The predictive value of CT signs of mixed ground-glass nodules in pathological subtypes and differentiation of lung adenocarcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Xiaowen ¹ , ZHAO Ziwei ² , LIU Jingwei ¹ , FANG Shaohan ³ , FENG Yihui ³ , ZHU Xiaolei ³ ,  GENG Guojun ³ ,  JIANG Jie ³

1. The Second Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, P. R. China;
2. Department of Pathology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, P. R. China;
3. The Second Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, Fujian, P. R. China;

Corresponding author：

GENG Guojun, Email: ggj622@126.com; JIANG Jie, Email: jiangjie06@126.com

Keywords：

Mixed ground-glass nodules; lung adenocarcinoma; solid components; pathological subtype; diagnosis; treatment

DOI：

10.7507/1007-4848.202203014

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the predictive value of CT signs of mixed ground-glass nodules in the pathological subtype and differentiation of lung adenocarcinoma. Methods The clinical data of 66 patients with mixed ground-glass nodules pathologically diagnosed as invasive adenocarcinoma (IAC) in the Second Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University from May to December 2021 were retrospectively analyzed, including 20 males and 46 females, aged 35-75 years. The CT findings were analyzed before operation, and the lesion profile was cut after operation to distinguish the ground-glass and solid components, and the pathological results of different positions were obtained. According to the postoperative pathological results, the patients were divided into a low-risk group (containing adherent type and no components of micropapillary subtype and solid subtype, n=16), a medium-risk group (containing niple or acinar type and no components of micropapillary subtype and solid subtype, n=38), and a high-risk group (containing micropapillary or solid subtype, n=12). The relationships between CT features and the pathological subtype and degree of differentiation were analyzed and compared. Results In 66 patients with IAC, the infiltration degree of solid components was greater than that of ground-glass components. When the solid component ratio (CTR) was≥25% (sensitivity 90.2%, specificity 64.0%, P=0.005), and the average CT value was＞−283.95 HU (sensitivity 82.9%, specificity 64.0%, P=0.000), the histological grade was more inclined to medium and low differentiation. The CTR, Ki-67, average CT value and histological grade of IAC in the medium- and high-risk groups were higher than those of nodules in the low-risk group. Conclusion The infiltration degree of solid components is higher than that of ground-glass components in IAC mixed ground-glass nodules. The pathological subtype, Ki-67 expression and histological grade of lung adenocarcinoma can be predicted according to its CT characteristics, which has important clinical significance for determining the timing of surgery.

Citation： ZHANG Xiaowen, ZHAO Ziwei, LIU Jingwei, FANG Shaohan, FENG Yihui, ZHU Xiaolei, GENG Guojun, JIANG Jie. The predictive value of CT signs of mixed ground-glass nodules in pathological subtypes and differentiation of lung adenocarcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(2): 191-197. doi: 10.7507/1007-4848.202203014 Copy

