Mixed Ground-glass Nodules Research Articles

Atypical characteristics of COVID-19 infection on CT imaging with preexisting combined pulmonary fibrosis and emphysema: A case report

Abstract Introduction: Combined pulmonary fibrosis and emphysema (CPFE) complicating Coronavirus Disease 2019 (COVID-19) is a challenging clinical scenario. Patient concerns: We report the case of a 44-year-old Chinese man with a medical history of CPFE showing atypical characteristics of COVID-19 infection on computed tomography (CT) imaging. Diagnoses: The patient was reported to have had close contact with a COVID-19 patient, with 4 real-time reverse transcriptase-polymerase chain reaction tests for COVID-19 - all positive. CT imaging showed scattered mixed ground-glass nodules and small ground-glass lesions in the lower and posterior parts of the posterior segment of the left upper lobes. Intervention: The patient received antiviral therapy (ritonavir tablets twice-daily, Xiyanping injection, and oral delivery of Keke capsules). Outcomes: On follow-up, nodules near the hilar side of the lung showed shrinkage at 7th day and nearly disappeared after 15 days. Conclusion: Clinicians should be alert to the results of lung CT examination and atypical lesions should be diagnosed in time. Precise clinical evaluation, well-directed monitoring, and intervention can effectively improve prognosis.

Two micro-portal video-assisted thoracic surgery of right S8 segmentectomy with systemic lymphadenectomy

: Better management of lung cancer is crucial for improving the prognosis of such lethal malignancy, and surgical treatment is one of the most important strategies for early lung cancer. Anatomic segmentectomy, in particular, provides the complete resection of lesions with the retention of maximal normal lung tissue. Several different techniques for lung segmentectomy have been described previously, whereas how to perform with concerns of minimal invasiveness and better accessibility for surgeons familiar with single-direction video-assisted thoracic surgery (VATS) remains to be elucidated. In the presented case, we described the applications of our two-micro-portal video-assisted thoracic segmentectomy as well as the plug-in multi-edge cutting method to a patient with a mixed ground-glass nodule in the anterior basal segment of the right lower lobe, and systemic lymphadenectomy was performed following the pathological diagnosis of invasive adenocarcinoma. The patient was discharged after a 4-day well recovery and was without recurrence or metastasis after 6 months of follow-up. Considering that the two micro-portal VATS would be more accessible for surgeons who are already familiar with the single-direction VATS and could yield the similar minimal invasiveness and less pain as uniport VATS, we believe that the presented two-micro-portal video-assisted thoracic segmentectomy is technically safe and feasible in lung cancer treatment and is worthy of promotion.

HRCT features between lepidic-predominant type and other pathological subtypes in early-stage invasive pulmonary adenocarcinoma appearing as a ground-glass nodule

BackgroundDifferent pathological subtypes of invasive pulmonary adenocarcinoma (IPA) have different surgical methods and heterogeneous prognosis. It is essential to clarify IPA subtypes before operation and high-resolution computed tomography (HRCT) plays a very important role in this regard. We aimed to investigate the HRCT features of lepidic-predominant type and other pathological subtypes of early-stage (T1N0M0) IPA appearing as a ground-glass nodule (GGN).MethodsWe performed a retrospective analysis on clinical data and HRCT features of 630 lesions in 589 patients with pathologically confirmed IPA (invasive foci > 5 mm) appearing as pure GGN (pGGN) and mixed GGN (mGGN) with consolidation-to-tumor ratio (CTR) ≤0.5 from January to December 2019. All GGNs were classified as lepidic-predominant adenocarcinoma (LPA) and nonlepidic-predominant adenocarcinoma (n-LPA) groups. Univariate analysis was performed to analyze the differences of clinical data and HRCT features between the LPA and n-LPA groups. Multivariate analysis was conducted to determine the variables to distinguish the LPA from n-LPA group independently. The diagnostic performance of different parameters was compared using receiver operating characteristic curves.ResultsIn total, 367 GGNs in the LPA group and 263 GGNs in the n-LPA group were identified. In the univariate analysis, the CTR, mean CT values, and mean diameters as well as mixed GGN, deep lobulation, spiculation, vascular change, bronchial change, and tumor–lung interface were smaller in the LPA group than in the n-LPA group (P < 0.05). Logistic regression model was reconstructed including the mean CT value, CTR, deep lobulation, spiculation, vascular change, and bronchial change (P < 0.05). Area under the curve of the logistic regression model for differentiating LPA and n-LPA was 0.840 (76.4% sensitivity, 78.7% specificity), which was significantly higher than that of the mean CT value or CTR.ConclusionsDeep lobulation, spiculation, vascular change, and bronchial change, CT value > − 472.5 HU and CTR > 27.4% may indicate nonlepidic predominant invasive pulmonary adenocarcinoma in GGNs.

