Abstract
To investigate the performance of combined 18F-FDG Positron Emission Tomography/Computed Tomography with high-resolution CT for differentiating invasive adenocarcinoma from adenocarcinoma in situ (pre-invasive lesion) or minimally invasive adenocarcinoma in stage IA lung cancer patients with solitary ground-glass opacity nodules. This retrospective study enrolled 58 consecutive stage IA pulmonary adenocarcinoma patients with solitary ground-glass opacity nodules. The characteristics and measurements of the ground-glass opacity nodules as pure ground-glass opacity nodules and mixed ground-glass opacity nodules in the pre-invasive or minimally invasive adenocarcinoma and invasive adenocarcinoma groups on Positron Emission Tomography/Computed Tomography and high-resolution CT were compared and analyzed. Ground-glass opacity nodules in the pre-invasive or minimally invasive adenocarcinoma group preferentially manifested as pure ground-glass opacity nodule (p < 0.01) compared to the invasive adenocarcinoma group. While cystic appearance was more common in the invasive adenocarcinoma group (p < 0.05). Significant differences were found in the diameter of the ground-glass opacity nodule itself and its solid component, and consolidation/tumor ratio between the two groups. The sensitivity in predicting invasive adenocarcinoma was higher with a combined consolidation/tumor ratio > 0.38 and SUVmax > 1.46 in mixed ground-glass opacity nodule when compared to those of SUVmax > 0.95 alone or consolidation/tumor ratio> 0.39 alone (both p > 0.05). For a mixed ground-glass opacity nodule combined consolidation/tumor ratio > 0.38 and SUVmax > 1.46 appears to better predict invasive adenocarcinoma in stage IA lung cancer patients with solitary ground-glass opacity nodules.
Highlights
Ground-glass opacity (GGO) is defined as an area of hazy increased attenuation that does not obscure underlying bronchial structures or vascular markings on high-resolution computed tomography (HRCT) [1]
Significant differences were found in the diameter of GGN (DGGN), Dsolid, and consolidation/ tumor ratio (CTR) between the two groups
DGGN and Dsolid were respectively correlated with both SUVmax and CTR, whereas cystic appearance was reverse correlated with both SUVmax and CTR
Summary
Ground-glass opacity (GGO) is defined as an area of hazy increased attenuation that does not obscure underlying bronchial structures or vascular markings on high-resolution computed tomography (HRCT) [1]. Patients with stage IA lung adenocarcinoma (i.e., peripheral lung cancers ≤ 3 cm in diameter without nodal and distant metastasis), usually present as a solitary ground-glass opacity nodule (GGN) on HRCT [2,3,4,5], and have a 5-year disease-free survival rate approaching 88% [6]. A percentage of 0.5 or less of the solid component of a GGN can identify early lung adenocarcinoma with clinical T1bN0M0 patients [13] and can be a useful independent preoperative prognostic indicator [23]. Among various strategies over morphologic evaluation, contrast-enhanced and dynamic MDCT have been applied to assess malignant GGNs with limited additional information [12]. Perfusion MDCT shows us promising for lung cancer [24], the increased radiation dose restricts its clinical application
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