Pulmonary adenocarcinoma is the most common pathological type of malignant pulmonary nodules, of which, invasive adenocarcinoma (IAC) is associated with a risk of recurrence. Pulmonary tuberculoma can sometimes present as noncalcified, solid pulmonary nodule with imaging characteristics such as lobulation, spiculation, and pleural indentation, which is difficult to distinguish from IAC. Magnetic resonance imaging (MRI) as a non-ionizing modality can be complementary tool for nodules assessment. This study aimed to evaluate the potential of the combined conventional and modified anatomical MRI sequences for differential diagnosis of IAC and tuberculoma. Sixty-seven patients with 82 noncalcified nodules underwent computed tomography (CT) and MRI (T1WI-starVIBE, T1WI-VIBE, T2WI-TSE-fBLADE). Two radiologists independently assessed nodule dimensions and morphologic features. The inter-method agreement of morphologic features assessment by CT and MRI sequences were compared using Kappa test. Multivariate logistic regression analyses were applied to identify independent predictors of IAC. Receiver operating characteristic (ROC) analysis was performed to investigate the differential diagnosis capability. Thirty-eight IACs and 44 tuberculomas were identified. Readers 1 and 2 underestimated the nodules mean diameter with T1WI-starVIBE (T1WI-VIBE, T2WI-TSE-fBLADE) by 0.86±1.71 mm (1.19±2.06, 0.15±1.96 mm) and 0.99±1.75 mm (1.27±2.04, 0.19±1.91 mm). The inter-method agreements between MRI and CT were "fair" to "excellent" in the evaluation of morphological features except for spiculation. Compared with the tuberculoma group, the IAC group was significant with unclear margin (T1WI-starVIBE, T1WI-VIBE), irregular morphology (CT, MRI), lobulation (CT, MRI), spiculation (T1WI-starVIBE, T2WI-TSE-fBLADE) and air bronchogram (CT, T1WI-starVIBE and T1WI-VIBE) (P<0.05). The area under the curve (AUC) values for the logistic model by the combination of CT and MRI were 0.867/0.877 (sensitivity 73.68%/76.32%, specificity 86.36%/86.36%) and were significantly higher than that by T1WI-starVIBE (P=0.002) and T1WI-TSE-fBLADE (P=0.03) (reader 1), as well as higher than that by CT (P=0.045) and T1WI-starVIBE (P=0.003) (reader 2). The combined conventional and modified anatomical MRI sequences has diagnostic potential in distinguishing pulmonary IAC from tuberculoma.