Multiple bronchiolar adenomas with malignant transformation and CCNE1 mutation: a case report and literature review

BackgroundBronchiolar adenoma (BA) is a recently proposed diagnostic terminology, which is considered as the expansion of the concept of ciliated muconodular papillary tumors. BA is considered to be a benign neoplasm, but a few previous cases have been reported with the possibility of malignant transformation. Therefore, the genetic and histological nature of BA is controversial so far. We describe a rare case of multiple BAs with malignant transformation and CCNE1 (cyclin E1) mutation to increase the understanding of this disease.Case descriptionA 56-year-old woman was admitted to our hospital due to two ground-glass nodules (GGNs) in the left lung detected by chest CT without symptom. The pure GGN located in the upper lingual segment about 6 mm in diameter and another mixed GGN located in the dorsal segment about 7 mm. The two GGNs have been found a year ago without treatment, and the mixed GGN become larger to 8 mm with vacuole sign in the next year health checkup. We performed a wedge resection of the two nodules completely by video-assisted thoracoscopy (VATS). Postoperative pathology indicated that the pure GGN was atypical bronchial adenoma, while the mixed GGN was atypical bronchial adenoma with malignant transformation which was missed in frozen section. Gene mutations analysis by next-generation sequencing (NGS) showed CCNE1 gene mutation in both lesions, and her-2 mutation was identified in the mixed GGN. The programmed cell death 1 ligand 1 (PD-L1) expression analysis of tumor cells showed 0% and less than 1% in the pure GGN and the mixed GGN, respectively.ConclusionBA is generally considered to be a benign tumor. The present study indicated that BA may be carcinogenic in atypical cases with some driver genes mutation and we should be vigilant for its potentiality of malignant transformation in clinical practice.

Comparison of Clinical and Pathological Characteristics Between Extremely Multiple GGNs and Single GGNs

ObjectiveThis study aims to compare the clinical and pathological characteristics between patients undergoing surgery for extremely multiple ground-glass nodules (GGNs) and those for single GGN.MethodsWe defined extremely multiple GGNs as follows: (i) number of GGNs ≥3, (ii) GGN diameter between 3 and 30 mm, and (iii) no less than three nodules that were surgically removed and pathologically diagnosed. Patients with extremely multiple GGNs and single GGNs who underwent surgery at the same time were retrospectively analyzed. The patients were divided into three groups according to the number of nodules: exceedingly multiple nodules (EMN) group (>10), highly multiple nodules (HMN) group (three to 10), and single nodule (SN) group. The clinical and pathological characteristics, surgical methods and prognosis were analyzed.ResultsNinety-nine patients with single nodules and 102 patients with extremely multiple nodules were enrolled. Among the patients with extremely multiple nodules, 43 (42.2%) had >10 nodules. There were no significant differences in demographic characteristics, such as age, sex, and smoking history, between the groups, but there were differences in tumor characteristics. All patients with >10 nodules showed bilateral pulmonary nodules and presented with both pure and mixed GGNs. The single GGNs were smaller in diameter, and the proportion of mixed GGNs and pathologically invasive adenocarcinoma was lower than that of the primary nodules in the exceedingly multiple GGNs group (p < 0.05). However, the proportion of both mixed GGNs and malignant nodules decreased significantly with the increasing number of total lesions. During postoperative follow-up, one patient in the highly multiple nodules group had a local recurrence, and 16 (15.7%) patients in the extremely multiple GGNs group and 10 (9.8%) patients in the single GGN group had enlarged unresected GGNs or additional GGNs.ConclusionsOur study revealed the clinical and pathologic characteristics, surgical methods, and prognosis of patients with extremely multiple GGNs and compared them with those of patients with a single GGN. Although the primary nodules in extremely multiple GGNs may have higher malignancy than those in the single nodule group, the proportion of both mGGNs and malignant nodules decreased significantly with the increasing number of lesions, and the prognosis of patients with extremely multiple GGNs was satisfied.

