Proportion Of Solid Component Research Articles

Preoperative markers for identifying CT ≤2 cm solid nodules of lung adenocarcinoma based on image deep learning.

The solid pattern is a highly malignant subtype of lung adenocarcinoma. In the current era of transitioning from lobectomy to sublobar resection for the surgical treatment of small lung cancers, preoperative identification of this subtype is highly important for patient surgical approach selection and long-term prognosis. A total of 1489 patients with clinical stage IA1-2 primary lung adenocarcinoma were enrolled. Based on patient clinical characteristics and lung imaging features obtained via deep learning, highly correlated diagnostic factors were identified through LASSO regression and decision tree analysis. Subsequently, a logistic model and nomogram were constructed. A restricted cubic spline (RCS) was used to calculate the optimal inflection point of quantitative data and the differences between the groups. The three-dimensional proportion of solid component (PSC), sex, and smoking status was identified as being highly correlated diagnostic factors for solid predominant adenocarcinoma. The logistic model had good prediction efficiency, and the area under the ROC curve was 0.85. Decision curve analysis demonstrated that the application of diagnostic factors can improve patient outcomes. RCS analysis indicated that the proportion of solid adenocarcinomas increased by 4.6 times when the PSC was ≥72%. A PSC of 72% is a good cutoff point. The preoperative diagnosis of solid-pattern adenocarcinoma can be confirmed by typical imaging features and clinical characteristics, assisting the thoracic surgeon in developing a more precise surgical plan.

Development and validation of a clinical decision tool for preoperative micropapillary and solid pattern lung adenocarcinoma of CT≤2cm.

Micropapillary (MP) and solid(S) pattern adenocarcinoma are highly malignant subtypes of lung adenocarcinoma. In today's era of increasingly conservative surgery for small lung cancer, effective preoperative identification of these subtypes is greatly important for surgical planning and long term survival of patients. For this retrospective study, the presence of MP and/or S was evaluated in 2167 consecutive patients who underwent surgical resection for clinical stage IA1-2 lung adenocarcinoma. MP and/or S pattern-positive patients and negative-pattern patients were matched at a ratio of 1:3. The Lasso regression model was used for data dimension reduction and imaging signature building. Multivariate logistic regression was used to establish the predictive model, presented as an imaging nomogram. The performance of the nomogram was assessed based on calibration, identification, and clinical usefulness, and internal and external validation of the model was conducted. The proportion of solid components (PSC), Sphericity, entropy, Shape, bronchial honeycomb, nodule shape, sex, and smoking were independent factors in the prediction model of MP and/or S lung adenocarcinoma. The model showed good discrimination with an area under the ROC curve of 0.85. DCA demonstrated that the model could achieve good benefits for patients. RCS analysis suggested a significant increase in the proportion of MP and/or S from 11% to 48% when the PSC value was 68%. Small MP and/or S adenocarcinoma can be effectively identified preoperatively by their typical 3D and 2D imaging features.

Value of CT Quantitative Parameters in Prediction of Pathological Types of Lung Ground Glass Nodules

The pathological types of lung ground glass nodules (GGNs) show great significance to the clinical treatment. This study was aimed to predict pathological types of GGNs based on computed tomography (CT) quantitative parameters. 389 GGNs confirmed by postoperative pathology were selected, including 138 cases of precursor glandular lesions [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)], 109 cases of microinvasive adenocarcinoma (MIA) and 142 cases of invasive adenocarcinoma (IAC). The morphological characteristics of nodules were evaluated subjectively by radiologist, as well as artificial intelligence (AI). In the subjective CT signs, the maximum diameter of nodule and the frequency of spiculation, lobulation and pleural traction increased from AAH+AIS, MIA to IAC. In the AI quantitative parameters, parameters related to size and CT value, proportion of solid component, energy and entropy increased from AAH+AIS, MIA to IAC. There was no significant difference between AI quantitative parameters and the subjective CT signs for distinguishing the pathological types of GGNs. AI quantitative parameters were valuable in distinguishing the pathological types of GGNs.

Management and outcome of adenoid cystic carcinoma of the major salivary glands: the 22-year experience of a single institution

Background Prognostic factors and survival rate are difficult to determine for adenoid cystic carcinoma(AdCC) of salivary glands. Aims/objectives To clarify the clinical characteristics of AdCC and examine factors associated with recurrence and prognosis by histopathological grade classification. Materials and methods Twenty-five patients with AdCC of the parotid gland and 10 patients with AdCC of the submandibular gland were included. We classified AdCC histopathologically by the proportion of solid components. Clinical features, fine-needle aspiration cytology (FNAC), and patient outcomes were examined according to grade. Factors associated with local recurrence and distant metastases were examined. Results Age was significantly higher in the grade III group than in the grade I group. The grade III group had significantly higher proportions of patients with cN+, pN+, and perineural invasion. In FNAC, lower-grade groups showed higher rates of correct histopathological type. Five-year disease-specific survival and disease-free survival rates were significantly lower in the grade III than in the grade I. Distant metastases were more common among patients with high-stage and perineural invasion. Conclusions Five-year survival is significantly worse in patients with grade III.