The purpose of this study was to analyze the vascular characteristics around pulmonary nodules with a diameter of 10-20mm. To explore their predictive value for the pathological nature of pulmonary nodules, computed tomography (CT) combined with three-dimensional computed tomography-bronchography and angiography (3D-CTBA) technique have been chosen as the method. 202 patients who were treated from January 2020 to December 2022 have been studied. They were all diagnosed with pulmonary ground glass nodules (GGNs) and obtained final pathologic results at the Department of Thoracic Surgery of Hebei General Hospital. In the meanwhile, the medical records were complete be enrolled in this study. All patients had underwent a chest CT scan in our hospital. The vessels surrounding the nodules were categorized into four types based on their relationships with the pulmonary nodules on the 3D reconstructed images. Type I (passing through): the vessel passes through the lesion, with no significant change in vessel size or shape throughout the path of travel; Type II (bypassed): vessels pass adjacent to the nodule, but no branch vessels supply the diseased tissue; Type III (twisted/dilated): twisting or thickening of blood vessels passing through the nodule, but no increase in number; Type IV (complex): a more complex vascular system other than those described in the above types, such as with irregular vasodilatation and convergent coexistence of vessels from multiple supply vessels. Data was analyzed by SPSS (version 26.0, Inc, Chicago, USA), with continuous data expressed as mean and standard deviation/Median (IQR), categorical variables expressed as numbers and percentages. For quantitative variables were analyzed using the Kruskal–Wallis test or Mann–Whitney U test. Categorical variables were analyzed using Fisher’s exact test or Chi-square test. Furthermore, the GGN-vessel relationship was compared between patients with microinvasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC). A P-value ≤ 0.05 was considered statistically significant. The Receiver Operating Characteristic (ROC) curve was used to determine the optimal diameter cut-off values for distinguishing IAC from MIA in nodules measuring 10–20 mm, with the Youden index applied to identify the cut-off value with the highest sensitivity and specificity. According to the pathology, all patients were divided into 3 groups:Benign nodule group (32 cases. 2 cases are sclerosing pneumoblastoma. 18 cases are found inflammatory lesions. 2 cases are pulmonary sarcoidosis. 1 case is pulmonary cyst. 7 cases are pulmonary hamartoma. 2 cases are pulmonary tuberculosis). Pre-infiltrative lesion group (36 cases. 4 cases are atypical adenomatous hyperplasia (AAH). 32 cases are adenocarcinoma in situ(AIS)). Infiltrative adenocarcinoma group (134 cases. 48 cases are MIA. 86 cases are IAC). The diameter of the pulmonary nodules of each group is: 13.0(11.0–14.7)mm, 13.0(12.0–15.0)mm, and 16.0(14.0–18.0)mm. The difference is statistically significant (P ≤ 0.001). 101 cases of mixed ground glass nodules (mGGNs) were found in all invasive adenocarcinoma groups and count a percentage of 75.4% (P ≤ 0.001). In invasive adenocarcinoma group, Type III (28/31) counts 90.3% (P = 0.009) and type IV (21/23) counts 91.3% (P = 0.008). This result is statistically different. The combination of type III and type IV vascular relationships showed a significant difference in the differential diagnostic value of the three groups of lung nodules (P < 0.001). For nodules 10–20 mm in diameter, the diameter cut-off value for IAC and MIA was 13.5 mm (AUC = 0.814, 95% CI: 0.74–0.89; specificity = 96.5%, sensitivity = 52.1%). The presence of Type IV vascular relationships in pure ground-glass nodules (pGGNs) showed a significant association with invasive adenocarcinoma (P = 0.038). Moreover, this vascular pattern demonstrated a significantly higher prevalence in invasive adenocarcinoma compared to pre-invasive lesions (P < 0.001). The different types of vessels ( arteries, veins, arteries and veins) crossing the nodule were analyzed showing no statistically significant difference (P = 0.078). For nodules with diameters of 10–20 mm, the presence of type III and IV vascular relationships in surrounding vasculature, a solid component, and a diameter ≥ 13.5 mm are more indicative of invasive lesions.

This study investigates the correlation between CT findings and clinicopathological features in patients with ground-glass nodular multifocal lung adenocarcinoma. A total of 203 lesions were identified and classified based on pathological results into 3 groups: preinvasive lesions (92 nodules), microinvasive adenocarcinoma (69 nodules), and invasive adenocarcinoma (42 nodules). CT imaging was performed on all patients, and the CT features were analyzed in relation to clinicopathological characteristics. Statistical analysis was performed using SPSS 22.0 software. Continuous variables were compared using one-way ANOVA or the Kruskal-Wallis test, while categorical variables were analyzed using the Chi-square test or Fisher exact test. Spearman correlation analysis was used to assess the relationship between CT features and clinicopathological characteristics. Significant differences were observed in nodule morphology, lobulation, vacuolation, burr sign, air bronchial sign, pleural indentation, tumor-lung interface, vascular characteristics, and ground-glass nodule type between the 3 groups (P < .05). The invasive adenocarcinoma group exhibited higher proportions of round/oval nodules, lobulation, vacuolation, burr sign, air bronchial sign, pleural depression, clear tumor-lung interface, vascular penetration, and partial solid nodules compared to the other 2 groups (P < .05). The microinvasive adenocarcinoma group showed a higher incidence of vacuolation, burr sign, pleural indentation, vascular penetration, and partial solid nodules than the preinvasive group (P < .05). No significant differences were found in the nodule locations among the groups (P > .05). The average size of nodules in the invasive group was significantly larger than in the other 2 groups (P < .05), while no difference was observed between the preinvasive and microinvasive groups (P > .05). The incidence of several CT signs, such as burr sign and pleural depression, negatively correlated with tumor differentiation (r = -0.311 to -0.378, all P < .05). The occurrence of pure ground-glass nodules was positively correlated with differentiation (R = 0.127, P < .05). Additionally, lesion characteristics like shape and lobulation were linked to lymph node metastasis (R = 0.313 to 0.415, P < .05). CT features in multifocal lung adenocarcinoma patients are closely related to pathological characteristics, providing valuable insights for clinical diagnosis and classification.