Deep sequencing reveals the genomic characteristics of lung adenocarcinoma presenting as ground-glass nodules (GGNs).

BackgroundThe concept of multi-step progression from atypical adenomatous hyperplasia (AAH) to invasive adenocarcinoma (ADC) has been proposed, and ground-glass nodules (GGNs) may play a critical role during the early lung tumorigenesis. We present the first comprehensive description of the genomic architecture of GGNs to unravel the genetic basis of GGN.MethodsWe investigated 30 GGN-like lungs ADC by performing >1,000× whole-exome sequencing (WES) and characterized the genomic variations and evaluate the relationship between the clinicopathologic and molecular characteristics in this disease.ResultsDespite the low somatic mutation burden, GGNs exhibited high intratumor heterogeneity (ITH) characterized by the proportion of subclonal mutations. Different mutagenesis shaped the genomes of GGN during cancer evolution and were mostly featured by molecular clock-like signatures that occur in clonal mutations and defective DNA mismatch signatures that occur in subclonal mutations. Moreover, 10.7–67.1% clonal mutations occurred after whole-genome doubling (WGD), indicating that WGD could be a frequent truncal event in GGNs. Samples with WGD showed higher genomic instability but lower ITH. These GGNs were characterized by recurrent focal copy-number changes that are highly associated with tumorigenesis, with only two genes (EGFR and RBM10) that were recurrently mutated. Additionally, GGNs with different pathological subtypes or computed tomography (CT) features exhibited distinct genetic characteristics. Lepidic predominant or pure GGNs in CT images carried a lower mutation burden and had a relatively stable genome than nonlepidic or mixed GGNs. GGNs with RBM10 mutations tended to accompany a pathologically lepidic pattern, indicating RBM10 may drive the distinct subtype of lung cancer with better prognosis.ConclusionsThese findings facilitated interpreting the genomic characteristics of GGNs, provided insight into the early stages of lung cancer evolution, and possessed potential clinical significance.

Solitary pulmonary capillary hemangioma of adult: a series of 10 cases

Objective: To examine the clinical features, diagnostic and therapeutic strategy of solitary pulmonary capillary hemangioma (SPCH). Methods: The data of 10 SPCH cases who underwent surgical operations from June 2017 to June 2020 in Shanghai Pulmonary Hospital, Tongji University were retrospectively reviewed. There were 4 males and 6 females, aged (49.8±13.6) years (range: 26 to 66 years). The clinical manifestations, imaging manifestations, treatment and pathological diagnosis were analyzed. Results: All patients were asymptomatic, and all nodules were detected by CT. The size of nodule was (14.9±5.8) mm (range: 8 to 30 mm). Seven of 10 cases showed the mixed ground-glass nodule appearance and 2 cases showed solid nodule and 1 case showed cystic solid nodule appearance in CT findings. The growth speed was very slow. The follow-up time was 4.5(21.5) months before surgery. Histologically, SPCH manifested as a solitary lesion composed of densely proliferating and dilated capillaries without cytologic atypia within the alveolar septa. Immunohistochemically, capillaries of SPCH uniformly expressed endothelial markers, such as CD31, CD34. The patients were followed up for 15.0(22.0) months after surgery and all recovered well. Conclusions: SPCH is probably an unrecognized benign capillary proliferative disease. SPCH lesions mimic early lung cancer on CT as mixed ground-glass nodule, may be misdiagnosed as other nonspecific benign lesions. With careful histologic examination, SPCH can be successfully diagnosed using CD34 or CD31 immunohistochemistry staining.

