Liu Yinan, Sun Hui, Zhou Fei, Su Chunxia, Gao Guanghui, Ren Shengxiang, Zhou Caicun, Zhang Zhemin, Shi Jingyun
Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, 200433, PR China.
Department of Medical Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, 200433, PR China; Department of Respiratory, Shanghai Pulmonary Hospital, Tongji University, Tongji University Medical School Cancer Institute, Shanghai, PR China.
Lung Cancer. 2017 Jun;108:192-197. doi: 10.1016/j.lungcan.2017.03.011. Epub 2017 Mar 27.
To comprehensively investigate the role of thin section computed tomography(TSCT) features to distinguish invasive adenocarcinoma(IA) from preinvasive or minimally invasive adenocarcinoma(MIA) appearing as pure or mixed ground glass nodules (pGGNs, mGGNs), and to distinguish adenocarcinoma in situ (AIS) from atypical adenomatous hyperplasia (AAH) in pGGNs.
Three hundred thirteen patients with 334 pathologically diagnosed GGNs according to the 2011 IASLC/ATS/ERS classification were included into this study. The TSCT features of the AAH-MIAs and IAs were compared and analyzed respectively in pGGNs (158 cases) and mGGNs (176 cases). Additionally, AIS (30 cases) and AAH (33 cases) were further analyzed in pGGNs. Receiver operating characteristic(ROC) analysis were performed to determine the cutoff values for the qualitative variables and their diagnostic performances.
In pGGNs, significant differences were found in the tumor volume(p=0.017, OR=4.98, 95%CI 1.33-18.62) and tumor mass(p=0.03, OR=5.04, 95%CI 1.17-21.59) between AAH-MIAs (AAH, AIS, MIA) group and IAs group, and tumor mass(p=0.037, OR=4.32, 95%CI 1.09-17.10) and standard deviation(SD) (p=0.019, OR=13.92, 95%CI 1.53-126.57) could distinguish AIS from AAH. In mGGNs, significant differences were found in consolidation size (p=0.006, OR=21.98, 95%CI 2.46-196.67) and consolidation mean CT value (p=0.011, OR=18.20, 95%CI1.96-168.88) between AAH-MIAs group and IAs group. Multivariate and ROC analyses revealed that in pGGNs, tumor size (≥1125mm) and mass (>386) were significantly associated with IAs. SD (≥68) and mass (≥70) were significant in distinguishing AIS from AAH. Larger consolidation of nodules (≥8.1mm) and higher CT values of the solid components (≥-222 HU) in mGGNs were significantly associated with IAs.
TSCT features can help distinguish IAs from AAH-MIAs both in pGGNs and mGGNs, and identify AIS from AAH in pGGNs, which indicated that imaging features may be helpful to guide the therapeutic choice for patients with GGNs which were considered as high risk of malignant diseases.
全面研究薄层计算机断层扫描（TSCT）特征在鉴别表现为纯磨玻璃结节（pGGN）或混合磨玻璃结节（mGGN）的浸润性腺癌（IA）与浸润前或微浸润性腺癌（MIA），以及在pGGN中鉴别原位腺癌（AIS）与非典型腺瘤样增生（AAH）方面的作用。
本研究纳入了313例患者的334个根据2011年国际肺癌研究协会（IASLC）/美国胸科学会（ATS）/欧洲呼吸学会（ERS）分类病理诊断为GGN的病例。分别对pGGN（158例）和mGGN（176例）中的AAH-MIA和IA的TSCT特征进行比较和分析。此外，对pGGN中的AIS（30例）和AAH（33例）进行进一步分析。采用受试者操作特征（ROC）分析来确定定性变量的临界值及其诊断性能。
在pGGN中，AAH-MIA（AAH、AIS、MIA）组与IA组之间在肿瘤体积（p = 0.017，OR = 4.98，95%CI 1.33 - 18.62）和肿瘤实性成分（p = 0.03，OR = 5.04，95%CI 1.17 - 21.59）方面存在显著差异，肿瘤实性成分（p = 0.037，OR = 4.32，95%CI 1.09 - 17.10）和标准差（SD）（p = 0.019，OR = 13.92，95%CI 1.53 - 126.57）可区分AIS与AAH。在mGGN中，AAH-MIA组与IA组之间在实变大小（p = 0.006，OR = 21.98，95%CI 2.46 - 196.67）和实变平均CT值（p = 0.011，OR = 18.20，95%CI 1.96 - 168.88）方面存在显著差异。多变量和ROC分析显示，在pGGN中，肿瘤大小（≥1125mm）和实性成分（>386）与IA显著相关。SD（≥68）和实性成分（≥70）在区分AIS与AAH方面具有显著意义。mGGN中较大的结节实变（≥8.1mm）和实性成分较高的CT值（≥ - 222HU）与IA显著相关。
TSCT特征有助于在pGGN和mGGN中鉴别IA与AAH-MIA，并在pGGN中鉴别AIS与AAH，这表明影像学特征可能有助于指导被认为具有恶性疾病高风险的GGN患者的治疗选择。