PurposeThis study aims to examine the diagnostic usefulness of CT imaging in distinguishing between various pathological forms of lung ground-glass nodules (GGNs).MethodsWe conducted a retrospective analysis on 210 patients with lung ground-glass nodules (GGNs) who received diagnosis and treatment at our hospital between January 2021 and May 2024. Every patient had comprehensive imaging and pathology investigations. Lesion size, three-dimensional ratio, two-dimensional ratio, size of solid components, form, spiculation, lobulation, and cavitation were studied across several pathological kinds of pulmonary ground-glass nodules (GGNs).ResultsOf the 210 patients, 51 were diagnosed with benign conditions, while 159 had malignant lesions distributed across AIS, MIA, and IAC. The imaging data revealed that pulmonary ground-glass nodules (GGNs) exhibiting spiculation, lobulation, cavitation, pleural indentation, irregular shape, and fuzzy borders were considerably more prevalent in the inflammatory group, atypical adenomatous hyperplasia (AAH) group, adenocarcinoma in situ (AIS) group, minimally invasive adenocarcinoma (MIA) group, and invasive adenocarcinoma (IAC) group. These differences were statistically significant (P < 0.05). Significant variations in lesion size and size of solid components were observed among the groups, with the inflammatory group having the smallest size, followed by the AAH group, AIS group, MIA group, and finally the IAC group (P < 0.05). Nevertheless, there were no statistically significant disparities in the three-dimensional ratio and two-dimensional ratio across the five groups (P > 0.05). The calculated areas under the curve for distinguishing pre-invasive lesions from MIA and MIA from IAC, depending on the size of solid components, were 0.705 and 0.814, respectively. These values indicate a high diagnostic accuracy.ConclusionA thorough examination of the CT imaging characteristics of ground-glass nodules is crucial for accurately distinguishing between various pathological forms of pulmonary GGNs.

Lung adenocarcinoma (LUAD), the most prevalent form of lung cancer. The transition from adenocarcinoma in situ (AIS), and minimally invasive adenocarcinoma (MIA) to invasive adenocarcinoma (IAC) is not fully understood. Intratumoral microbiota may play a role in LUAD progression, but comprehensive stage-wise analysis is lacking. Tumor and bronchoalveolar lavage fluid (BALF) samples from patients with AIS/MIA or IAC were collected for next-generation sequencing to characterize microbial diversity and composition. DNA extraction involved lysing samples with nuclease and protease, followed by homogenization and elution. Sequencing libraries were prepared and sequenced on the Illumina platform. Whole exome sequencing was performed to identify somatic mutations and genetic variants. Bioinformatics analysis, including taxonomic annotation with Kraken2 and de novo assembly with MEGAHIT, was conducted to process metagenomic data. Correlation analysis was performed to link microbial species with mutated genes using custom R scripts. Metagenomic analysis revealed a distinct microbial profile in IAC compared to AIS/MIA, with increased abundance of Bacteroidetes and Firmicutes in the IAC group. Bosea sp. and Microbacterium paludicola, were less abundant in IAC, suggesting a potential protective role in early-stage disease. Conversely, Mycolicibacterium species were more prevalent in IAC, indicating a possible contribution to disease progression. Genetic sequencing identified PTPRZ1 strongly correlating with microbial composition, suggesting a mechanistic link between microbiota and genetic alterations in LUAD. This study characterizes microbial communities in various stages of LUAD, revealing links between microbiota and genetic mutations. The unique microbiota suggests its role in LUAD progression and as a therapeutic target.

With the increasing use of lung cancer screening, the detection of ground glass nodules (GGNs) has risen. However, the natural course of GGNs and their relationship to pathologic features remains unclear. Differentiating between invasive and pre-invasive lesions based on GGN growth may improve clinical intervention timing. Ki-67, a proliferation marker, holds value in assessing tumor malignancy. This study analyzes the association between GGN growth, pathology, and Ki-67 expression to provide new insights into early-stage lung cancer management. We retrospectively evaluated 183 GGNs with at least two preoperative CT scans. Nodule location, type, natural course, and volume doubling time (VDT) were compared between invasive adenocarcinoma (IAC) and pre-IAC groups. We also assessed differences in Ki-67 expression and correlated VDT with Ki-67 levels. A total of 183 nodules were finally included; gender, nodule location, smoking history, and duration of follow-up did not differ between the IAC group and the pre-IAC group, whereas age was statistically different between the two groups. Of the 183 nodules, 52 showed growth and the predominant pathologic type was IAC, these IACs showed more PSN in nodule type, while the IAC group showed more significant differences in nodule type, nodules growth, and VDT than the pre-IAC group. There were also differences in pathologic type and VDT between different Ki-67 expression groups, and Ki-67 expression gradually increased as VDT decreased. Lung adenocarcinoma (LUAD) presenting as GGNs exhibit distinct natural courses among pathologic subtypes. VDT effectively distinguishes these growth characteristics, with IACs showing shorter VDT. The significant correlation between VDT and Ki-67 expression suggests that combining these parameters may provide valuable insights into the biological behavior and invasiveness of LUAD.