1.	Ahn H, Lee KH, Kim J, et al. Diameter of the solid component in subsolid nodules on low-dose unenhanced chest computed tomography: Measurement accuracy for the prediction of invasive component in lung adenocarcinoma. Korean J Radiol, 2018, 19(3): 508-515.
2.	周丽芬, 李小虎, 张为, 等. 混合磨玻璃结节肺腺癌CT表现与病理对照研究. 安徽医科大学学报, 2019, 54(1): 124-130.
3.	金艳凤, 黄琴, 魏中华, 等. 孤立性部分实性肺结节28例影像学与临床病理分析. 临床与实验病理学杂志, 2019, 35(4): 459-461.
4.	李媛, 谢惠康, 武春燕. WHO胸部肿瘤分类(第5版)中肺肿瘤部分解读. 中国癌症杂志, 2021, 31(7): 574-580.
5.	方三高, 陈真伟, 魏建国. 2021年第5版WHO胸部肿瘤分类. 诊断病理学杂志, 2021, 28(7): 591-593, 607.
6.	Mazzone PJ, Lam L. Evaluating the patient with a pulmonary nodule: A review. JAMA, 2022, 327(3): 264-273.
7.	孔芳, 段艳华, 宋学林, 等. 高分辨率CT鉴别诊断良、恶性实性孤立性肺结节. 中国医学影像技术, 2021, 37(8): 1168-1172.
8.	陈方榕, 方振剑, 佘晖, 等. 孤立性肺结节空间分布与病理及恶性征象的关系. 基层医学论坛, 2019, 23(34): 4936-4938.
9.	李晓, 陈新晖, 李建钢. CT诊断肺亚实性结节肺癌的特征与临床病理的关系. 中国CT和MRI杂志, 2020, 18(1): 61-64.
10.	Tsubokawa N, Mimae T, Miyata Y, et al. Prognostic significance of vascular invasion in intermediate-grade subtype of lung adenocarcinoma. Jpn J Clin Oncol, 2016, 46(11): 1015-1021.
11.	Reginelli A, Capasso R, Petrillo M, et al. Looking for lepidic component inside invasive adenocarcinomas appearing as CT solid solitary pulmonary nodules (SPNs): CT morpho-densitometric features and 18-FDG PET findings. Biomed Res Int, 2019, 2019: 7683648.
12.	Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
13.	Qu Y, Aly RG, Takahashi Y, et al. Micropapillary lung adenocarcinoma and micrometastasis. J Thorac Dis, 2017, 9(10): 3443-3446.
14.	Sica G, Yoshizawa A, Sima CS, et al. A grading system of lung adenocarcinomas based on histologic pattern is predictive of disease recurrence in stageⅠtumors. Am J Surg Pathol, 2010, 34(8): 1155-1162.
15.	Warth A, Muley T, Meister M, et al. The novel histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification system of lung adenocarcinoma is a stage-independent predictor of survival. J Clin Oncol, 2012, 30(13): 1438-1446.
16.	Yoshizawa A, Motoi N, Riely GJ, et al. Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: Prognostic subgroups and implications for further revision of staging based on analysis of 514 stageⅠcases. Mod Pathol, 2011, 24(5): 653-664.
17.	Chang JY, Mehran RJ, Feng L, et al. Stereotactic ablative radiotherapy for operable stageⅠnon-small-cell lung cancer (revised STARS): Long-term results of a single-arm, prospective trial with prespecified comparison to surgery. Lancet Oncol, 2021, 22(10): 1448-1457.
18.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
19.	Morales-Oyarvide V, Mino-Kenudson M. High-grade lung adenocarcinomas with micropapillary and/or solid patterns: A review. Curr Opin Pulm Med, 2014, 20(4): 317-323.
20.	Wang D, Chen D, Zhang C, et al. Analysis of the relationship between Ki-67 expression and chemotherapy and prognosis in advanced non-small cell lung cancer. Transl Cancer Res, 2020, 9(5): 3491-3498.
21.	Landman A. 2021 world conference on lung cancer. Lancet Oncol, 2021, 22(10): e429.
22.	Ma M, She Y, Ren Y, et al. Micropapillary or solid pattern predicts recurrence free survival benefit from adjuvant chemotherapy in patients with stageⅠB lung adenocarcinoma. J Thorac Dis, 2018, 10(9): 5384-5393.
23.	Yasukawa M, Ohbayashi C, Kawaguchi T, et al. Analysis of histological grade in resected lung-invasive adenocarcinoma. Anticancer Res, 2019, 39(3): 1491-1500.
24.	Obayashi K, Shimizu K, Nakazawa S, et al. The impact of histology and ground-glass opacity component on volume doubling time in primary lung cancer. J Thorac Dis, 2018, 10(9): 5428-5434.
25.	Wu YJ, Liu YC, Liao CY, et al. A comparative study to evaluate CT-based semantic and radiomic features in preoperative diagnosis of invasive pulmonary adenocarcinomas manifesting as subsolid nodules. Sci Rep, 2021, 11(1): 66.
26.	Wu G, Woodruff HC, Shen J, et al. Diagnosis of invasive lung adenocarcinoma based on chest CT radiomic features of part-solid pulmonary nodules: A multicenter study. Radiology, 2020, 297(2): 451-458.
27.	Lee KH, Goo JM, Park SJ, et al. Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thorac Oncol, 2014, 9(1): 74-82.
28.	Kim H, Park CM, Koh JM, et al. Pulmonary subsolid nodules: What radiologists need to know about the imaging features and management strategy. Diagn Interv Radiol, 2014, 20(1): 47-57.
29.	Qi L, Lu W, Wu N, et al. Persistent pulmonary subsolid nodules with a solid component smaller than 6 mm: What do we know? J Thorac Dis, 2020, 12(8): 4584-4587.
30.	Chen PA, Huang EP, Shih LY, et al. Qualitative CT criterion for subsolid nodule subclassification: Improving interobserver agreement and pathologic correlation in the adenocarcinoma spectrum. Acad Radiol, 2018, 25(11): 1439-1445.