HRCT features differentiate synchronous multiple primary lung adenocarcinomas from intrapulmonary metastases

Objective: To investigate the high resolution CT (HRCT) features of lung adenocarcinoma for differentiating synchronous multiple lung adenocarcinoma from lung adenocarcinoma with intrapulmonary metastasis. Methods: The clinical and imaging features of 131 lesions from 62 patients of synchronous multiple primary lung adenocarcinoma (primary group) and 67 lesions from 31 patients of lung adenocarcinoma with intrapulmonary metastases (metastasis group) were retrospectively analyzed. According to the types of lesion, including pure ground glass nodule (pGGN), mixed ground glass nodule (mGGN) and solid nodule (SN), the image feature matching types of patients were divided into 7 types. The differences of image feature matching types between the primary group and the metastasis group were compared. Multiple lesions in the lung of patients were classified into the main lesion and the concomitant lesions according to their size. The differences including the size of the main lesion and the concomitant lesion (long diameter of nodule, long diameter of solid component in nodule), whether it contains ground glass components in nodule, shape, lobulation, margin, spiculation, bubble-like lucency, pleural retraction and pleural attachment were recorded and analyzed. The differences of image features of main lesion and the concomitant lesion in the primary group and the metastasis group were compared. Results: The image feature matching types of pGGN + mGGN and mGGN + mGGN were more common in the primary group, and the ground glass component contained pGGN or mGGN was accounted for 62.9%(39/62). At least one lesion containing the ground glass component was accounted for 96.8% (60/62). There were two types in metastatic groups, mGGN+ SN and SN+ SN accounting for 6.5% (2/31) and 93.5% (29/31), respectively. There were significant differences in image feature matching types between the primary group and metastatic group (P<0.01). Univariate analysis of the main lesions between the two groups showed that the gender, smoking history, long diameter of the main lesion, long diameter of the solid component, the ground glass component and pleural attachment were statistically different (P<0.05). Further analysis by multivariate logistic regression showed that the male (OR=5.742, P=0.010), SN (OR=41.291, P<0.01) and pleural attachment (OR=9.288, P=0.001) were the three significant risk factors associated with the main lesions in metastasis group.The most common concomitant lesions in primary group were pGGN, containing the ground glass component. However, all of the concomitant lesions in the metastatic group were SN (P<0.01), showing round lesions with well-defined margin, attaching the pleura (P<0.05). Conclusions: The HRCT features of lung adenocarcinoma can differentiate synchronous multiple lung adenocarcinoma from lung adenocarcinoma with intrapulmonary metastasis. At least one lesion contains ground glass components (pGGN or mGGN) in synchronous multiple primary lung adenocarcinoma, while SN is more common in lung adenocarcinoma with lung metastasis. Lung cancer with intrapulmonary metastasis can be considered when the main lesion is SN with pleural attachment and the intrapulmonary accompanying lesion is also solid nodules without lobular, speculation and bubble-like lucency.

Diagnostic value and imaging features of multi-detector CT in lung adenocarcinoma with ground glass nodule patients.

This study investigated the application value and imaging features of multi-detector CT (MDCT) in the treatment of lung adenocarcinoma with ground glass nodules (GGN). The medical data of 168 patients with pulmonary GGN in Shengli Oilfield Central Hospital from January 2013 to June 2015 were analyzed. Patients with microinvasive adenocarcinoma and invasive adenocarcinoma were included in group A (invasive lung adenocarcinoma, n=98), while patients with atypical adenomatous hyperplasia and adenocarcinoma in situ were included in group B (pre-invasive lung adenocarcinoma, n=70). The imaging features of MDCT were compared. ROC curves of the size of nidus and the size of solid component were drawn for the diagnosis of invasive lung adenocarcinoma. Logistic multivariate regression analysis was used to analyze the risk factors that affected invasive lung adenocarcinoma. There were significant differences in nidus, burr, and lobes of the patients between groups A and B. The size of nidus and the size of solid component of the patients in group A were significantly higher than those of the patients in group B. The AUCs of the size of the nidus and the size of the solid component of the invasive lung adenocarcinoma were 0.891 and 0.902, respectively. The AUC of the combined diagnosis was 0.984. Size of the nidus, size of the solid component, nature of the lesion, burr, and lobes were all risk factors for invasive lung adenocarcinoma. In patients with GGN, size of the nidus and size of the solid component can be used as excellent diagnostic parameters for invasive lung adenocarcinoma, and nidus size (≥9.8 mm), size of the solid component (≥0.9 mm), the mixed GGN nature of the nidus, burr and lobes can distinguish invasive lung adenocarcinoma and pre-invasive lesions.