Efficacy of Lauromacrogol Injection for Ablation of Benign Predominantly Cystic Thyroid Nodules and Related Factors: A Prospective Study.

ObjectiveTo prospectively evaluate the efficacy of lauromacrogol injection for ablation (LIA) of benign predominantly cystic thyroid nodules and its related factors.Materials and MethodsA total of 142 benign predominantly cystic thyroid nodules (median volume, 12.5 mL; range, 0.4–156 mL) in 137 patients (male:female sex ratio, 36:101; mean age ± standard deviation [SD], 49 ± 13 years) were treated with LIA after being confirmed as benign via cytology. The volume reduction rate (VRR) of the nodules and cosmetic score were evaluated during follow-up at 1, 3, and 6 months after treatment and every 6 months thereafter. A VRR of ≥ 50% at the 12-month follow-up was considered to indicate effective treatment. The associations between the clinical factors and nodular ultrasound features, including the initial nodule volume, proportion of solid components, vascularity grade and ineffective treatment (VRR of < 50% at the 12-month follow-up), and regrowth were analyzed.ResultsAll patients completed follow-up for at least 12 months. The average ± SD follow-up period was 32 ± 11 months (range, 12–54 months). The effective treatment rate was 73.2% (104/142), while the regrowth rate was 12.0% (17/142) at the last follow-up. Grade 2–3 intranodular vascularity in the solid components of the nodules was the only independent factor associated with ineffective treatment, with an odds ratio (reference category, grade 0–1) of 3.054 (95% confidence interval, 1.148–8.127) (p = 0.025).ConclusionLIA is an effective treatment for predominantly cystic thyroid nodules. Grade 2–3 intranodular vascularity in the solid components of nodules is the only independent risk factor for ineffective LIA.

Guidelines for the Investigation and Management of Ground Glass Nodules.

The clinical significance of ground-glass nodules (GGNs) has been investigated in extensive clinical research for many years. The natural history of GGNs is known to be closely related to their size, proportion of solid components, and size progression over time. Based on these data, several guidelines for GGN management have been published worldwide. The indications for nonsurgical biopsy or surgical resection of GGNs are as follows: pure GGNs between 5 and 10 mm in size if they increase in size or show development of a solid component at follow-up, pure GGNs >10–15 mm that remain stable but persistent, part-solid nodules >8 mm persisting at follow-up, or part-solid nodules with a solid component >6 mm at follow-up. Newly updated data considering geographical or racial factors and recent developments in surgical techniques may improve the surgical indications for GGNs in the near future.

Value of CT Features on Differential Diagnosis of Pulmonary Subsolid Nodules and Degree of invasion Prediction in Pulmonary Adenocarcinoma

背景与目的亚实性肺结节为肺原发腺癌的常见计算机体层成像（computed tomography, CT）表现，依据其CT影像特征预测病理分型对确定临床治疗策略具有临床价值。本研究根据病理分类，回顾性分析良性、不典型腺瘤样增生（atypical adenomatous hyperplasia, AAH）/原位腺癌（adenocarcinoma in situ, AIS）/微侵袭性腺癌（minimally invasive adenocarcinoma, MIA）、侵袭性腺癌三组亚实性肺结节的CT征象，评估其在良恶性鉴别及恶性侵袭程度判别中的价值。方法回顾性分析106例经手术切除亚实性结节的CT征象。依据手术病理分为良性和恶性组，恶性组根据侵袭程度分为无/微侵袭组（AAH/AIS/MIA）、侵袭性腺癌组，测量结节大小、实性成分比例、瘤肺界面、形状、边缘、胸膜牵拉征、空气支气管征、结节内血管异常等CT征象。根据单因素分析（χ2检验、非参数检验Mann-Whitney U检验）结果筛选有统计学差异的变量，纳入Logistic回归多因素分析。结果Logistic回归分析显示清晰的瘤肺界面、空气支气管征以及结节内血管异常是恶性结节的重要预测指标，风险比分别为38.1（95%CI: 5.0-287.7; P < 0.01）、7.9（95%CI: 1.3-49.3; P=0.03）、7.2（95%CI: 1.4-37.0; P=0.02）。更大的实性成分所占比例是侵袭性腺癌与AAH/AIS/MIA组鉴别的重要指标，其风险比分别为1.04（95%CI: 1.01-1.06, P=0.01）。结论亚实性结节中出现清晰的瘤肺界面、空气支气管征、结节内血管异常提示其恶性概率增加。恶性结节中实性成分所占比例越大预示着侵袭性更高。

