Abstract
PurposeTo construct a preoperative nomogram to differentiate invasive pulmonary adenocarcinomas (IPAs) from preinvasive lesions in patients with solitary pure ground-glass nodules (GGN).MethodsA primary cohort of patients with pathologically confirmed pulmonary solitary pure GGN after surgery were retrospectively studied at five institutions from January 2009 to September 2015. Half of the patients were randomly selected and assigned to a model-development cohort, and the remaining patients were assigned to a validation cohort. A nomogram predicting the invasive extent of the solitary GGNs was constructed based on the independent risk factors. Predictive performance was evaluated by concordance index (C-index) and calibration curve.ResultsOut of 898 cases included in the study, 501 (55.8%) were preinvasive lesions and 397 (44.2%) were IPAs. In the univariate analysis, lesion size (p < 0.001), lesion margin (p = 0.041), lesion shape (p < 0.001), mean computed tomography (CT) value (p = 0.018), presence of pleural indentation (p = 0.017), and smoking status (p = 0.014) were significantly associated with invasive extent. In multivariate analysis, lesion size (p < 0.001), lesion margin (p = 0.042), lesion shape (p < 0.001), mean CT value (p = 0.014), presence of pleural indentation (p = 0.026), and smoking status (p = 0.004) remained the predictive factors of invasive extent. A nomogram was developed and validation results showed a C-index of 0.94, demonstrating excellent concordance between predicted and observed results.ConclusionsWe established and validated a novel nomogram that can identify IPAs from preinvasive lesions in patients with solitary pure GGN.
Highlights
Pulmonary ground-glass nodules (GGN) have been increasingly encountered in routine clinical practice [1]
It is well established that these preinvasive lesions can be followed up alone or treated safely with limited resection, as they eventually might evolve into invasive lesion and require resection [6,7,8]
The Japanese Society of CT Screening recommends that a workup should be performed to make a definitive diagnosis if a pure GGN is 15 mm or larger in maximal diameter on a thin-section computed tomography (TSCT) scan
Summary
Pulmonary ground-glass nodules (GGN) have been increasingly encountered in routine clinical practice [1]. In terms of managing a solitary pure GGN, Fleischner Society recommends that lesions larger than 5 mm require a surveillance CT examination for a minimum of 3 years, if persistent and unchanged [3]. This is consistent with the American College of Chest Physicians recommendations [4]. Several studies have demonstrated that pure GGNs of ≥ 10 mm in diameter is one of the TSCT scan features of invasive pulmonary adenocarcinoma (IPA; including minimally invasive adenocarcinoma, MIA and invasive adenocarcinoma, IA) [9, 10]. It is important to discriminate IPAs from preinvasive lesions in patients with pure GGN before surgery, which could be helpful in selecting patients suitable for sublobar resection
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