Preliminary recommendations for lung surgery during COVID-19 epidemic period.

Preliminary recommendations for lung surgery during COVID-19 epidemic period.

Predictive model for the diagnosis of benign/malignant small pulmonary nodules.

There is some doubt that all nodules <8 mm are really mainly benign and that simple follow-up is adequate in all cases. The purpose of this study is to create a predictive model for the diagnosis of benign and malignant small pulmonary nodules.This was a retrospective case–control study of patients who had undergone pulmonary nodule resection at the Zhejiang University Jinhua Hospital. Patients with pulmonary nodules of ≤10 mm in size on chest high-resolution computed tomography were included. Patients’ demographic characteristics, clinical features, and high-resolution computed tomography findings were collected. Logistic regression and receiver-operating characteristic analysis were used to create a predictive model for malignancy.A total of 216 patients were included: 160 with malignant and 56 with benign nodules. Nodule density (odds ratio [OR] = 0.996, 95% confidence interval [CI]: 0.993–0.998, P = .001), vascular penetration sign (OR = 3.49, 95% CI: 1.39–8.76, P = .008), nodule type (OR = 4.27, 95% CI: 1.48–12.29, P = .007), and incisure surrounding nodules (OR = 0.18, 95% CI: 0.04–0.84, P = .03) were independently associated with malignant nodules. These factors were used to create a mathematical model that had an area under the receiver-operating characteristic curve of 0.744. Using a cut-off of 0.762 resulted in 63.1% sensitivity and 75.0% specificity.This study proposes a pulmonary nodule prediction model that can estimate benign/malignant lung nodules with good sensitivity and specificity. Mixed ground-glass nodules, vascular penetration sign, density of lung nodules, and the absence of incisure signs are independently associated with malignant lung nodules.

Analysis of lymph node metastasis in 200 patients with non-small cell lung cancer.

BackgroundLymph node metastasis occurs although clinical stage IA is a relatively early stage for patients with non-small cell lung cancer (NSCLC). This study aimed to explore the influencing factors of lymph node metastasis.MethodsA total of 200 patients diagnosed with clinical stage IA NSCLC preoperatively from July 2014 to July 2016 were examined. Every patient underwent lobectomy and systematic lymph node dissection. Their clinicopathological characteristics and status of lymph node metastasis are analyzed.ResultsThe rates of both N1 and N2 lymph node metastasis increase with the increase in the tumor diameter. The N1 lymph node metastasis rate is 0%, 2.82%, and 9.52%, while the N2 lymph node metastasis rate is 0%, 4.23%, and 25.40% for pure ground-glass nodules, mixed ground-glass nodules (solid component <50%), and mixed ground-glass nodules (solid component >50%), respectively. The difference is statistically significant (P=0.000). Patients with squamous cell carcinoma have a relatively higher N1 lymph node metastasis rate comparing with patients with adenocarcinoma (P<0.05). Tumors locate in the inner half lobe (close to hilus) are prone to metastasize to lymph nodes (P=0.018). Multiple regression analysis shows that tumor diameter, solid component rate, and tumor location are relevant factors for lymph node metastasis.ConclusionsIn patients with NSCLC, who have tumors smaller than 1 cm, pure ground-glass nodules, or tumors locate in the lateral half lobe, lymph node metastasis is rare and selective lymphadenectomy is considerable.