HRCT morphological characteristics distinguishing minimally invasive pulmonary adenocarcinoma from invasive pulmonary adenocarcinoma appearing as subsolid nodules with a diameter of ≤3 cm

To differentiate retrospectively the morphological characteristics at high-resolution computed tomography (CT) between minimally invasive pulmonary adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IAC) appearing as subsolid nodules (SNs) with a diameter of ≤3cm and to provide information to help operative decision-making. The patient notes of 260 patients with SNs of ≤3cm in diameter (98 with MIA and 162 with IAC) confirmed at surgery and histopathology from September 2008 to June 2012 were reviewed retrospectively at the Department of Radiology, Weifang Respiratory Disease Hospital. Sixty-seven patients had pure ground-glass nodules (PGGNs) and 193 had mixed ground-glass nodules (MGGNs). Patients were grouped according to the final pathology: minimally invasive MIA and IAC. The HRCT characteristics were compared between the two groups. There were statistically significant differences in the pattern, shape, diameter of solid components, proportion of solid components, CT radiodensity values of the ground-glass and solid components, borders, margins, air bronchograms, microvascular signs, and pleural indentations of the nodules between the two groups (all p<0.05). Multivariate and receiver operating characteristic (ROC) analyses indicated significant predictors of MIAs were as follows: small lesion diameter (≤14.7mm), solid components ≤7mm, <50% of solid components, low CT radiodensity values of the solid components (≤-107HU), air bronchograms in the ground-glass opacity components, and microvascular signs. The morphological characteristics at high-resolution CT can be used to differentiate between MIAs and IACs appearing as SNs with a diameter of ≤3cm and provide information to help operative decision-making.

Squamous Cell Carcinoma Arising in Ovarian Teratoma: A Diagnostic Conundrum.

Sir, Germ cell tumors (GCT) comprise 20–30 % of the ovarian tumors [1]. Mature cystic teratoma (MCT) is the most common benign GCT comprising 10–20 % of all tumors in women of reproductive age group. The cancers in the ovary are most commonly of epithelial origin with serous cystadenocarcinoma and mucinous cystadenocarcinoma comprising the majority of these lesions. Malignant germ cell tumors are less common and malignant transformation of MCT is rare. Most common malignancy to occur in the setting of MCT is SCC, though other malignancies including sarcomas, melanomas and carcinoid have been highlighted in case reports [2]. The other differentials of SCC in the ovary to the considered are of de novo origin, metastases and transformation in endometriotic foci. De novo origin of SCC in an ovary is extremely rare [3]. We recently reviewed two cases of SCC in the background ofMCT. Both these middle aged females presented with a few months history of vague lower abdominal pain and distension. Evaluation revealed unilateral ovarian masses. CA-125 levels were normal. Pre-operative diagnosis of malignant epithelial ovarian neoplasm was considered in both cases and staging laparotomy was performed. Histopathology, however, revealed a diagnosis of MCT with malignant transformation based on the findings of solid cystic tumor showing areas of calcification, fat and hair [Fig. 1]. The clinical features, imaging findings and per-operative findings are no different from other ovarian malignancies and the diagnosis is established by histopathology. The importance of diagnosing this entity preoperatively lies in the prognosis that has been found to be uniformly poor even after several forms of adjuvant treatment. These tumors usually present in the post-menopausal women with the age range of 45–65 years, though cases of these tumors in young women have been documented in literature [4]. Patients present with non-specific complaints of vague abdominal pain, nausea, vomiting, constipation, vaginal bleeding, abdominal enlargement and weight loss. Examination findings including the abdominal and per-vaginal examination are non-specific and reveal a pelvic or abdomino-pelvic mass. Imaging in these cases is not specific and confirms the presence of a complex pelvic mass and provides an insight into the disease extent and the presence of metastases that is critical before the surgical exploration is undertaken. However, certain clinical, imaging and biochemical markers for suspecting these cases have been suggested by various researchers. These include older age at presentation, large size (>10 cm at presentation) and proportion of solid component [5]. The most important differential diagnosis to be considered is the metastasis, particularly from cervical carcinoma, by both clinical examination and at histopathology [6]. S. Sharma (*) :N. Gupta :A. Rajwanshi Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India e-mail: drsaniya.sharma@gmail.com

