Pure Ground-glass Nodules Research Articles

Pure and Part-Solid Pulmonary Ground-Glass Nodules: Measurement Variability of Volume and Mass in Nodules with a Solid Portion Less than or Equal to 5 mm

To prospectively assess and compare the measurement variability of volume and mass for pure and part-solid ground-glass nodules (GGNs) with solid portions less than or equal to 5 mm by using a commercially available volumetric software program. This prospective study was approved by the institutional review board. Written informed consent was obtained. From November 2011 to June 2012, 73 patients (26 men and 47 women) with 94 GGNs (>5 mm and <20 mm; 72 pure and 22 part-solid GGNs) were prospectively enrolled and underwent two consecutive computed tomographic (CT) examinations. Both the volume and mass of GGNs were measured with volumetric software by two radiologists. Intraobserver, interobserver, and interscan variability were analyzed and compared by using the Bland-Altman method and coefficients of variation. The influence of the solid portion of GGNs and GGN size on interscan variability was investigated with multiple linear regression analysis and analysis of variance. Nodule segmentation was successful in 420 of 438 (95.9%) segmentations. As for volume measurement, interscan variability ranged from -17.3% to 18.5%, while intraobserver and interobserver variability ranged from -7.6% to 8.5% and from -11.7% to 18.1%, respectively. Interscan variability in mass measurement ranged from -17.7% to 18.6%, while intraobserver and interobserver variability ranged from -8.4% to 9.4% and from -17.5% to 11.8%, respectively. In the coefficient of variation comparison, there were no significant differences in volume and mass measurements for intraobserver, interscan, and interobserver variability. Measurement variability of volume and mass was not significantly influenced by the presence of a solid portion, solid portion size, or GGN size. Mass measurement of GGNs showed measurement variability from -17.7% to 18.6% and may be a useful method in the follow-up of GGNs with solid portions less than or equal to 5 mm.

F-054TUMOUR STANDARDIZED UPTAKE VALUE ON POSITRON EMISSION TOMOGRAPHY IS A NOVEL PREDICTOR OF ADENOCARCINOMA IN SITU FOR C-STAGE IA LUNG CANCER PATIENTS WITH PART-SOLID NODULE ON THIN-SECTION COMPUTED TOMOGRAPHY SCAN

Adenocarcinoma in situ (AIS), which was defined as having a pathologically non-invasive nature by the new IASLC/ATS/ERS classification, might be included in patients that showed part-solid nodule on thin-section CT. Between 2008 and 2011, 556 c-stage IA lung cancer patients underwent pulmonary resection. The findings obtained by preoperative thin-section CT were reviewed for all patients and categorized as pure ground-glass nodule (GGN), part-solid, or pure-solid based on the findings on thin-section CT, i.e. consolidation/tumour ratio (CTR). Part-solid nodule was defined as a tumour with 0 < CTR < 1.0, which indicated focal nodular opacity containing both solid and GGN components. All patients were evaluated by positron emission tomography (PET) and the maximum standardized uptake value (SUVmax) was recorded. Several clinicopathological features were investigated to identify predictors of AIS using multivariate analyses. 112 c-stage IA lung cancer patients showed a part-solid appearance on thin-section CT. Among them, AIS was found in 10 (23.8%) of 42 patients with 0 < CTR ≤ 0.5 in contrast to 3 (4.3%) of 70 patients with 0.5 < CTR < 1.0. According to multivariate analyses, SUVmax and CTR were significant predictors of AIS in patients with part-solid nodule (P = 0.0421, 0.0221). Mean SUVmax of the patients with AIS was 0.57 (0-1.6). Moreover, in the subgroup of part-solid nodule with SUVmax ≤ 1.0 and CTR ≤ 0.40, which were shown as cutoff values of predicting AIS based on the result of receiver operating characteristics curve, 6 (40%) of 15 patients with these criteria showed pathologic non-invasive nature even in the patients with part-solid nodule. Among clinical stage IA adenocarcinoma with part-solid nodule on thin-section CT scan, extremely low level of SUVmax could correspond to a radiologically pure GGO and pathologically AIS. Preoperative tumour SUVmax on PET could yield important information for predicting the non-invasiveness in patients with part-solid nodule. All authors have declared no conflicts of interest.