Plasma extracellular vesicle microRNAs for pulmonary ground-glass nodules

ABSTRACTIn this study, we evaluated the diagnostic value and molecular characteristics of plasma extracellular vesicles (EVs)-derived miRNAs for patients with solitary pulmonary nodules (SPNs), particularly ground-glass nodules (GGNs). This study was registered at www.clinicaltrials.gov under registration number NCT03230019. Small RNA sequencing was performed to assess plasma EVs miRNAs in 59 patients, including 12 patients with benign nodules (2017, training set). MiRNA profiles of 40 an additional individuals were sequenced (2018, validation set). Overall, 16 pure GGNs, 21 mixed GGNs, and 42 solid nodules were included, with paired post-operative plasma samples available for 20 patients. The target miRNA/reference miRNA ratio was used to construct a support vector machine (SVM) model. The SVM model with the best specificity showed 100% specificity in both the training and validation sets independently. The model with the best sensitivity showed 100% and 96.9% sensitivity in the training and validation sets, respectively. Principal component analysis revealed that pure GGN distributions were distinct from those of solid nodules, and mixed GGNs had a diffuse distribution. Among differentially expressed miRNAs, miR-500a-3p, miR-501-3p, and miR-502-3p were upregulated in tumor tissues and enhanced overall survival. The SVM classifier accurately distinguished malignant GGNs and benign nodules. The distinct profile characteristics of miRNAs provided insights into the feasibility of EVs miRNAs as prognostic factors in lung cancer.

Clinical Characteristics and Prognosis of Sub-centimeter Lung Adenocarcinoma

背景与目的随着肺癌筛查的逐渐推广，越来越多的患者被确诊为亚厘米(直径≤1 cm)肺腺癌。亚厘米肺腺癌多为早期肺癌，但目前关于亚厘米肺腺癌的研究仍不充分。本研究针对亚厘米肺腺癌患者临床特征及预后进行分析，为该类患者的诊疗提供依据。方法回顾性分析2012年1月-2016年12月北京大学人民医院经胸腔镜手术病理确诊为亚厘米肺腺癌患者的临床及预后资料。根据结节影像学特征将患者分为纯磨玻璃结节(pure ground-glass nodules, pGGN)、混杂性磨玻璃结节(mixed ground-glass nodules, mGGN)和实性结节(solid nodules, SN)组，对比三组患者临床特征并对不同直径结节行亚组分析。此外，通过多因素分析筛选亚厘米肺浸润性腺癌的独立危险因素。结果本组共182例患者，中位年龄54(27-75)岁。男性57例，女性125例。女性亚厘米肺腺癌患者无吸烟史比例显著高于男性(P < 0.001)。所有1 mm-10 mm pGGN、1 mm-5 mm mGGN及1 mm-5 mm SN患者术后病理除原发灶外无其他阳性发现。46例6 mm-10 mm mGGN患者中有3例侵犯胸膜，1例发现脉管癌栓。39例6 mm-10 mm SN患者中有5例侵犯胸膜，2例发现脉管癌栓，2例出现淋巴结转移。侵犯胸膜、发现脉管癌栓或淋巴结转移的患者其病理类型均为浸润性腺癌。多因素Logistic回归分析发现吸烟史、既往肿瘤病史、mGGN、SN和肿瘤直径 > 5 mm是病理为肺浸润性腺癌的独立危险因素。中位随访时间44(22-82)个月，全组患者5年无复发生存率100.0%，总生存率98.9%。结论亚厘米肺腺癌患者发病年龄相对较小。影像学表现为6 mm-10 mm mGGN和6 mm-10 mm SN的亚厘米肺浸润性腺癌患者存在侵犯胸膜或淋巴结转移可能。吸烟史、既往肿瘤病史、mGGN、SN和肿瘤直径 > 5 mm为亚厘米肺浸润性腺癌的独立危险因素。对于亚厘米肺腺癌患者，早期发现并采取合适且有效的外科干预可获得良好的预后。

Attenuation and Morphologic Characteristics Distinguishing a Ground-Glass Nodule Measuring 5-10 mm in Diameter as Invasive Lung Adenocarcinoma on Thin-Slice CT.

