Mixed Ground-glass Nodules Research Articles

A clinically applicable model more suitable for predicting malignancy or benignity of pulmonary ground glass nodules in women patients

BackgroundIn recent years, clinicians often encounter patients with multiple pulmonary nodules in their clinical practices. As most of these ground glass nodules (GGNs) are small in volume and show no spicule sign, it is difficult to use Mayo Clinic Model to make early diagnosis of lung cancer accurately, especially in large numbers of nonsmoking women who have no tumor history. Other clinical models are disadvantaged by a relatively high false-positive or false-negative rate. Therefore, there is an urgent need to establish a new model of predicting malignancy or benignity of pulmonary GGNs for the sake of making accurate and early diagnosis of lung cancer.MethodsIncluded in this study were GGNs surgically resected from patients who were admitted to Yiwu Central Hospital from January 2018 to March 2024, including both male and female patients, there is no gender specific issue. The nature of all these GGN tissues was confirmed pathologically. The case data were statistically analyzed to establish a mathematical prediction model, the prediction performance of which was verified by the pathological results.ResultsAltogether 261 GGN patients met the inclusion criteria. Using the results of logistic regression analysis, a mathematical prediction equation was established as follows: Malignant probability (mP) = ex/ (1 + ex); when mP was > 0.5, the GGN was considered as malignant, and when mP was ≤ 0.5, it was considered as benign. x= -2.46 + 1.032*gender + 1.85*mGGN + 1.40*VCS-0.0027*mean CT value of the nodule + 0.078*maximum diameter of the nodule, where e represents the natural logarithm; if the patient was a female, gender = 1 (otherwise = 0); if the pulmonary nodule was a mixed GGN, mGGN = 1 (otherwise = 0); if the pulmonary nodule had vascular convergence sign, VCS = 1 (otherwise = 0). The prediction performance of the mathematical prediction model was verified as follows: the negative prediction value was 0.97156 and the positive prediction value was 0.3800 in the model group versus 1 and 0.25 in the verification group.ConclusionIn this study, we identified female gender, mGGN, VCS, mean CT value and maximum nodule diameter as five key factors for predicting malignancy or benignity of pulmonary nodules, based on which we established a mathematical prediction model. This novel innovation may provide a useful auxiliary tool for predicting malignancy and benignity of pulmonary nodules, especially in women patients.

H-marker via bronchoscopy under LungPro navigation combined with cone-beam computed tomography for locating multiple pulmonary ground-glass nodules: A case report and literature review.

Pulmonary ground-glass nodules (GGNs) pose challenges in intraoperative localization due to their primarily nonsolid composition. This report highlights a novel approach using H-marker deployment guided by LungPro navigation combined with cone-beam computed tomography (CBCT) for precise localization of multiple GGNs. A 55-year-old female patient presented at Sir-Run-Run-Shaw Hospital, Zhejiang University School of Medicine, in June 2021, requiring thoracoscopic surgery for the management of multiple GGNs in her right lung. She had a recent history of thoracoscopic wedge resection for a lesion in her lower left lung 3 months prior. Computed tomography scans revealed the presence of 3 mixed GGNs in the right lung, with further confirmation identifying these as solitary pulmonary nodules, necessitating surgical intervention. The patient underwent thoracoscopic surgery, during which the multiple nodules in her right lung were precisely localized utilizing an H-marker implanted bronchoscopically under the guidance of LungPro navigation technology, with CBCT providing additional confirmation of nodule positioning. This innovative combination of technologies facilitated accurate targeting of the lesions. Postoperative histopathological analysis confirmed the nodules to be microinvasive adenocarcinomas. Radiographic examination with chest X-rays demonstrated satisfactory lung expansion, indicating effective lung function preservation following the procedure. Follow-up assessments have shown no evidence of tumor recurrence, suggesting successful treatment. The employment of H-marker implantation guided by the LungPro navigation system with CBCT confirmation presents a feasible and efficacious strategy for localizing multiple pulmonary GGNs. To further validate its clinical utility and safety, large-scale, multicenter, prospective studies are warranted. This approach holds promise in enhancing the precision and outcomes of surgeries involving GGNs.

The value of predicting the invasiveness and degree of infiltration of pulmonary ground-glass nodules based on computed tomography features and enhanced quantitative analysis.