To investigate the diagnostic value of 18 F-fluorodeoxyglucose(FDG) PET/computed tomography (CT) for infiltrative subsolid nodules at different stages of lung adenocarcinoma and to explore predictive factors for invasive adenocarcinoma, providing compelling evidence for timely intervention. A retrospective analysis was conducted on PET/CT imaging data of 170 subsolid nodules lesions confirmed postoperatively as lung adenocarcinoma or precursor glandular lesions. Lesions were categorized into preinvasive lesions including atypical adenomatous hyperplasia and adenocarcinoma in situ, microinvasive adenocarcinoma, and invasive adenocarcinoma. Compared the differences in imaging features and metabolic parameters among different groups and used a multifactor logistic regression model and receiver operating characteristic curve analysis to identify predictive factors for invasive adenocarcinoma. From preinvasive lesions through microinvasive adenocarcinoma to invasive adenocarcinoma, there was a gradual increase in nodule diameter, nodule area, and proportion of part-solid nodule. Statistical significance ( P < 0.05) was observed in the rates of spiculation and pleural indentation between preinvasive lesions versus microinvasive adenocarcinoma and invasive adenocarcinoma groups. The maximum standardized uptake value and maximum standardized uptake ratio show statistically significant differences ( P < 0.05) between the invasive adenocarcinoma group and the other groups. Logistic regression analysis indicated that nodule composition, nodule diameter, and maximum standardized uptake ratio were predictive factors for invasive adenocarcinoma ( P < 0.05). For part-solid nodules, the longest diameter of the solid component has a high diagnostic value. The imaging features of 18 F-FDG PET/CT contribute to the diagnosis of infiltrative subsolid nodules at different stages of lung adenocarcinoma, providing robust evidence for timely intervention.

Background: To test the value of Computed tomography (CT) features in predicting the infiltration degree and pathological subtype of ground glass lung adenocarcinoma (≤ 3 cm). Materials and Methods: Data from 412 lung adenocarcinoma patients with mixed ground glass nodules on CT from Jan. 2017 to Dec. 2021 were tested retrospectively. The patients were separated by the infiltrating degree into a minimally invasive adenocarcinoma (MIA) group and an invasive adenocarcinoma (IAC) group. Then the IAC group was subdivided into low-, medium-and high-risk groups by the prognosis differences among subtypes, which were of lepidic, papillary, and micropapillary predominance respectively. Results: Average diameter of nodules, average CT value, solid component ratio, lobe sign, and burr sign were independent risk factors of IAC. The average diameter of nodules ≥ 12.5 mm, solid component ratio ≥ 20.96%, average CT value ≥ -473.07 HU, positive lobe sign and positive burr sign indicated the nodules were more likely IAC. Average CT value, and solid component ratio were independent risk factors for the high-risk pathological type of lung adenocarcinoma. The average CT value ≥ -242.92 HU and solid component ratio ≥ 69.536% indicated nodules were more likely the high-risk pathological type of lung adenocarcinoma. Conclusion: CT imaging features improve the diagnostic efficacy of ground glass nodules, and have certain clinical value.

This study was conducted to explore the differential diagnostic value of PET/computed tomography (PET/CT) combined with high-resolution computed tomography (HRCT) in predicting the invasiveness of ground-glass nodules (GGNs). This retrospective analysis included 67 patients (mean age 62.5 ± 8.4, including 45 females and 22 males) with GGNs who underwent preoperative 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/CT and HRCT examinations between January 2018 and October 2022. Based on the postoperative pathological results of lung adenocarcinoma, the patients were classified into two groups: invasive adenocarcinoma (IAC) and non-IAC. Besides, the clinical and imaging information of these patients was collected. HRCT signs include the existence of air bronchial signals, vascular convergence, pleural indentation, lobulation, and spiculation. Moreover, the diameter of solid components (D Solid ), diameter of ground-glass nodules (D GGN ), and computed tomography values of ground-glass nodules (CT GGN ) were measured concurrently. Furthermore, the mean standardized uptake value, maximal standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis were assessed during PET/CT. Associations between invasiveness and these factors were evaluated using univariate and multivariate analyses. The results of logistic regression analysis demonstrated that D GGN , D Solid , consolidation tumor ratio (CTR), CT GGN , and SUVmax were independent predictors in the IAC group. The combined diagnosis based on these five predictors revealed that area under the curve was 0.825. The D GGN , D Solid , CTR, CT GGN , and SUVmax in GGNs were independent predictors of IAC, and combining 18 F-FDG PET/CT metabolic parameters with HRCT may improve the predictive value of pathological classification in lung adenocarcinoma.