BTOG-117WHAT IS THE APPROPRIATE OPERATIVE STRATEGY FOR RADIOLOGICALLY SOLID TUMOURS IN SUBCENTIMETRE LUNG CANCER PATIENTS?

OBJECTIVES: Solid lung cancers, even subcentimetre lesions, are considered to be invasive pathologically. However, the clinicopathological features and appropriate operative strategies in patients with these small lesions are still controversial, especially for those with a radiologically solid appearance. METHODS: Between 2004 and 2011, 135 patients underwent pulmonary resection for subcentimetre lung cancer with clinical-N0 (c-N0) status. The findings of preoperative thin-section computed tomography (CT) were reviewed, and subcentimetre lung cancer was divided into three groups: pure ground-glass nodule, part-solid and pure-solid lesions. RESULTS: Among the 135 subcentimetre lung cancer patients with c-N0 status, 71 showed a solid appearance on thin-section CT scan. Furthermore, pathological nodal examinations were performed in 49 patients, and nodal involvement was found pathologically in 6 (12.2%) patients. All of them had pure-solid tumours (P= 0.0010). Among the patients with solid subcentimetre lung cancers, the maximum standardized uptake value (SUVmax) was the only significant predictor of nodal involvement by a multivariate analysis (P= 0.0205). With regard to the surgical outcomes, the overall 5-year survival and disease-free survival rates were 100 and 97.8% for partsolid lesions, and 87.3 and 74.8% for pure-solid lesions, respectively. Moreover, there was a significant difference in disease-free survival between a high SUVmax group (60.0%) and a low SUVmax group (94.9%) (P= 0.0013).

The value of chest tomosynthesis in locating a ground glass nodule (GGN) during endobronchial ultrasonography with a guide sheath: a case report.

A 74-year-old man was referred to our department for work-up of a pure ground glass nodule (GGN) on computed tomography (CT). He was suspected to have lung cancer by CT scan, but no lesion was visible on chest X-ray. Chest tomosynthesis was performed before bronchoscopy, showing a clear GGN. We could not detect a tumor signal on endobronchial ultrasonography so we relied on the chest tomosynthesis image as a guide during transbronchial biopsy. The diagnosis of adenocarcinoma was confirmed on histopathology. In this case, transbronchial biopsy under the guidance of chest tomosynthesis was useful for the diagnosis of GGN.

Invasive Pulmonary Adenocarcinomas versus Preinvasive Lesions Appearing as Ground-Glass Nodules: Differentiation by Using CT Features

To retrospectively investigate the differentiating computed tomographic (CT) features between invasive pulmonary adenocarcinoma (IPA) and preinvasive lesions appearing as ground-glass nodules (GGNs) in 253 patients. This study was approved by the institutional review board. From January 2005 to October 2011, 272 GGNs were pathologically confirmed (179 IPAs and 93 preinvasive lesions) in 253 patients and were included in this study. There were 64 pure GGNs and 208 part-solid GGNs. Preinvasive lesions consisted of 21 atypical adenomatous hyperplasias and 72 adenocarcinomas in situ. To identify the differentiating CT features between IPAs and preinvasive lesions and to evaluate their differentiating accuracy, logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed, respectively. In pure GGNs, preinvasive lesions were significantly smaller and more frequently nonlobulated than IPAs (P < .05). Multivariate analysis revealed that lesion size was the single significant differentiator of preinvasive lesions from IPAs (P = .029). The optimal cut-off size for preinvasive lesions was less than 10 mm (sensitivity, 53.33%; specificity, 100%). In part-solid GGNs, there were significant differences in lesion size, solid portion size, solid proportion, margin, border, and pleural retraction between IPAs and preinvasive lesions (P < .05). Multivariate analysis revealed that smaller lesion size, smaller solid proportion, nonlobulated border, and nonspiculated margin were significant differentiators of preinvasive lesions (P < .05), with excellent differentiating accuracy (area under ROC curve, 0.905). In pure GGNs, a lesion size of less than 10 mm can be a very specific discriminator of preinvasive lesions from IPAs. In part-solid GGNs, preinvasive lesions can be accurately distinguished from IPAs by the smaller lesion size, smaller solid proportion, nonlobulated border, and nonspiculated margin.