1. Ahn H, Lee KH, Kim J, et al. Diameter of the solid component in subsolid nodules on low-dose unenhanced chest computed tomography: Measurement accuracy for the prediction of invasive component in lung adenocarcinoma. Korean J Radiol, 2018, 19(3): 508-515.
2. 周丽芬, 李小虎, 张为, 等. 混合磨玻璃结节肺腺癌CT表现与病理对照研究. 安徽医科大学学报, 2019, 54(1): 124-130.
3. 金艳凤, 黄琴, 魏中华, 等. 孤立性部分实性肺结节28例影像学与临床病理分析. 临床与实验病理学杂志, 2019, 35(4): 459-461.
4. 李媛, 谢惠康, 武春燕. WHO胸部肿瘤分类(第5版)中肺肿瘤部分解读. 中国癌症杂志, 2021, 31(7): 574-580.
5. 方三高, 陈真伟, 魏建国. 2021年第5版WHO胸部肿瘤分类. 诊断病理学杂志, 2021, 28(7): 591-593, 607.
6. Mazzone PJ, Lam L. Evaluating the patient with a pulmonary nodule: A review. JAMA, 2022, 327(3): 264-273.
7. 孔芳, 段艳华, 宋学林, 等. 高分辨率CT鉴别诊断良、恶性实性孤立性肺结节. 中国医学影像技术, 2021, 37(8): 1168-1172.
8. 陈方榕, 方振剑, 佘晖, 等. 孤立性肺结节空间分布与病理及恶性征象的关系. 基层医学论坛, 2019, 23(34): 4936-4938.
9. 李晓, 陈新晖, 李建钢. CT诊断肺亚实性结节肺癌的特征与临床病理的关系. 中国CT和MRI杂志, 2020, 18(1): 61-64.
10. Tsubokawa N, Mimae T, Miyata Y, et al. Prognostic significance of vascular invasion in intermediate-grade subtype of lung adenocarcinoma. Jpn J Clin Oncol, 2016, 46(11): 1015-1021.
11. Reginelli A, Capasso R, Petrillo M, et al. Looking for lepidic component inside invasive adenocarcinomas appearing as CT solid solitary pulmonary nodules (SPNs): CT morpho-densitometric features and 18-FDG PET findings. Biomed Res Int, 2019, 2019: 7683648.
12. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
13. Qu Y, Aly RG, Takahashi Y, et al. Micropapillary lung adenocarcinoma and micrometastasis. J Thorac Dis, 2017, 9(10): 3443-3446.
14. Sica G, Yoshizawa A, Sima CS, et al. A grading system of lung adenocarcinomas based on histologic pattern is predictive of disease recurrence in stageⅠtumors. Am J Surg Pathol, 2010, 34(8): 1155-1162.
15. Warth A, Muley T, Meister M, et al. The novel histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification system of lung adenocarcinoma is a stage-independent predictor of survival. J Clin Oncol, 2012, 30(13): 1438-1446.
16. Yoshizawa A, Motoi N, Riely GJ, et al. Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: Prognostic subgroups and implications for further revision of staging based on analysis of 514 stageⅠcases. Mod Pathol, 2011, 24(5): 653-664.
17. Chang JY, Mehran RJ, Feng L, et al. Stereotactic ablative radiotherapy for operable stageⅠnon-small-cell lung cancer (revised STARS): Long-term results of a single-arm, prospective trial with prespecified comparison to surgery. Lancet Oncol, 2021, 22(10): 1448-1457.
18. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
19. Morales-Oyarvide V, Mino-Kenudson M. High-grade lung adenocarcinomas with micropapillary and/or solid patterns: A review. Curr Opin Pulm Med, 2014, 20(4): 317-323.
20. Wang D, Chen D, Zhang C, et al. Analysis of the relationship between Ki-67 expression and chemotherapy and prognosis in advanced non-small cell lung cancer. Transl Cancer Res, 2020, 9(5): 3491-3498.
21. Landman A. 2021 world conference on lung cancer. Lancet Oncol, 2021, 22(10): e429.
22. Ma M, She Y, Ren Y, et al. Micropapillary or solid pattern predicts recurrence free survival benefit from adjuvant chemotherapy in patients with stageⅠB lung adenocarcinoma. J Thorac Dis, 2018, 10(9): 5384-5393.
23. Yasukawa M, Ohbayashi C, Kawaguchi T, et al. Analysis of histological grade in resected lung-invasive adenocarcinoma. Anticancer Res, 2019, 39(3): 1491-1500.
24. Obayashi K, Shimizu K, Nakazawa S, et al. The impact of histology and ground-glass opacity component on volume doubling time in primary lung cancer. J Thorac Dis, 2018, 10(9): 5428-5434.
25. Wu YJ, Liu YC, Liao CY, et al. A comparative study to evaluate CT-based semantic and radiomic features in preoperative diagnosis of invasive pulmonary adenocarcinomas manifesting as subsolid nodules. Sci Rep, 2021, 11(1): 66.
26. Wu G, Woodruff HC, Shen J, et al. Diagnosis of invasive lung adenocarcinoma based on chest CT radiomic features of part-solid pulmonary nodules: A multicenter study. Radiology, 2020, 297(2): 451-458.
27. Lee KH, Goo JM, Park SJ, et al. Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thorac Oncol, 2014, 9(1): 74-82.
28. Kim H, Park CM, Koh JM, et al. Pulmonary subsolid nodules: What radiologists need to know about the imaging features and management strategy. Diagn Interv Radiol, 2014, 20(1): 47-57.
29. Qi L, Lu W, Wu N, et al. Persistent pulmonary subsolid nodules with a solid component smaller than 6 mm: What do we know? J Thorac Dis, 2020, 12(8): 4584-4587.
30. Chen PA, Huang EP, Shih LY, et al. Qualitative CT criterion for subsolid nodule subclassification: Improving interobserver agreement and pathologic correlation in the adenocarcinoma spectrum. Acad Radiol, 2018, 25(11): 1439-1445.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The predictive value of CT signs of mixed ground-glass nodules in pathological subtypes and differentiation of lung adenocarcinoma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content