The incidence and mortality rate of lung cancer are the highest in the world among all malignant tumors. Accurate assessment of ground-glass nodules (GGNs) is crucial in reducing lung cancer mortality. This study aimed to explore the value of computed tomography (CT) features and quantitative parameters in predicting the invasiveness and degree of infiltration of GGNs. Lesions were classified into three groups based on pathological types: the precursor glandular lesion (PGL) group, including atypical adenomatoid hyperplasia and adenocarcinoma in situ; the minimally invasive adenocarcinoma group; and the invasive adenocarcinoma group. Quantitative and qualitative data of the nodules were compared, and receiver operating characteristic (ROC) curve analysis was performed for each quantitative parameter. Binary logistic regression analysis was used to evaluate independent predictors of GGN invasiveness. There were significant differences in lesion size, morphology, nodule type, bronchial abnormality, internal vascular sign and pleural retraction among the three groups (P<0.05). There were significant differences in all CT quantitative parameters (CT attenuation value in the plain phase, CT attenuation value in the arterial phase, CT attenuation value in the venous phase, arterial phase enhancement difference, venous phase enhancement difference, arterial phase enhancement index and venous phase enhancement index) among the three groups (P<0.001). The ROC curve analysis showed that the CT attenuation value in the plain phase, CT attenuation value in each enhanced phase, enhancement difference and enhancement index had good discriminatory power. Binary logistic regression analysis revealed that nodule type and internal vascular sign were independent risk factors for GGN invasiveness. CT features combined with enhanced scanning and quantitative analysis have important value in predicting the invasiveness of GGNs. The type of pulmonary nodule detected on CT (pure GGN or mixed GGN) and the presence of internal vascular signs are independent risk factors for GGN invasiveness.

Sublobar resection for ground-glass opacity became a recommend surgery choice supported by the JCOG0804/JCOG0802/JCOG1211 results. Sublobar resection includes segmentectomy and wedge resection, wedge resection is suitable for non-invasive lesions, but in clinical practice, when pathologists are uncertain about the intraoperative frozen diagnosis of invasive lesions, difficulty in choosing the appropriate operation occurs. The purpose of this study was to analyze how to select invasive lesions with clinic-pathological characters. A retrospective study was conducted on 134 cases of pulmonary nodules diagnosed with minimally invasive adenocarcinoma by intraoperative freezing examination. The patients were divided into two groups according to intraoperative frozen results: the minimally invasive adenocarcinoma group and the at least minimally invasive adenocarcinoma group. A variety of clinical features were collected. Chi-square tests and multiple regression logistic analysis were used to screen out independent risk factors related to pathological upstage, and then ROC curves were established. In addition, an independent validation set included 1164 cases was collected. Independent risk factors related to pathological upstage were CT value, maximum tumor diameter, and frozen result of AL-MIA. The AUC of diagnostic mode was 71.1% [95%CI: 60.8-81.3%]. The independent validation included 1164 patients, 417 (35.8%) patients had paraffin-based pathology of invasive adenocarcinoma. The AUC of diagnostic mode was 75.7% [95%CI: 72.9-78.4%]. The intraoperative frozen diagnosis was AL-MIA, maximum tumor diameter larger than 15mm and CT value is more than - 450Hu, highly suggesting that the lung GGO was invasive adenocarcinoma which represent a higher risk to recurrence. For these patients, sublobectomy would be insufficient, lobectomy or complementary treatment is encouraged.