Incidental, subsolid pulmonary nodules at CT: etiology and management

Pulmonary nodules, both solid and subsolid, are common incidental findings on computed tomography (CT) studies. Subsolid nodules (SSNs) may be further classified as either pure ground-glass nodules or part-solid nodules. The differential diagnosis for an SSN is broad, including infection, organizing pneumonia, inflammation, hemorrhage, focal fibrosis, and neoplasm. Adenocarcinomas of the lung are currently the most common type of lung cancer, representing 30–35% of all primary lung tumors, and the subtype of bronchioloalveolar cell carcinoma (BAC) commonly presents as an SSN. In 2011, a new classification system for lung adenocarcinomas was proposed by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society. An important feature of the new system is the relinquishment of the term BAC in favor of more specific histologic subtypes. It has been reported that these subtypes are associated with characteristic CT findings. This article reviews the new classification system of lung adenocarcinomas, discusses and illustrates the associated CT findings, and outlines the current recommendations for further diagnosis, treatment, and follow-up of SSNs based on computed tomography findings.

低悪性度と考えにくいすりガラス結節影型肺腺癌の一例

低悪性度と考えにくいすりガラス結節影型肺腺癌の一例

Long-Term Surveillance of Ground-Glass Nodules: Evidence from the MILD Trial

The purpose of this study was to evaluate the natural evolution of ground-glass nodules (GGNs) in the Multicentric Italian Lung Detection (MILD) trial, which adopted a nonsurgical approach to this subset of lesions. From September 2005 to August 2007, 56 consecutive MILD participants with 76 GGNs were identified from 1866 individuals who underwent baseline low-dose computed tomography. The features of GGNs were assessed and compared with the corresponding repeat low-dose computed tomographies after a mean time of 50.26 ± 7.3 months. The GGNs were classified as pure (pGGN) or part-solid (psGGN) GGNs. The average of the maximum and the minimum diameters for both pGGNs and psGGNs and the maximum diameter of the solid portion of psGGNs were manually measured. At follow-up, GGNs were classified as follows: resolved, decreased, stable, or progressed (according to three defined growth patterns). A total of 15 of 48 pGGNs (31.3%) resolved, 4 of 48 (8.3%) decreased in size, 21 of 48 (43.8%) remained stable, and 8 of 48 (16.7%) progressed. Among the psGGNs with a solid component smaller than 5 mm, 3 of 26 (11.5%) resolved, 11 of 26 (42.3%) remained stable, and 12 of 26 (46.2%) progressed. One of the two psGGNs with a solid component larger than 5 mm remained stable, and the other decreased in size. Four lung cancers were detected among the GGN subjects, but only one arose from a psGGN, and was resected in stage Ia. The progression rate of the GGNs toward clinically relevant disease was extremely low in the MILD trial and supports an active surveillance attitude.

Subsolid pulmonary nodules

Given the higher rate of malignancy of subsolid pulmonary nodules and the considerably lower growth rate of ground-glass nodules (GGNs), dedicated standardized guidelines for management of these nodules have been proposed, including long-term low-dose computed tomography (CT) follow-up (≥3 years). Physicians must be familiar with the strategic management of subsolid pulmonary nodules, and should be able to identify imaging features that suggest invasive adenocarcinoma requiring a more aggressive management. Low-dose CT screening studies for early detection of lung cancer have increased our knowledge of pulmonary nodules, and in particular our understanding of the strong although imperfect correlation of the subsolid pulmonary nodules, including pure GGNs and part-solid nodules, with the spectrum of preinvasive to invasive lung adenocarcinoma. Serial CT imaging has shown stepwise progression in a subset of these nodules, characterized by increase in size and density of pure GGNs and development of a solid component, the latter usually indicating invasive adenocarcinoma. There is close correlation between the CT features of subsolid nodules (SSNs) and the spectrum of lung adenocarcinoma. Standardized guidelines are suggested for management of SSNs.

Effect of Lung Volume and Gravity on the Attenuation and Size of a Pure Ground-Glass Nodule

Detecting potentially malignant changes in a pure ground-glass nodule (GGN) is challenging. The development of a solid component is a known sign, which may help in differentiating benign from malignant GGN. We report the case of a 58-year-old man presenting with a pure GGN in the posterior segment of the right lower lobe. Follow-up computed tomographic scan after 1 year showed marked increase in attenuation (from -319 HU to +27 HU), whereas the average size of the nodule decreased (from 7 to 4.7 mm). On a computed tomographic scan in the prone position the nodule seemed larger (7.8 mm) and appeared as a pure GGN (-406 HU). Such changes were attributed to the reduction of lung volume and gravity.