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.

Safety and efficacy of a novel transbronchial radiofrequency ablation system for lung tumours: One year follow-up from the first multi-centre large-scale clinical trial (BRONC-RFII).

Radiofrequency ablation (RFA) is an emerging treatment of lung cancer, yet it is accompanied by certain safety concerns and operational limitations. This first multi-centre, large-scale clinical trial aimed to investigate the technical performance, efficacy and safety of an innovative transbronchial RFA system for lung tumours. The study enrolled patients with malignant lung tumours who underwent transbronchial RFA using an automatic saline microperfusion system between January 2021 and December 2021 across 16 medical centres. The primary endpoint was the complete ablation rate. The performance and safety of the technique, along with the 1-year survival rates, were evaluated. This study included 126 patients (age range: 23-85 years) with 130 lung tumours (mean size: 18.77 × 14.15 mm) who had undergone 153 transbronchial RFA sessions, with a technique success rate of 99.35% and an average ablation zone size of 32.47 mm. At the 12-month follow-up, the complete ablation rate and intrapulmonary progression-free survival rates were 90.48% and 88.89%, respectively. The results of patients with ground-glass nodules (GGNs) were superior to those of the patients with solid nodules (12-month complete ablation rates: solid vs. pure GGN vs. mixed GGN: 82.14% vs. 100% vs. 96.08%, p = 0.007). No device defects were reported. Complications such as pneumothorax, haemoptysis, pleural effusion, pulmonary infection and pleural pain were observed in 3.97%, 6.35%, 8.73%, 11.11% and 10.32% of patients, respectively. Two subjects died during the follow-up period. Transbronchial RFA utilizing an automatic saline microperfusion system is a viable, safe and efficacious approach for the treatment for lung tumours, particularly for patients with GGNs.

The clinical, radiological, postoperative pathological, and genetic features of nodular lung adenocarcinoma: a real-world single-center data.

The preoperative differential diagnosis of nodular lung adenocarcinoma has long been a challenging issue for thoracic surgeons. This study aimed to explore differential diagnosis of nodular lung adenocarcinoma by comprehensively analyzing its clinical, computed tomography (CT) imaging, and postoperative pathological and genetic features. The clinical, CT imaging, and postoperative pathological features of different classifications of nodular lung adenocarcinoma were retrospectively analyzed through univariate and multivariate statistical methods. There were 132 patients with nodular lung adenocarcinoma enrolled. Firstly, compared with ground-glass nodular lung adenocarcinoma, solid nodular lung adenocarcinoma was more common in women [odds ratio (OR), 3.662; 95% confidence interval (CI): 1.066-12.577] and older adults (OR, 1.061; 95% CI: 1.007-1.119), and CT signs were mostly lobulation (OR, 4.957; 95% CI: 1.714-14.337) and spiculation (OR, 8.214; 95% CI: 2.740-24.621); the mean CT (CTm) value of solid nodular lung adenocarcinoma was significantly higher than that of ground-glass nodular lung adenocarcinoma, and the optimal diagnostic threshold was -267.5 Hounsfield units (HU). Secondly, the maximum diameter of nodule size (NSmax) of invasive adenocarcinoma (IAC) was significantly greater than that of minimally IAC (MIA; OR, 6.306; 95% CI: 1.191-33.400) or atypical adenomatous hyperplasia (AAH)/adenocarcinoma in situ (AIS; OR, 189.539; 95% CI: 4.720-7,610.476), and the optimal diagnostic threshold between IAC and MIA was 1.35 cm; the CTm value of IAC was significantly higher than that of MIA, and the optimal diagnostic threshold was -460.75 HU. Thirdly, lepidic-predominant adenocarcinoma (LPA) manifest more commonly as pure ground-glass nodule (pGGN; OR, 6.252; 95% CI: 1.429-27.358) or mixed ground-glass nodule (mGGN; OR, 4.224; 95% CI: 1.223-14.585). Moreover, the mutation rate of epidermal growth factor receptor (EGFR) in IAC was 70.69% (41/58). The EGFR mutation rates of mGGNs (OR, 8.794; 95% CI: 1.489-51.933) and solid nodules (SNs; OR, 12.912; 95% CI: 1.597-104.383) were significantly higher than that of pGGNs. Furthermore, compared with those of micropapillary-predominant adenocarcinoma (MPA), solid-predominant adenocarcinoma (SPA), or invasive mucinous adenocarcinoma (IMA), there were significantly higher EGFR mutation rates in acinar-predominant adenocarcinoma/papillary-predominant adenocarcinoma (APA/PPA; OR, 55.925; 95% CI: 4.045-773.284) and LPA (OR, 38.265; 95% CI: 2.307-634.596). Different classifications of nodular lung adenocarcinoma have their own clinicopathological and CT imaging features, and the latter is the main predictor.