Sub-lobar resection versus lobectomy for challenging intraoperative frozen sections in lung adenocarcinoma within 3 cm

Adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) are considered pre-invasive forms of lung adenocarcinoma (LUAD) with a 5-year recurrence-free survival of 100%. We investigated genomic profiles in early tumorigenesis and distinguished mutational features of preinvasive to invasive adenocarcinoma (IAC) for early diagnosis. Molecular information was obtained from a 689-gene panel in the 90 early-stage LUAD Chinese patients using next-generation sequencing. Gene signatures were identified between pathology subtypes, including AIS/MIA (n=31) and IAC (n=59) in this cohort. Mutational and clinicopathological information was also obtained from the Cancer Genome Atlas (TCGA) as a comparison cohort. A higher mutation frequency of TP53, RBM10, MUC1, CSMD, MED1, LRP1B, GLI1, MAP3K, and RYR2 was observed in the IAC than in the AIS/MIA group. The AIS/MIA group showed higher mutation frequencies of ERBB2, BRAF, GRIN2A, and RB1. Comparable mutation rates for mutually exclusive genes (EGFR and KRAS) across cohorts highlight the critical transition to invasive LUAD. Compared with the TCGA cohort, EGFR, KRAS, TP53, and RBM10 were frequently mutated in both cohorts. Despite limited gene mutation overlap between cohorts, we observed variant mutation types in invasive LUAD. Additionally, the tumor mutation burden (TMB) values were significantly lower in the AIS/MIA group than in the IAC group in both the Chinese cohort (P=0.0053) and TCGA cohort (P<0.01). These findings highlight the importance of distinguishing preinvasive from invasive LUAD in the early stages of LUAD and both pathology and molecular features in clinical practice, revealing genomic tumor heterogeneity and population differences.

Few studies about the association between computed tomography (CT) perfusion imaging parameters and invasiveness in lung adenocarcinoma (LUAD) have been conducted using low dose spectral CT perfusion imaging. The purpose of this study was to investigate application of spectral revolution CT low-dose perfusion imaging in the differential diagnosis of different pathological subtypes of LUAD. This was a cross-sectional study based on historical data from January 2018 to May 2019 in Peking University Cancer Hospital & Institute. A total of 62 cases were enrolled, including 2 cases of atypical adenomatous hyperplasia (AAH), 3 cases of adenocarcinoma in situ (AIS), 4 cases of minimally invasive adenocarcinoma (MIA), and 53 cases of invasive adenocarcinoma (IAC), all confirmed with pathology. The inclusion and exclusion criteria were regulated. Using Revolution low-dose CT perfusion imaging (GE, USA), the CT perfusion parameters of hemodynamics were obtained: blood flow (BF), blood volume (BV), impulse residue function time of arrival (IRF TO), maximum slope of increase (MSI), mean transit time (MTT), permeability surface area product (PS), positive enhancement integral (PEI), and maximum enhancement time (Tmax). Univariate analysis of variance (ANOVA) or Kruskal-Wallis test was used to compare the differences of CT perfusion quantitative parameters among AAH, AIS, MIA, and IAC. Mann-Whitney test was used to compare the difference of CT perfusion imaging parameters between preinvasive lesions (AAH and AIS) and invasive lung cancer (MIA and IAC). Statistically significant differences in IRF TO were observed in LUAD with different invasiveness, namely, among AIS, MIA, and IAC groups (0.56±0.74 vs. 0.54±1.08 vs. 4.39±2.19, P=0.004). Statistically significant differences in IRF TO were also observed between pre-invasive lesions group (AAH and AIS) and invasive lung cancer group (MIA and IAC) (1.12±1.27 vs. 3.75±2.79, P=0.031), and between AAH + AIS + MIA groups and IAC group (0.83±1.13 vs. 4.12±2.69, P<0.001). There were no statistically significant differences in other CT perfusion parameters of hemodynamics among different pathological subtypes of LUAD (P>0.05). The low-dose perfusion parameter IRF TO of revolution CT has the potential to be employed in the differential diagnosis of different pathological subtypes of LUAD.

We assessed the feasibility of spectral CT imaging for diagnosing lung adenocarcinomas manifesting as ground-glass nodules (GGNs) with varying Ki-67 expression. Spectral CT parameters in 116 patients with lung adenocarcinomas manifesting as GGNs were analyzed. Cases were grouped into pre-invasive/minimally invasive adenocarcinoma (pre/MIA) and invasive adenocarcinoma (IA) groups. The Ki-67 labeling index (Ki-67 LI) was measured and compared between the two groups. Ki-67 LI was divided into three grades based on the number of positive-stained cells. Spectral CT parameters (diameter, water, and iodine concentrations of the lesion [WCL and ICL], the slope of the spectral Hounsfield unit curve [λHU], and CT values from 40 to 140 keV [at 10 keV intervals]) were compared among the three different grades. The correlation between quantitative spectral CT imaging parameters and Ki-67 LI was analyzed using Spearman correlation analysis. Ki-67 LI in the IA group was significantly higher than in the pre/MIA group (p < 0.01). Grade 2 had higher diameter, WCL, and monochromatic CT values, and grade 1 had higher ICL and λHU. The WCL and monochromatic CT values were highly and positively correlated with Ki-67 LI. CT40keV had the highest correlation with Ki-67 LI, the diameter was moderately correlated with Ki- 67 LI, and ICL and λHU were weakly correlated with Ki-67 LI. Spectral CT, a noninvasive diagnostic method, is valuable for predicting Ki-67 expression higher in IA, thus allowing preoperative evaluation of lung adenocarcinomas manifesting as GGNs.