CT-Guided Percutaneous Transthoracic Localization of Pulmonary Nodules Prior to Video-Assisted Thoracoscopic Surgery Using Barium Suspension

ObjectiveTo describe our initial experience with CT-guided percutaneous barium marking for the localization of small pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS).Materials and MethodsFrom October 2010 to April 2011, 10 consecutive patients (4 men and 6 women; mean age, 60 years) underwent CT-guided percutaneous barium marking for the localization of 10 small pulmonary nodules (mean size, 7.6 mm; range, 3-14 mm): 6 pure ground-glass nodules, 3 part-solid nodules, and 1 solid nodule. A 140% barium sulfate suspension (mean amount, 0.2 mL; range, 0.15-0.25 mL) was injected around the nodules with a 21-gauge needle. The technical details, surgical findings and pathologic features associated with barium localizations were evaluated.ResultsAll nodules were marked within 3 mm (mean distance, 1.1 mm; range, 0-3 mm) from the barium ball (mean diameter, 9.6 mm; range, 8-16 mm) formed by the injected barium suspension. Pneumothorax occurred in two cases, for which one needed aspiration. However, there were no other complications. All barium balls were palpable during VATS and visible on intraoperative fluoroscopy, and were completely resected. Both the whitish barium balls and target nodules were identifiable in the frozen specimens. Pathology revealed one invasive adenocarcinoma, five adenocarcinoma-in-situ, two atypical adenomatous hyperplasias, and two benign lesions. In all cases, there were acute inflammations around the barium balls which did not hamper the histological diagnosis of the nodules.ConclusionCT-guided percutaneous barium marking can be an effective, convenient and safe pre-operative localization procedure prior to VATS, enabling accurate resection and diagnosis of small or faint pulmonary nodules.

Long term follow-up for small pure ground-glass nodules: implications of determining an optimum follow-up period and high-resolution CT findings to predict the growth of nodules

To identify the optimum follow-up period for pure ground-glass nodules (GGN) measuring less than 15 mm in diameter, and to evaluate whether the initial HRCT findings can be used as predictors for the progression of pure GGN. A total of 150 pure GGNs present in 111 patients were evaluated. The series of HRCT images for each GGN at the time of the initial detection, 2 years after detection, and at the final follow-up were evaluated. The HRCT findings of GGN were compared between the "increasing nodule" and "non-increasing nodule" groups. Most (87.3%) pure GGN did not increase whereas some nodules (12.7%) eventually increased after long-term follow-up (mean 66.0 ± 25.0 months). Six (31.6%) out of the 19 increasing nodules were regarded as stable at the 2 year follow-up examination. Some morphological findings on initial HRCT, including a size greater than 10 mm (p = 0.001), lobulated margins (p = 0.015), and a bubble-like appearance (p = 0.002), were significantly associated with the growth of pure GGNs. More than 2 years of follow-up are necessary to detect the growth of pure GGNs. Some characteristic findings indicated a high likelihood of future growth of the GGN.

Persistent Pure Ground-Glass Nodules in the Lung: Interscan Variability of Semiautomated Volume and Attenuation Measurements

The purpose of this article is to assess the interscan variability of semiautomated volume and attenuation measurements for pulmonary persistent pure ground-glass nodules. Thirty pure ground-glass nodules in 25 patients referred for known pure ground-glass nodules were evaluated with two consecutive unenhanced chest CT examinations performed within 10 minutes. For the second limited scan, patients were asked to first get off and then get back on the table to simulate a follow-up examination. CT images were reconstructed using two different algorithms (sharp, B60F; medium sharp, B50F). Two chest radiologists independently measured the volumes and attenuations of pure ground-glass nodules, twice on the first CT scan and once on the second CT scan, using commercial software. Interscan variability was measured using the Bland-Altman method. Nodule segmentation was successful in 98.3% (177/180) and 97.8% (176/180) of measurements with B60F and B50F, respectively. With respect to volume measurements, interscan variability for reviewer 1 was -17.7% to 18.3% with B60F and -18.8% to 15.7% with B50F; interscan variability for reviewer 2 was -18.6% to 18.9% with B60F and -15.6% to 17.2% with B50F. With respect to attenuation measurements, interscan variability for reviewer 1 was -7.2% to 7.9% with B60F and -7.9% to 9.4% with B50F; interscan variability for reviewer 2 was -7.7% to 8.1% with B60F and -8.5% to 9.9% for B50F. Variations in volume and attenuation measurements of persistent pure ground-glass nodules using commercial software were reasonably small, allowing the detection of clinically relevant growth.