APPLICATION VALUE OF CT INDEXES COMBINED WITH TUMOR MARKERS AND 7-TAAB IN THE DIAGNOSIS OF INVASIVE LUNG CANCER BASED ON IMPROVED ARTIFICIAL INTELLIGENCE TECHNOLOGY

Objective: To investigate the efficacy of artificially intelligent CT metrics combined with tumor markers and 7-TAABs in predicting the infiltrative nature of mixed ground-glass nodules in the lungs to provide a basis for rational clinical decision-making. Materials and Methods: The clinical data of patients admitted to Changshu Hospital affiliated with Soochow University (Hospital 1) and the Eighth People’s Hospital of Tongzhou District, Nantong City (Hospital 2) from January 2022 to June 2023 were retrospectively analyzed, and a total of 427 cases were included in the study based on the nadir criteria. Three hundred twenty cases from Hospital 1 were randomly grouped into a training set ([Formula: see text]) and an internal validation set ([Formula: see text]), and 107 cases from Hospital 2 were used for the external validation set. The correlations between patients’ clinicoradiological characteristics, tumor markers, and seven tumor autoantibodies (7-TAABs) were analyzed by the Mantel test and further by univariate and multivariate logistic regression analyses to screen the risk factors for the development of infiltrative tumors in the ground-glass nodes and to establish a joint model, which was combined with the clinicoradiological model and the model of the serological indexes in the internal and external validation sets were performed to compare the subject work characteristics (ROC) curves, clinical calibration curves, and clinical decision curves to evaluate their predictive efficacy and clinical utility. Results: Of the 427 cases included, 174 were in the noninfiltrating group, and 253 were in the infiltrating group. There was a significant relationship between tumor markers, seven tumor autoantibodies, and lung cancer infiltrability, and after multifactorial logistic regression analysis, a bronchial air sign, probability of malignancy, nodule diameter, percentage of solidity, VEGF, proGRP, GAGE7, and 7-TAABs were the risk factors for determining the development of infiltrative lesions in early-stage lung nodules. The clinicoradiological model was superior to the serological index model on both internal and external validation sets (AUC values were: 0.926 versus 0.839, [Formula: see text]; 0.895 versus 0.751, [Formula: see text]), and the combined model was slightly superior to the clinicoradiological model on both internal and external validation sets (AUC values were: 0.928 versus 0.926, [Formula: see text]; 0.914 versus 0.895, [Formula: see text]). The combined model performed optimally in terms of calibration accuracy and net clinical benefit, suggesting that a model constructed based on AI CT metrics combined with tumor markers and 7-TAABs would be beneficial to clinicians in predicting the infiltrative nature of early-stage lung cancer. Conclusion: The column-line diagram model built based on CT indexes improved by artificial intelligence technology combined with tumor markers and 7-TAAB can better predict the infiltration of lung tumors, which has specific clinical application value.

Application of artificial intelligence-based dual source CT scanning in the differentiation of lung adenocarcinoma in situ and minimally invasive adenocarcinoma.