BackgroundMixed ground-glass lung nodules are a high-risk factor for lung adenocarcinoma. This study aimed to analyze the value of SDCT electron density imaging in the detection of mixed ground-glass lung nodules (GGNs).Method150 patients with GGNs confirmed by chest SDCT and surgical pathology were retrospectively analyzed. GGNs were screened by two senior radiologists by the double-blind method based on conventional CT and SDCT electron density images. Average CT values and electron density (ED) values of GGNs were measured for all, solid and ground-glass.ResultThirty pGGN cases determined by conventional CT were found to be mGGN on electron density images, including 23 in the invasive adenocarcinoma group (detection rate of 35.38%), which was significantly higher than that of the PGL group (14.89%, P < 0.05). In electron density images, average CT values and ED values in the PGL and invasive adenocarcinoma groups with pGGNs were no difference. The average CT value and ED value were significantly higher in the mGGN invasive adenocarcinoma group compared with the PGL group (P < 0.05). Meanwhile, ROC curve analysis of average CT value and ED value revealed AUC values for mGGN infiltration of 0.759 and 0.752.ConclusionSDCT can improve GGN visualization and increase the detection rate of mGGN compared with conventional CT. Attention should be paid to invasive adenocarcinoma for lung GGNs detected as mGGNs with high average CT value or ED value.

Deep learning algorithms (DLAs) could enable automatic measurements of solid portions of mixed ground-glass nodules (mGGNs) in agreement with the invasive component sizes measured during pathologic examinations. However, the measurement of pure ground-glass nodules (pGGNs) based on DLAs has rarely been reported in the literature. To evaluate the use of a commercially available DLA for the automatic measurement of pGGNs on computed tomography (CT). In this retrospective study, we included 68 patients with 81 pGGNs. The maximum diameter of the nodules was manually measured by senior radiologists and automatically segmented and measured by the DLA. Agreement between the measurements by the radiologist and DLA was assessed using Bland-Altman plots, and correlations were analyzed using Pearson correlation. Finally, we evaluated the association between the radiologist and DLA measurements and the invasiveness of lung adenocarcinoma in patients with pGGNs on preoperative CT. The radiologist and DLA measurements exhibited good agreement with a Bland-Altman bias of 3.0%, which were clinically acceptable. The correlation between both sets of maximum diameters was also strong, with a Pearson correlation coefficient of 0.968 (P < 0.001). In addition, both sets of maximum diameters were larger in the invasive adenocarcinoma group than in the non-invasive adenocarcinoma group (P < 0.001). Automatic pGGNs measurements by the DLA were comparable with those measured manually and were closely associated with the invasiveness of lung adenocarcinoma.

Few studies about lung ground-glass nodules (GGNs) have been done using non-enhancement spectral computed tomography (CT) imaging. To examine the association between spectral CT parameters, Ki-67 expression, and invasiveness in lung adenocarcinoma manifesting as GGNs. Spectral CT parameters were analyzed in 106 patients with lung GGNs. The Ki-67 labeling index (Ki-67 LI) was measured, and patients were divided into low expression and high expression groups according to the number of positive-stained cells (low expression ≤10%; high expression >10%). Spectral CT parameters were compared between low and high expression groups. The correlation between spectral CT parameters and Ki-67 LI was estimated by Spearman correlation analysis. Cases were divided into a preinvasive and minimally invasive adenocarcinoma (MIA) group (atypical adenomatous hyperplasia, adenocarcinoma in situ, and MIA) and invasive adenocarcinoma (IA) group. Spectral CT parameters were compared between the two groups. The diagnostic performance was evaluated using receiver operating characteristic analysis. There were significant differences in water concentration of lesions (WCL) and monochromatic CT values between the low and high expression groups. CT 40 keV had the highest correlation coefficient with Ki-67 LI. WCL and monochromatic CT values were significantly higher in the IA group than in the pre/MIA group. The value of area under the curve of CT 40 keV was 0.946 (95% confidence interval=0.905-0.988) for differentiating the two groups; the cutoff was -280.66 Hu. Spectral CT is an effective non-invasive method for the prediction of proliferation and invasiveness in lung adenocarcinoma manifesting as GGNs.