Ground-glass nodules found in two patients with malignant melanomas: different growth rate and different histology

We report two pathologically proven pure ground-glass nodules found in two patients with malignant melanoma. In one patient, the nodule showed no growth over 2 months and was found to be bronchioloalveolar carcinoma, whereas in the other patient, a nodule grew rapidly over 3 months and was histologically confirmed to be metastatic melanoma.

Differentiation between malignancy and inflammation in pulmonary ground-glass nodules: The feasibility of integrated 18F-FDG PET/CT

Background 18F-FDG PET/CT has been used to differentiate malignant solid lung nodules from benign nodules. We assess the feasibility of integrated 18F-FDG PET/CT for the differentiation of malignancy from inflammation manifested as ground-glass nodules (GGNs) on chest CT. Methods A total of 68 GGNs in 45 patients (M:F = 24:21; mean age, 61) fulfilled the following criteria: (a) nodules composed of ≥50% ground-glass opacity, (b) patients who underwent integrated PET/CT within 1 week following dedicated chest CT, (c) definitive diagnosis determined by pathological specimen or at least 9 months of follow-up, and (d) lesions ≥10 mm in diameter. 36 malignant GGNs were pathologically proved as adenocarcinoma ( n = 20), bronchioloalveolar carcinoma ( n = 11), low-grade lymphoma ( n = 3), metastatic mucinous adenocarcinoma ( n = 1) and unknown low-grade malignancy ( n = 1). 32 inflammatory GGNs were confirmed as pneumonic infiltration as they had disappeared on follow-up CT and were associated with compatible clinical features ( n = 26) or as chronic inflammation with fibrosis by VATS biopsy ( n = 6). Using CT density histogram analysis, 14 were classified as pure GGNs and 54 as part-solid nodules. Integrated PET/CT was evaluated by measuring the maximum standardized uptake value (SUV) at the region of interest located at each lesion. The Mann–Whitney U test was performed to compare the SUV of malignancy and inflammation. The optimal cut-off value of SUV to differentiate malignancy from inflammation was determined using a receiver operating characteristic-based positive test. Sensitivity, specificity, accuracy, and positive predictive values (PPV) and negative predictive values (NPV) were calculated at the level of the optimal cut-off value. SUV showing 100% PPV for inflammatory GGNs was evaluated. Results In part-solid nodules, the maximum SUV was significantly higher in inflammation (2.00 ± 1.18; range, 0.48–5.60) than in malignancy (1.26 ± 0.71; range, 0.32–2.6) ( P = 0.018). On the other hand, in pure GGNs, the maximum SUV of malignancy (0.64 ± 0.19; range, 0.43–0.96) and inflammation (0.74 ± 0.28; range, 0.32–1.00) showed no difference ( P = 0.37). Using the optimal cut-off value of SUV as 1.2 ( P = 0.01) sensitivity, specificity, accuracy, PPV and NPV in part-solid nodules were 62.1%, 80.0%, 70.4%, 78.3% and 64.5%, respectively. Six part-solid nodules, which showed a maximum SUV of higher than 2.6, were all inflammations. Conclusion The part-solid nodules with positive FDG-PET could be inflammatory nodules rather than malignant nodules. This is a quite paradoxical result when considering the basic knowledge that malignant pulmonary nodules have higher glucose metabolism.