OBJECTIVE. The purpose of this study is to comprehensively investigate the role of multiple features seen on thin-section CT (TSCT) in the differential diagnosis of ground-glass nodules (GGNs) measuring 5-10 mm in diameter as invasive adenocarcinoma (IAC). MATERIALS AND METHODS. The TSCT features of 313 surgically diagnosed GGNs from 288 patients were retrospectively reviewed. A logistic regression model was applied, and the AUC values for the model and the size and attenuation of the lesions were compared using ROC curve analysis. RESULTS. A total of 247 lung adenocarcinomas in situ (AISs) and minimally invasive adenocarcinomas (MIAs) (hereafter referred to as the AIS-MIA group) and 66 invasive adenocarcinomas (IACs) were identified. Compared with the AIS-MIA group, the IAC groups were significantly larger in size and had higher attenuation values, a higher frequency of mixed GGNs (all p < 0.001), bubblelike appearance, spiculation, pleural indentation, different locations, and a lower frequency of clear tumor-lung interface (all p < 0.05). The logistic model included size and attenuation (both p < 0.001; odds ratio [OR], 1.872 and 1.009, respectively) as well as tumor-lung interface (p = 0.001; OR, 0.242), bubblelike appearance (p < 0.05; OR, 2.205), and type of nodule. The AUC value for the logistic model was 0.847 (sensitivity, 80.3%; specificity, 81.0%) and was significantly higher than that for size or attenuation (both p < 0.01). CONCLUSION. Radiologic features could help in the differential diagnosis of a GGN that was 5-10 mm in diameter as IAC versus AIS or MIA. GGNs larger than 8.12 mm and with attenuation greater than -449.52 HU were more likely to be IAC.

Correction: Solitary ground-glass opacity nodules of stage IA pulmonary adenocarcinoma: combination of 18F-FDG PET/CT and high-resolution computed tomography features to predict invasive adenocarcinoma.

[This corrects the article DOI: 10.18632/oncotarget.15577.].

HRCT features distinguishing minimally invasive adenocarcinomas from invasive adenocarcinomas appearing as mixed ground-glass nodules

Background: Relying on the features of a selected high-resolution computed tomography (HRCT) scan to investigate the differences between invasive adenocarcinomas (IACs) and minimally invasive adenocarcinomas (MIAs) manifesting as mixed ground-glass nodules (MGGNs), has proven to be challenging. This has made identifying candidates for a sublobar or a lobectomy resection a similarly difficult task. Methods: The HRCT scans of 200 MGGNs (102 MIAs and 98 IACs) confirmed in 186 patients were reviewed retrospectively. All nodules were proven surgically and pathologically. HRCT characteristics carried by the IACs and MIAs were analyzed and compared using a univariate analysis. Variables with statistical significance were entered into a multivariate logistic regression analysis. The variables showing distinct differences in the analyses on multivariate logistic regression underwent a receiver operating characteristic (ROC) test, which was performed to ascertain the cutoff values for the qualitative variables, in addition to their diagnostic performance. Results: The statistically significant differences were found between the two groups in the computed tomography (CT) values of the ground-glass, whole nodule and solid components, in addition to the diameter of the solid component, nodule diameter, lobulated shape, air bronchogram, bubble lucency, and pleural indentation. Additionally, multivariate logistic regression and ROC analyses suggested that the IACs were significantly associated with a larger nodule (≥17 mm) and solid component diameters (≥4 mm), and higher CT values of the whole nodule [≥−408 Hounsfield units (HU)] and solid components (≥−143 HU) in the MGGNs with the air bronchogram. Conclusions: HRCT features were clearly discriminated between MIAs and IACs which had appeared as MGGNs, and can thus be useful for selecting candidates for sublobar resection or lobectomy resection.

CT characterization of different pathological types of subcentimeter pulmonary ground-glass nodular lesions.