PURPOSE We aimed to evaluate and compare the growth patterns among pathological types of inde- terminate subsolid nodules in patients without a history of cancer as observed on computed tomography (CT). METHODS This retrospective study included 77 consecutive patients with 80 indeterminate subsolid nod- ules on unenhanced thin-section CT. Subsolid nodules were classified into 2 growth pattern groups based on volume: growth (n = 35) and non-growth (n = 42). According to the pathologi- cal diagnosis, subsolid nodules were further subdivided into 3 groups: adenocarcinoma in situ (growth, n = 8 vs. non-growth, n = 22), minimally invasive adenocarcinoma (n = 14 vs. n = 15), and invasive adenocarcinoma (n=13 vs. n=5). Kaplan-Meier and Cox proportional hazards regres- sion analyses were performed to identify the risk factors for subsolid nodules growth. The CT findings of the 35 subsolid nodules in the growth group were compared among the 3 pathologi- cal groups. RESULTS In the growth group, the overall mean volume doubling time and mass doubling time (MDT) were 811.5 days and 616.5 days, respectively. Patient's age (odds ratio=1.041, P=.045) and CT subtype of non-solid nodule and part-solid nodule (odds ratio=3.430, P=.002) could predict subsolid nodule growth. The baseline volume, mass, and mean CT value were larger in the inva- sive adenocarcinoma group than in the adenocarcinoma in situ group (all P < .01). The shortest volume doubling time was observed in the invasive adenocarcinoma group, followed by the minimally invasive adenocarcinoma group and the adenocarcinoma in situ group. A shorter mass doubling time was observed in the minimally invasive adenocarcinoma group than in the adenocarcinoma in situ group (all P < .02). CONCLUSION As age increases, the risk of pulmonary subsolid nodule growth increases by 4% each year, and part-solid nodules have a 3 times higher risk of growth compared to non-solid nodules in patients with no history of cancer. Subsolid nodules with more aggressive pathological charac- teristics grow at a faster rate.

背景与目的肺癌是国内外致死率最高的恶性肿瘤，肺结节的精确检测是降低肺癌死亡率的关键。人工智能辅助诊断系统在肺结节检测、良恶性鉴别和浸润亚型诊断等领域发展迅速，对其效能进行验证是促进其应用于临床的前提。本研究旨在评估人工智能辅助诊断系统预测肺结节早期肺腺癌浸润亚型的效能。方法回顾性分析2016年1月1日-2021年12月31日期间兰州大学第二医院收治的223例肺结节早期肺腺癌患者的临床资料，将早期肺腺癌分为浸润性腺癌组(n=170)和非浸润性腺癌组(n=53)，其中非浸润性腺癌组又分为微浸润性腺癌组(n=31)和浸润前病变组(n=22)。比较各组的恶性概率和影像特征等信息，分析其对早期肺腺癌浸润亚型的预测能力，并对人工智能辅助诊断早期肺腺癌浸润亚型定性诊断的结果与术后病理进行一致性分析。结果早期肺腺癌不同浸润亚型肺结节的平均CT值(P < 0.001)、直径(P < 0.001)、体积(P < 0.001)、恶性概率(P < 0.001)、胸膜凹陷征(P < 0.001)、分叶征(P < 0.001)、毛刺征(P < 0.001)差异均有统计学意义; 随着早期肺腺癌不同浸润亚型浸润性增加，各组参数显性征象比例也逐渐升高; 在二分类问题上，人工智能辅助诊断系统定性诊断早期肺腺癌浸润亚型的敏感性、特异性及曲线下面积(area under the curve, AUC)分别为81.76%、92.45%和0.871; 在三分类问题上，人工智能辅助诊断系统定性诊断早期肺腺癌浸润亚型的准确率、召回率、F1分数及AUC分别为83.86%、85.03%、76.46%和0.879。结论该人工智能辅助诊断系统对肺结节早期肺腺癌浸润亚型具有一定的预测价值，随着算法的优化和数据的完善或可为患者个体化治疗提供指导。