Abstract
ObjectivesPulmonary ground-glass nodules (GGNs) are occasionally diagnosed as invasive adenocarcinomas. This study aimed to evaluate the clinicopathological features of patients with pulmonary GGNs to identify factors predictive of pathological invasion.MethodsWe retrospectively evaluated 101 pulmonary GGNs resected between July 2006 and November 2013 and pathologically classified them as adenocarcinoma in situ (AIS; n = 47), minimally invasive adenocarcinoma (MIA; n = 30), or invasive adenocarcinoma (I-ADC; n = 24). The age, sex, smoking history, tumor size, and computed tomography (CT) attenuation of the 3 groups were compared. Receiver operating characteristic (ROC) curve analyses were performed to identify factors that could predict the presence of pathologically invasive adenocarcinomas.ResultsTumor size was significantly larger in the MIA and I-ADC groups than in the AIS group. CT attenuation was significantly greater in the I-ADC group than in the AIS and MIA groups. In ROC curve analyses, the sensitivity and specificity of tumor size (cutoff, 11 mm) were 95.8% and 46.8%, respectively, and those for CT attenuation (cutoff, −680 HU) were 95.8% and 35.1%, respectively; the areas under the curve (AUC) were 0.75 and 0.77, respectively. A combination of tumor size and CT attenuation (cutoffs of 11 mm and −680 HU for tumor size and CT attenuation, respectively) yielded in a sensitivity and specificity of 91.7% and 71.4%, respectively, with an AUC of 0.82.ConclusionsTumor size and CT attenuation were predictive factors of pathological invasiveness for pulmonary GGNs. Use of a combination of tumor size and CT attenuation facilitated more accurate prediction of invasive adenocarcinoma than the use of these factors independently.
Highlights
We have previously evaluated the usefulness of computed tomography (CT) as a screening tool for lung cancer [1,2]
Tumor size was significantly larger in the minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (I-ADC) groups than in the adenocarcinoma in situ (AIS) group (p = 0.0100 and 0.0025, respectively)
Approximately a quarter of the resected pure ground-glass nodules (GGNs) were diagnosed as invasive adenocarcinomas, and we found that tumor size and mean CT attenuation were useful in predicting pathological invasiveness
Summary
We have previously evaluated the usefulness of computed tomography (CT) as a screening tool for lung cancer [1,2]. With the increased use of CT screening, cases of lung cancer appearing as pure ground-glass nodules (GGNs), which are radiologically nonsolid nodules, are being detected with increasing frequency [3]. Neoplastic cells in pure GGNs are usually distributed along preexisting alveolar structures in a lepidic growth pattern without interstitial invasion [4], and because of this, limited resection is sometimes indicated in patients with pulmonary pure GGNs. a subset of pulmonary pure GGNs are associated with pathological invasion, and, in general, it is difficult to distinguish between pure GGNs with invasion and those without invasion by CT examination. The relationship between pathological invasiveness and radiological findings of pulmonary pure GGNs has not yet been fully elucidated, and the objective of this study was to evaluate the demographic and clinicopathological features of patients with pulmonary pure GGNs in order to identify factors predictive of pathological invasion
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