Lung adenocarcinoma is the most common type of lung cancer with highly incidence and mortality. Due to the overlap of morphological features, it is difficult to distinguish clinically between preinvasive lesions (in situ adenocarcinoma, AIS) and invasive lesions (minimally invasive adenocarcinoma, MIA), which appear as ground glass cloudy nodules. This study was performed to probe the application value of artificial intelligence (AI)-based dual source CT scanning in the differentiation of AIS as well as MIA. The clinical data of 136 patients in Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to January 2022 were retrospectively analyzed. The accuracy of AI in distinguishing lung AIS (n=76) and MIA (n=60) were analyzed. The effectiveness of AI in detecting nodules and its diagnostic efficacy for AIS and MIA were explored. The proportion of patients with clear and regular lesion boundaries in AIS was higher than that in MIA. The mean lesion diameter of AIS patients was shorter than MIA patients. There was no difference in the CT value between AIS and MIA in the ground glass nodule density area of pure ground glass nodule and mixed ground glass nodule, but the CT value of the solid nodule density area in AIS was lower. The occurrence of pulmonary vascular abnormality, air bronchogram sign, and pleural depression in AIS patients were lower than MIA patients. The detection rate of AI for lung adenocarcinoma with nodule diameter ≤ 5 mm, complete solid nodules and ground glass nodules was significantly higher than radiologists. The sensitivity, specificity, positive prediction rate, negative prediction rate and accuracy of AI detection were significantly higher than radiologists. AI-based dual source CT scanning can clearly show the morphological characteristics of lung adenocarcinoma, which is helpful for the differential diagnosis of lung AIS as well as MIA.

Lung microwave ablation: Post-procedure imaging features and evolution of pulmonary ground-glass nodule-like lung cancer.

To retrospectively examine the imaging characteristics of chest-computed tomography (CT) following percutaneous microwave ablation (MWA) of the ground-glass nodule (GGN)-like lung cancer and its dynamic evolution over time. From June 2020 to May 2021, 147 patients with 152 GGNs (51 pure GGNs and 101 mixed GGNs, mean size 15.0 ± 6.3 mm) were enrolled in this study. One hundred and forty-seven patients underwent MWA procedures. The imaging characteristics were evaluated at predetermined time intervals: immediately after the procedure, 24-48 h, 1, 3, 6, 12, and ≥18 months (47 GGNs). This study population included 147 patients with 152 GGNs, as indicated by the results: 43.5% (66/152) adenocarcinoma in situ, 41.4% (63/152) minimally invasive adenocarcinoma, and 15.1% (23/152) invasive adenocarcinoma. Immediate post-procedure tumor-level analysis revealed that the most common CT features were ground-glass opacities (93.4%, 142/152), hyperdensity within the nodule (90.7%, 138/152), and fried egg sign or reversed halo sign (46.7%, 71/152). Subsequently, 24-48 h post-procedure, ground-glass attenuations, hyperdensity, and the fried egg sign remained the most frequent CT findings, with incidence rates of 75.0% (114/152), 71.0% (108/152), and 54.0% (82/152), respectively. Cavitation, pleural thickening, and consolidation were less frequent findings. At 1 month after the procedure, consolidation of the ablation region was the most common imaging feature. From 3 to 12 months after the procedure, the most common imaging characteristics were consolidation, involutional parenchymal bands and pleural thickening. At ≥18 months after the procedure, imaging features of the ablation zone revealed three changes: involuting fibrosis (80.8%, 38/47), consolidation nodules (12.8%, 6/47), and disappearance (6.4%, 3/47). This study outlined the anticipated CT imaging characteristics of GGN-like lung cancer following MWA. Diagnostic and interventional radiologists should be familiar with the expected imaging characteristics and dynamic evolution post-MWA in order to interpret imaging changes with a reference image.

Computed tomography imaging and clinical characteristics of pulmonary ground-glass nodules ≤2 cm with micropapillary pattern.

The aim of this study was to investigate the imaging features, lymph node metastasis, and genetic mutations in micropapillary lung adenocarcinoma (imaging with mixed ground-glass nodules) ≤2 cm, to provide a more precise and refined basis for the selection of lung segment resection. A retrospective analysis of 162 patients with surgically resected pathologically confirmed cancers ≤2.0 cm in diameter (50 cases of micropapillary mixed ground-glass nodules [mGGNs], 50 cases of nonmicropapillary mGGNs, and 62 cases of micropapillary SNs [solid nodules]) was performed. mGGNs were classified into five categories according to imaging features. The distribution of these five morphologies in micropapillary with mGGN and nonmicropapillary with mGGN was analyzed. The postoperative pathology and prognosis of lymph node metastasis were also compared between micropapillary mGGNs and micropapillary with SNs. After searching the TCGA database, we demonstrated heterogeneity, high malignancy and high risk of microcapillary lung cancer cancers. Different pathological subtypes of mGGN differed in morphological features (p < 0.05). The rate of lymph node metastasis was significantly higher in micropapillary mGGNs than in nonmicropapillary mGGNs. In the TCGA database samples, lactate transmembrane protein activity, collagen transcription score, and fibroblast EMT score were remarkably higher in micropapillary adenocarcinoma. Other pathological subtypes had a better survival prognosis and longer disease-free survival compared with micropapillary adenocarcinoma. mGGNs ≤2 cm with a micropapillary pattern have a higher risk of lymph node metastasis compared with SNs, and computed tomography (CT) imaging features can assist in their diagnosis.