To explore the CT characteristics of small lung nodules and improve the diagnosis of pulmonary ground-glass nodules less than 10 mm in size. We retrospectively analyzed CT images of 161 pulmonary nodules (less than 10 mm in size) with spiculation, lobulation, vacuoles, and pleural indentation and compared these images with pathological results or follow-up CT images. The relationships between the ground-glass nodules (GGNs) and blood vessels were observed. The GGN-vessel relationship was divided into four types, Type I (pass-by), Type II (pass-through), Type III (distorted/dilated), Type IV (complicated). The vessels traveling through a GGN were divided into three categories, category A (arteries), category B (veins), category C (arteries and veins). 161 GGNs were divided into three groups (benign group, pre-invasive group, and adenocarcinoma group) according to their pathological diagnosis. Significant differences in density of nodules were observed among the three different groups (p < 0.05). Significant differences in the shape (round/round-like or not) of the nodules were observed between the benign group and the pre-invasive group and between the pre-invasive group and the adenocarcinoma group (p < 0.05). No significant differences in the presence of vacuoles were observed between the benign group and the pre-invasive group or between the pre-invasive group and the adenocarcinoma group (p ＞0.05), but a significant difference was observed between the benign group and the adenocarcinoma group (p < 0.05). The differences in the vascularization of the lesions among the three groups were statistically significant (p < 0.05). No significant differences or correlations were observed between vascular categories and GGN groups (p > 0.05). For subcentimeter nodules, mixed GGNs with vacuoles, well-defined border, combined with Type III or Type IV GGN-vessel relationship may strongly suggest malignant. Previous studies mainly focused on CT diagnosis of pulmonary nodules (≤ 3 cm in diameter), but this study focused on ground-glass nodules less than 10 mm in diameter, which had not been fully studied. For subcentimeter nodules, mixed GGNs with vacuoles, well-defined border, especially the GGN-vessel relationship manifest as Type III (distorted/dilated) or Type IV (complicated) may strongly suggest malignant.

HRCT features distinguishing minimally invasive adenocarcinomas from invasive adenocarcinomas appearing as mixed ground-glass nodules

Background: Relying on the features of a selected high-resolution computed tomography (HRCT) scan to investigate the differences between invasive adenocarcinomas (IACs) and minimally invasive adenocarcinomas (MIAs) manifesting as mixed ground-glass nodules (MGGNs), has proven to be challenging. This has made identifying candidates for a sublobar or a lobectomy resection a similarly difficult task.

Multislice spiral CT findings and its diagnostic value of mixed glandular glass nodular adenocarcinoma

Objective To analyze the characteristics of mixed ground glass nodular adenocarcinoma in multi-slice spiral CT(MSCT) and its diagnostic value. Methods This study was prospective study, 120 patients with mixed glass nodules lung adenocarcinoma were classified as lung adenocarcinoma in the People's Hospital of Xinzhou from January 2014 to December 2016.178 cases of mixed glass nodular pneumonitis were classified as pneumonia.The MSCT signs were compared between the two groups.The imaging features of medullographic nodules with different pathologic types of lung adenocarcinoma by grouping of patients with lung adenocarcinoma were compared. Results In the lung adenocarcinoma group, the dizzy uneven thickness rate(61.67%), leaf rate(60.00%), clear boundary rate(80.83%), blood vessels, gather tax rate(64.17%), pleural indentation rate(61.67%) were significantly higher than those in the pneumonia group(35.96%, 35.39%, 41.01%, 44.94%, 41.57%, χ2=8.69, 12.47, 33.64, 7.62, 7.97, all P<0.01). The mixed grinding glass nodules of IAC, MIA and MIS in size, number, shape, position and density were significantly different(all P<0.05). The IAC type mixed grinding glass nodules was irregular single nodules(volume generally≥5 mm), common deviation centricity growth, and with blood vessels.The AIS type mixed grinding glass nodule was single nodule(volume generally≥5 mm), formed a polygon or dotted, common growth of centricity, vascular density was close to the same level.The volume of the MIA type mixed grinding hyaline nodules was most <5 mm, common to multiple, with oval or round most, common to deviate from the centricity growth, lower density than plane tree blood vessels. Conclusion MSCT is helpful in the differential diagnosis of mixed ground glass nodules of lung adenocarcinoma and mixed ground glass nodular inflammatory lesions, and pathological types have leaded to the identification of mixed ground glass nodules of lung adenocarcinoma MSCT, which has higher application value. Key words: Lung neoplasms; Adenocarcinoma; Tomography, spiral computed; Diagnosis