Multi-slice spiral CT study of the relationships between pulmonary ground glass nodules and bronchi

Objective To investigate the relationships and types between pulmonary ground glass nodules (GGN) and bronchi and explore its value in diagnosis. Methods One hundred and twenty-seven GGN lesions were reviewed after (include 68 lesions of pulmonary adenocarcinoma,15 lesions were preinvasive lesions and 44 benign lesions) with MSCT.It was observed that lesion distribution,content of solid components and relationships between GGNs and bronchi both in axial images and multi-planar reformation (MPR) images.The lesions were divided to three types according to the ratio of ground glass opacity.Type A was pure GGN.Type B was mixed GGN which contain 76% to 99% of ground glass opacity content.Type C was mixed GGN which contain 50% to 75% ground glass opacity content.The relationships between GGN and bronchi were divided into five types.Type I: The bronchi were“cutoff”in the solid part of GGN.TypeⅡ: The bronchi were distortion and extension in the solid parts of GGN.TypeⅢ: The bronchi were distortion and extension in the GGO parts of GGN.TypeⅣ:The bronchi were normal course in the GGO parts of GGN.TypeⅤ: The bronchi were circumvent GGN lesions.SPSS16.0 software was used for statistical analysis,measurement data using independent t test,measurement data using Pearsonχ2test; when there was a theory number<1 or income probability close to test level,then using Fisher's exact test,Spearman rank correlation were used for analyze the content of ground glass in GGN and its relationship with the bronchial type.It was considered to be statistically significant whenPvalue less than 0.05. Results (1) There was no significant statistic significance about lesion's location among 3 groups.The P value of group of invasive adenocarcinoma,preinvasive group and benign group were 1.000,1.000,0.817 respectively. (2) The incidence of having relationships between GGN and bronchi were significant statistic significance among 3 groups (χ2=36.32,P<0.01). (3) There were 14 cases of group of invasive adenocarcinoma,0 case of preinvasive group,0 case of benign group when the relationship between GGN and bronchi were typeⅠ.There were 25 cases of group of invasive adenocarcinoma,0 case of preinvasive group,3 cases of benign group when the relationship between GGN and bronchi were typeⅡ.There were 10 cases of group of invasive adenocarcinoma,0 case of preinvasive group,2 case of benign group when the relationship between GGN and bronchi were typeⅢ.There were 8 cases of group of invasive adenocarcinoma,1 case of preinvasive group,12 cases of benign group when the relationship between GGN and bronchi were typeⅣ.There was 1 case of group of invasive adenocarcinoma,0 case of preinvasive group,9 case of benign group when the relationship between GGN and bronchi were typeⅤ.There was significant statistic significance among 3 groups of relationships between GGN bronchi (P<0.01).The relationships between GGN and bronchi of adenocarcinomas most manifest as type I and typeⅡ.There were no relationships with bronchi of most preinvasive lesions.The relationships between GGN and bronchi of benign lesions most manifest as typeⅣand typeⅤ. (4) It was divided into 3 categories according to different proportion of solid components in CT images.There were 17,19 and 49 cases in Category A,B,C respectively,and the difference of GGO percentage among different categories with the relationships between GGN and bronchi were correlation statistic significance (r=-0.546,P<0.01). Conclusions There were different manifestations of relationships between GGN and bronchi in different kind of lesions.It may help to differential diagnosis through comprehensive evaluate the content of GGO area of lesions. Key words: Bronchi; Multiple pulmonary nodules; Tomography,X-ray computed

Differentiation of Benign and Malignant Solid Pseudopapillary Neoplasms of the Pancreas

The aim of this study was to investigate differential imaging features between benign and malignant solid pseudopapillary neoplasms (SPN) of the pancreas on computed tomographic and magnetic resonance imagings. Between January 2001 and January 2007, we identified 30 patients with confirmed SPN by surgery. The computed tomographic and magnetic resonance images were reviewed by 3 radiologists in consensus. Each tumor was analyzed for the following categories: location of tumor, tumor margin, proportion of solid component, morphology of capsule, growth pattern, calcification, and presence of upstream pancreatic ductal dilatation. Benign SPN usually had oval/round or smoothly lobulated margins, and malignant SPN more commonly had focal lobulated margins (P = 0.027). Presence of complete encapsulation was more frequently seen in benign SPN, whereas focal discontinuity of capsule was more commonly seen in malignant SPN (P = 0.005). There was no statistical difference between benign and malignant tumors in other imaging findings. A focal lobulated margin and a focal discontinuity of the capsule may suggest malignant SPN, whereas a round or smoothly lobulated margin and a complete encapsulation were more commonly seen in benign SPN.