Usefulness of Quantitative Analysis Using Relative Electron Density-Based Image of Subsolid Nodule in Chest HRCT

To study the usefulness of quantitative analysis using the relative electron density-based image in the diagnosis of subsolid nodule by chest high-resolution CT. The phantom study measured the CT number(HU), relative electron density(%EDW) and maximum diameter of the nodules by placing artificial nodules in the chest phantom. The patient study was conducted on 172 patients with subsolid nodules from April 2022 to January 2023. The volume and diameter of subsolid nodules in the CT number-based image and relative electron density-based image were measured separately after dividing the two groups: mixed ground-glass nodule and pure ground-glass nodule. The correlation studied between measuring the CT number(HU) and relative electron density(%EDW) by setting the region of interest. The CT number(HU) and diameter values in the phantom study were not significantly different from the actual values of the artificial nodules.(P&gt;0.05) As a result of the patient study, the volume and diameter of subsolid nodules were increased in the relative electron density-based image compared to the CT number-based image for both the mixed ground-glass nodule and pure ground-glass nodule groups.(P&lt;0.05) The CT number(HU) and relative electron density(%EDW) showed a strong positive correlation in both the phantom and patient study.(P&lt;0.05) Providing visual imaging information using CT number-based and relative electron density-based images simultaneously can offer many advantages in establishing future treatment plans through accurate quantitative analysis of subsolid nodules.

Prediction of Lymph Node Metastasis of Mixed Ground-glass Nodules Based on Clinical Imaging Information

Previous studies have shown that lymph node metastasis only occurs in some mixed ground-glass nodules (mGGNs) which the pathological results were invasive adenocarcinoma (IAC). However, the presence of lymph node metastasis leads to the upgrading of tumor-node-metastasis (TNM) stage and worse prognosis of the patients, so it is important to perform the necessary evaluation before surgery to guide the operation method of lymph node. The aim of this study was to find suitable clinical and radiological indicators to distinguish whether mGGNs with pathology as IAC is accompanied by lymph node metastasis, and to construct a prediction model for lymph node metastasis. From January 2014 to October 2019, the patients with resected IAC appearing as mGGNs in computed tomography (CT) scan were reviewed. All the lesions were divided into two groups (with lymph node metastasis or not) according to their lymph node status. Lasso regression model analysis by applying R software was used to evaluate the relationship between clinical and radiological parameters and lymph node metastasis of mGGNs. A total of 883 mGGNs patients were enroled in this study, among which, 12 (1.36%) showed lymph node metastasis. Lasso regression model analysis of clinical imaging information in mGGNs with lymph node metastasis showed that previous history of malignancy, mean density, mean density of solid components, burr sign and percentage of solid components were informative. Prediction model for lymph node metastasis in mGGNs was developed based on the results of Lasso regression model with area under curve=0.899. Clinical information combined with CT imaging information can predict lymph node metastasis in mGGNs.

Dual-layer spectral detector CT (SDCT) can improve the detection of mixed ground-glass lung nodules.

Mixed 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). 150 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. Thirty 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. SDCT 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.

Detection efficacy of analog [18F]FDG PET/CT, digital [18F]FDG, and [13N]NH3 PET/CT: a prospective, comparative study of patients with lung adenocarcinoma featuring ground glass nodules.

