Abstract

ObjectiveTo explore the correlation between the spectral computed tomography (CT) imaging parameters and the Ki-67 labeling index in lung adenocarcinoma.MethodsSpectral CT imaging parameters [iodine concentrations of lesions (ICLs) in the arterial phase (ICLa) and venous phase (ICLv), normalized IC in the aorta (NICa/NICv), slope of the spectral HU curve (λHUa/λHUv) and monochromatic CT number enhancement on 40 keV and 70 keV images (CT40keVa/v, CT70keVa/v)] in 34 lung adenocarcinomas were analyzed, and common molecular markers, including the Ki-67 labeling index, were detected with immunohistochemistry. Different Ki-67 labeling indexes were measured and grouped into four grades according to the number of positive-stained cells (grade 0, ≤1%; 1%<grade 1≤10%; 10%<grade 2≤30%; and grade 3, >30%). One-way analysis of variance (ANOVA) was used to compare the four different grades, and the Bonferroni method was used to correct the P value for multiple comparisons. A Spearman correlation analysis was performed to further research a quantitative correlation between the Ki-67 labeling index and spectral CT imaging parameters.ResultsCT40keVa, CT40keVv, CT70keVa and CT70keVv increased as the grade increased, and CT70keVa and CT70keVv were statistically significant (P<0.05). These four parameters and the Ki-67 labeling index showed a moderate positive correlation with lung adenocarcinoma nodules. ICL, NIC and λHU in the arterial and venous phases were not significantly different among the four grades.ConclusionsThe spectral CT imaging parameters CT40keVa, CT40keVv, CT70keVa and CT70keVv gradually increased with Ki-67 expression and showed a moderate positive correlation with lung adenocarcinomas. Therefore, spectral CT imaging parameter-enhanced monochromatic CT numbers at 70 keV may indicate the extent of proliferation of lung adenocarcinomas.

Highlights

  • A new international multidisciplinary classification of lung adenocarcinoma was proposed by the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European Respiratory Society (ERS) in 2011 [1] and adopted by theWorld Health Organization (WHO) in 2015 [2] and widely used in China [3]

  • Lung adenocarcinoma is classified into atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) according to the nature of proliferation and invasion, with different prognoses

  • Of the thirty-four patients, 1 had MIA (2.9%) and 33 had IAC (97.1%); there were 15 solid nodules and 19 ground glass nodules (GGNs), which presented as predominant lepidic growth in 9 cases, predominant acinar growth in 9 cases, solid growth in 2 cases, papillary growth in 2 cases, micropapillary growth in 1 case and infiltrating mucinous adenocarcinoma in 1 case; mixed growth was observed in 10 cases

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Summary

Introduction

A new international multidisciplinary classification of lung adenocarcinoma was proposed by the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European Respiratory Society (ERS) in 2011 [1] and adopted by theWorld Health Organization (WHO) in 2015 [2] and widely used in China [3]. Chinese Journal of Cancer Research, Vol 32, No 1 February 2020 the progression of lung adenocarcinoma, and the Ki-67 labeling index is a prognostic biomarker that is widely estimated by the immunohistochemical assessment of the nuclear antigen Ki-67. Advances in our understanding of the pathologic and radiologic features of GGNs and an awareness of the significance of the CT attenuation number in assessing lung adenocarcinoma presented as GGNs were recently reported [17,18,19]. Spectral CT imaging as a new quantitative tool is used to assess the perfusion of pulmonary parenchyma in patients with lung cancer [20]. Spectral CT imaging parameters are more suitable or precise for quantifying the invasion of lung adenocarcinoma than traditional chest CT imaging parameters [21,22]

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