and mixed GGN (mGGN) with consolidation-to-tumor ratio (CTR) ≤0.5 from January to December 2019. All GGNs were classified as lepidic-predominant adenocarcinoma (LPA) and nonlepidic-predominant adenocarcinoma (n-LPA) groups. Univariate analysis was performed to analyze the differences of clinical data and HRCT features between the LPA and n-LPA groups. Multivariate analysis was conducted to determine the variables to distinguish the LPA from n-LPA group independently. The diagnostic performance of different parameters was compared using receiver operating characteristic curves.ResultsIn total, 367 GGNs in the LPA group and 263 GGNs in the n-LPA group were identified. In the univariate analysis, the CTR, mean CT values, and mean diameters as well as mixed GGN, deep lobulation, spiculation, vascular change, bronchial change, and tumor–lung interface were smaller in the LPA group than in the n-LPA group (P < 0.05). Logistic regression model was reconstructed including the mean CT value, CTR, deep lobulation, spiculation, vascular change, and bronchial change (P < 0.05). Area under the curve of the logistic regression model for differentiating LPA and n-LPA was 0.840 (76.4% sensitivity, 78.7% specificity), which was significantly higher than that of the mean CT value or CTR.ConclusionsDeep lobulation, spiculation, vascular change, and bronchial change, CT value > − 472.5 HU and CTR > 27.4% may indicate nonlepidic predominant invasive pulmonary adenocarcinoma in GGNs.

Highlights

  • Different pathological subtypes of invasive pulmonary adenocarcinoma (IPA) have different surgical methods and heterogeneous prognosis

  • According to whether or not it contained a solid component, a ground-glass nodule (GGN) can be classified as pure GGN and mixed GGN, a mGGN is divided into ground glasspredominant mGGN (0 < CTR ≤ 0.5) and solidpredominant mGGN (0.5 < CTR < 1) according to a consolidation-to-tumor ratio (CTR) on high-resolution computed tomography (HRCT) [4]

  • Previous studies [11,12,13] have shown that HRCT features of GGN have high diagnostic value in differentiating early IPA from preinvasive lesions (PIL) and minimally invasive adenocarcinoma (MIA), but there are few studies on the correlation of HRCT features among subtypes of IPAs

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Summary

Introduction

Different pathological subtypes of invasive pulmonary adenocarcinoma (IPA) have different surgical methods and heterogeneous prognosis. We aimed to investigate the HRCT features of lepidic-predominant type and other pathological subtypes of early-stage (T1N0M0) IPA appearing as a ground-glass nodule (GGN). The 2015 World Health Organization (WHO) Classification of Lung Tumors [5] classified invasive pulmonary adenocarcinoma (IPA) into lepidic-predominant adenocarcinoma (LPA), acinar-predominant adenocarcinoma (APA), papillary-predominant adenocarcinoma (PPA), micropapillary-predominant adenocarcinoma (MPA), solid-predominant adenocarcinoma (SPA) according to the main growth patterns. Previous studies [11,12,13] have shown that HRCT features of GGN have high diagnostic value in differentiating early IPA from preinvasive lesions (PIL) and minimally invasive adenocarcinoma (MIA), but there are few studies on the correlation of HRCT features among subtypes of IPAs. it is essential that HRCT features should be used to identify LPA from other subtypes in IPAs with GGN

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