This prospective study compared the detection efficacy of analog 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) (aF PET/CT), digital [18F]FDG PET/CT (dF PET/CT), and digital 13N-ammonia (13N-NH3) PET/CT (dN PET/CT) for patients with lung adenocarcinoma featuring ground glass nodules (GGNs). Eighty-seven patients with lung adenocarcinoma featuring GGNs who underwent dF and dN PET/CT were enrolled. Based on the GGN component, diameter, and solid-part size, 87 corresponding patients examined using aF PET/CT were included, with age, sex, and lesion characteristics closely matched. Images were visually evaluated, and the tumor to background ratio (TBR) was used for semi-quantitative analysis. Ultimately, 40 and 47 patients with pure GGNs (pGGNs) and mixed GGNs (mGGNs), respectively, were included. dF PET/CT revealed more positive lesions and higher tracer uptake in GGNs than did aF PET/CT (53/87 vs. 26/87, p < 0.05; TBR: 3.08 ± 4.85 vs. 1.42 ± 0.93, p < 0.05), especially in mGGNs (44/47 vs. 26/47, p < 0.05; TBR: 4.48 ± 6.17 vs. 1.78 ± 1.16, p < 0.05). However, dN PET/CT detected more positive lesions than did dF PET/CT (71/87 vs. 53/87, p < 0.05), especially in pGGNs (24/40 vs. 9/40, p < 0.05). dF PET/CT provides superior detection efficacy over aF PET/CT for patients with lung adenocarcinoma featuring GGNs, particularly mGGNs. dN PET/CT revealed superior detection efficacy over dF PET/CT, particularly in pGGNs. aF, dF, and dN PET/CT are valuable non-invasive examinations for lung cancer featuring GGNs, with dN PET/CT offering the best detection performance. • Digital PET/CT provides superior detection efficacy over analog PET/CT in patients with lung adenocarcinoma featuring GGNs. • dN PET/CT can offer more help in the early detection of malignant GGN.

Measuring pure ground-glass nodules on computed tomography: assessing agreement between a commercially available deep learning algorithm and radiologists' readings.

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.

Establishment of a malignancy and benignancy prediction model of sub-centimeter pulmonary ground-glass nodules based on the inflammation-cancer transformation theory.

BackgroundIn recent years, Chinese clinicians are frequently encountered by patients with multiple lung nodules and these intensity ground-glass nodules (GGNs) are usually small in size and some of them have no spicule sign. In addition, early lung cancer is diagnosed in large numbers of non-heavy smokers and individuals with no caner history. Obviously, the Mayo model is not applicable to these patients. The aim of the present study is to develop a new and more applicable model that can predict malignancy or benignancy of pulmonary GGNs based on the inflammation-cancer transformation theory.Materials and methodsIncluded in this study were patients who underwent surgical resection or lung puncture biopsy of GGNs in Shanghai 10th People’s Hospital between January 1, 2018 and May 31, 2021 with the inclusion criterion of the maximum diameter of GGN < 1.0 cm. All the included patients had their pulmonary GGNs diagnosed by postoperative pathology. The patient data were analyzed to establish a prediction model and the predictive value of the model was verified.ResultsAltogether 100 GGN patients who met the inclusion criteria were included for analysis. Based on the results of logistic stepwise regression analysis, a mathematical predication equation was established to calculate the malignancy probability as follows: Malignancy probability rate (p) = ex/(1 + ex); p > 0.5 was considered as malignant and p ≤ 0.5 as benign, where x = 0.9650 + [0.1791 × T helper (Th) cell] + [0.2921 × mixed GGN (mGGN)] + (0.4909 × vascular convergence sign) + (0.1058 × chronic inflammation). According to this prediction model, the positive prediction rate was 73.3% and the negative prediction rate was 100% versus the positive prediction rate of 0% for the Mayo model.ConclusionBy focusing on four major factors (chronic inflammation history, human Th cell, imaging vascular convergence sign and mGGNs), the present prediction model greatly improves the accuracy of malignancy or benignancy prediction of sub-centimeter pulmonary GGNs. This is a breakthrough innovation in this field.

This video is going to show you how it works to identify the target nodule by using positioning method of 3D localization based on anatomical landmarks. A 71 years old male patient with a mixed ground glass nodule was found in the lower lobe of left lung. First, the head of the transverse process of the vertebral body as point

This video is going to show you how it works to identify the target nodule by using positioning method of 3D localization based on anatomical landmarks. A 71 years old male patient with a mixed ground glass nodule was found in the lower lobe of left lung. First, the head of the transverse process of the vertebral body as point

Evaluation of the dual vascular supply patterns in ground-glass nodules with a dynamic volume computed tomography.