Predictive CT findings of malignancy in ground-glass nodules on thin-section chest CT: the effects on radiologist performance

Our purpose was to identify thin-section chest computed tomography (CT) findings of malignancy other than the presence of a solid portion within ground-glass nodules (GGNs) and to evaluate whether the radiologists' performance in determining malignancy can be enhanced with this information. The predictive CT findings of malignancy extracted from the CT findings of 80 GGNs (47 malignant, 33 benign) were a size of >8 mm [odds ratio (OR), 10.930; P = 0.045] and a lobulated border (OR, 13.769; P = 0.016) for pure GGNs and a lobulated border (OR, 10.200; P = 0.024) for mixed GGNs. Four chest radiologists and five radiology residents participated in the observer performance study with CT of 130 GGNs (67 malignant, 63 benign). Receiver-operating characteristic (ROC) analysis was used to compare radiologists' performances before and after providing these predictive findings. For pure GGNs, mean areas under the curve (A(z)) of all readers without and with CT predictive information were significantly different (0.621 +/- 0.052 and 0.766 +/- 0.055, P < 0.05). For mixed GGNs, the A(z) values achieved without and with predictive information were not significantly different (0.727 +/- 0.064 and 0.764 +/- 0.056, P > 0.05). Information about lesion size and morphological characteristics can enhance radiologists' performance in determining malignancy of pure GGNs.

Detection Sensitivity of a Commercial Lung Nodule CAD System in a Series of Pathologically Proven Lung Cancers

To evaluate the performance of a commercially available computer-aided detection (CAD) system in a series of pathologically proven lung cancers. Sixty-nine chest computed tomography (CT) scans obtained in 12 subjects (8 females, 4 males, age 51 to 75 y, mean 63 y) with 15 pathologically proven lung cancers were retrospectively selected from 2156 entry and follow-up CT scans from a lung cancer screening program. CT scans were retrospectively analyzed using a commercially available CAD system for detecting lung nodules. When first detectable proven lung cancer nodules ranged in maximum diameter from 3 to 38 mm (10.4+/-9.2 mm) with CAD detection sensitivity stratified by size: 0/2 (0%) < or =3 mm, 5/8 (62.5%) 4 to 10 mm, 2/3 (66.7%) 11 to 15 mm, 0/0 16 to 20 mm, 2/2 (100%) >20 mm, and overall sensitivity 9/15 (60%). The sensitivity for all CT scans (first detectable and follow-up), stratified by nodule size as above, was, respectively, 0/2, 18/25, 24/28, 6/9, 5/5, and overall 53/69 (76.8%). Excluding nodules <4 mm and pure ground-glass nodules, the sensitivity for all CT scans by size was 18/24 (75%) 4 to 10 mm, 21/22 (95.4%) 11 to 15 mm, 6/6 (100%) 16 to 20 mm, 5/5 (100%) >20 mm, and overall 50/57 (87.7%). At resection (13) or biopsy (2) nodules were: adenocarcinoma (10), squamous cell carcinoma (3), and small cell carcinoma (2). The CAD system showed good sensitivity for solid and semisolid cancers > or =4 mm (sensitivity 87.7%) and excellent for those > or =11 mm (sensitivity >95.4%).

Peripheral vascular disease. Its significance for general practitioners and specialists: De Takáts, Géza: J. A. M. A. 104: 1463, 1935

To assess whether quantitative computed tomography (CT) can help predict histological invasiveness of pulmonary adenocarcinoma appearing as pure ground glass nodules (pGGNs).A total of 110 pulmonary pGGNs were retrospectively evaluated, and pathologically classified as pre-invasive lesions, minimally invasive adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IPA). Maximum nodule diameters, largest cross-sectional areas, volumes, mean CT values, weights, and CT attenuation values at the 0th,2th,5th, 25th, 50th,75th, 95th, 98th and100th percentiles on histogram, as well as 2th to 98th, 5th to 95th, 25th to 75th,and 0th to 100thslopes, respectively, were compared among the three groups.Of the 110 pGGNs, 50, 28, and 32 were pre-invasive lesions, MIA, and IPA, respectively. Maximum nodule diameters, largest cross-sectional areas, andmass weights were significantly larger in the IPA group than in pre-invasive lesions. The 95th, 98th, 100th percentiles, and 2th to 98th, 25th to 75th, and 0th to 100thslopes were significantly different between pre-invasive lesions and MIA or IPA. Logistic regression analysis showed that the maximum nodule diameter (OR = 1.21, 95%CI: 1.071–1.366, p < 0.01) and 100th percentile on histogram (OR = 1.02, 95%CI: 1.009–1.032, p < 0.001) independently predicted histological invasiveness.Quantitative analysis of CT imaging can predict histological invasiveness of pGGNs, especiallythe maximum nodule diameter and 100th percentile on CT number histogram; this can instruct the long-term follow-up and selective surgical management.