BACKGROUNDIn recent years, the detection rate of ground-glass nodules (GGNs) has been improved dramatically due to the popularization of low-dose computed tomography (CT) screening with high-resolution CT technique. This presents challenges for the characterization and management of the GGNs, which depends on a thorough investigation and sufficient diagnostic knowledge of the GGNs. In most diagnostic studies of the GGNs, morphological manifestations are used to differentiate benignancy and malignancy. In contrast, few studies are dedicated to the assessment of the hemodynamics, i.e., perfusion parameters of the GGNs. AIMTo assess the dual vascular supply patterns of GGNs on different histopathology and opacities.METHODSForty-seven GGNs from 47 patients were prospectively included and underwent the dynamic volume CT. Histopathologic diagnoses were obtained within two weeks after the CT examination. Blood flow from the bronchial artery [bronchial flow (BF)] and pulmonary artery [pulmonary flow (PF)] as well as the perfusion index (PI) = [PF/(PF + BF)] were obtained using first-pass dual-input CT perfusion analysis and compared respectively between different histopathology and lesion types (pure or mixed GGNs) and correlated with the attenuation values of the lesions using one-way ANOVA, student’s t test and Pearson correlation analysis.RESULTSOf the 47 GGNs (mean diameter, 8.17 mm; range, 5.3-12.7 mm), 30 (64%) were carcinoma, 6 (13%) were atypical adenomatous hyperplasia and 11 (23%) were organizing pneumonia. All perfusion parameters (BF, PF and PI) demonstrated no significant difference among the three conditions (all P > 0.05). The PFs were higher than the BFs in all the three conditions (all P < 0.001). Of the 30 GGN carcinomas, 14 showed mixed GGNs and 16 pure GGNs with a higher PI in the latter (P < 0.01). Of the 17 benign GGNs, 4 showed mixed GGNs and 13 pure GGNs with no significant difference of the PI between the GGN types (P = 0.21). A negative correlation (r = -0.76, P < 0.001) was demonstrated between the CT attenuation values and the PIs in the 30 GGN carcinomas. CONCLUSIONThe GGNs are perfused dominantly by the PF regardless of its histopathology while the weight of the BF in the GGN carcinomas increases gradually during the progress of its opacification.

Malignancy risk stratification for solitary pulmonary nodule: A clinical practice guideline.

The detection rate of the solitary pulmonary nodule (SPN) is increasing with the popularization of CT scanning. Malignancy risk stratification for SPN is a major clinical difficulty. There have been several guidelines for SPN assessment. Inconsistency of these guidelines makes the clinical application difficult and confusing. In this Rapid Recommendation, solid and subsolid SPNs are recommended to be evaluated respectively. Six factors, namely the combination of age with sex, smoking history, history of malignancy, family history of malignancy, and nodule size, are recommended for malignancy risk stratification for both kinds of SPNs; the border of nodules (spiculation and lobulation) is recommended for evaluating solid SPNs and the density of nodules (pure or mixed ground-glass nodule) is recommended for subsolid nodules. Among them, smoking history and radiologic features (nodule diameter, border, and density) are of relatively higher importance. A scoring system was proposed to assist malignancy risk stratification of SPNs, with a total score ranging from six points to 15 points (if solid) or 17 points (if subsolid). For each SPN, regardless of solid or subsolid in nature, a total score of ≤ 7 points suggested a low risk of being malignant, while 7 to 9 points suggested medium risk, and ≥ 9 points suggested high risk. This rapid recommendation was developed using the MAGIC (Making GRADE the Irresistible Choice) methodological framework. First, a clinical subcommittee identified the topic of recommendation and requested evidence. Then, an independent evidence synthesis subcommittee performed a comprehensive literature review and evaluated the evidence. Finally, based on findings from the systematic review and use of real-world data, the clinical subcommittee formulated recommendations, including the scoring system, through a consensus procedure. A total of 13857 patients with SPNs were included in the meta-analysis and the association between 12 candidate factors and the risk of SPNs being malignant was studied. Eventually, seven factors were recommended for SPNs evaluation, and a scoring system was proposed. The parameters included are objective. Therefore, this recommendation is feasible in clinical practice. However, there are several uncertainties, such as a lack of further verification. It might be misclassified by the scoring system. Clinicians could choose the most suitable scheme according to the recommendation, along with their own experience in specific situations.

Clinical Characteristics and Risk Factors Analysis for Visceral Pleural Invasion in Mixed Ground-glass Nodular Lung Adenocarcinoma

背景与目的目前国内肺癌仍是发病率和致死率最高的恶性肿瘤，肺腺癌是其最常见的亚型，影像学中表现为混合性磨玻璃结节(mixed ground glass nodule, mGGN)的肺癌逐渐增多。脏层胸膜侵犯(visceral pleural invasion, VPI)是影响mGGN型肺腺癌预后的重要因素。本研究旨在探索分析mGGN型肺腺癌发生VPI的危险因素。方法回顾性分析2016年11月-2019年11月南京医科大学第一附属医院收治的接受根治性手术的128例mGGN型肺腺癌患者的临床资料，包括影像、病理和生物学特征，其中男性40例、女性88例，年龄30岁-81(60.3±9.3)岁。采用单因素卡方检验与多因素Logistic回归分析调查mGGN型肺腺癌发生VPI的各项危险因素。结果符合纳入标准的128例mGGN型肺腺癌患者中57例被诊断有VPI发生。性别、实性成分最大径、实性成分比例(consolidation tumor ratio, CTR)、毛刺征、肺部疾病史、高血压家族史、肿瘤-胸膜空间位置分型(relation of lesion to pleura, RLP)、支气管与结节走行关系在VPI(+)组和VPI(-)组间的差异均有统计学意义(P < 0.05)。Logistic多因素回归分析发现RLP(OR=3.529, 95%CI: 1.430-8.713, P=0.006)和支气管与结节走行关系(OR=3.993, 95%CI: 1.517-10.51, P=0.005)是VPI发生的独立危险因素(P < 0.05)。结论临床诊治应综合上述参数评估mGGN型肺腺癌发生VPI的可能性。RLP和支气管与结节走行关系异常作为VPI的独立危险因素，对判断mGGN型肺腺癌发生VPI具有一定的指导意义。

Application Value of Spectral CT Imaging in Quantitative Analysis of Early Lung Adenocarcinoma.

Objective To investigate the clinical value of gemstone energy spectral CT imaging for the quantitative analysis of early lung adenocarcinoma. Methods 76 cases of pulmonary ground-glass nodules pathologically confirmed as precancerous lesion and early lung cancer (including pure ground-glass nodules in 46 cases and mixed ground-glass nodules in 30 cases) underwent chest CT scan first and then underwent contrast-enhanced gemstone energy spectral CT to get arterial phase images, venous phase images, and delayed phase images. All the lesions were set the region of interest (ROI). Cases of the pure ground-glass nodule (pGGN) were measured at the maximum level of lesions, cases of the mixed ground-glass nodule (mGGN) were measured in two areas of ground-glass and solid components, CT value and iodine concentrations of lesions in three-phase scanning were separately measured, and at the same time, iodine concentrations of the thoracic aorta were also measured. The normalized iodine concentrations (NICs) were calculated, that is, the ratio of iodine concentrations of lesions and the thoracic aorta. CT values of lesions were also measured at each stage of 70 keV. All the quantitative data were expressed by the mean ± standard deviation, and paired t-test was used for pairwise comparison. Results In 76 cases, in the spectral CT imaging mode, the NIC value of solid components of the GGN was 0.33 ± 0.16 in the arterial phase (AP), 0.52 ± 0.25 in the venous phase (VP), and 0.58 ± 0.34 in the delayed phase (DP). There were significant differences of P values of NICs between each two phases in both solid component cases and the ground-glass component cases in AP/VP, VP/DP, and AP/DP (P < 0.05); there were no statistically significant P values of CT values between each two phases in three-period enhanced CT in both the solid component cases and the ground-glass component cases in AP/VP, VP/DP, and AP/DP (P > 0.05). Conclusion Gemstone energy spectral CT with quantitative imaging can dynamically reflect the enhancement features of the pulmonary GGN.