Depatment of Radiology, The First Affiliated Hospital of Wenzhou Medical University, NO.2 Fuxue Rd, Wenzhou, 325000, China.
Department of Radiology, Xiangshan Affiliated Hospital of Wenzhou Medical University, Xiangshan, 315700, China.
Eur J Radiol. 2021 Jun;139:109683. doi: 10.1016/j.ejrad.2021.109683. Epub 2021 Mar 27.
We aimed to investigate the risk factors of invasive pulmonary adenocarcinoma, especially to report and validate the use of our newly identified arc concave sign in predicting invasiveness of pure ground-glass nodules (pGGNs).
From January 2015 to August 2018, we retrospectively enrolled 302 patients with 306 pGGNs ≤ 20 mm pathologically confirmed (141 preinvasive lesions and 165 invasive lesions). Arc concave sign was defined as smooth and sunken part of the edge of the lesion on thin-section computed tomography (TSCT). The degree of arc concave sign was expressed by the arc chord distance to chord length ratio (AC-R); deep arc concave sign was defined as AC-R larger than the optimal cut-off value. Logistic regression analysis was used to identify the independent risk factors of invasiveness.
Arc concave sign was observed in 65 of 306 pGGNs (21.2 %), and deep arc concave sign (AC-R > 0.25) were more common in invasive lesions (P = 0.008). Under microscope, interlobular septal displacements were found at tumour surface. Multivariate analysis indicated that irregular shape (OR, 3.558; CI: 1.374-9.214), presence of deep arc concave sign (OR, 3.336; CI: 1.013-10.986), the largest diameter > 10.1 mm (OR, 4.607; CI: 2.584-8.212) and maximum density > -502 HU (OR, 6.301; CI: 3.562-11.148) were significant independent risk factors of invasive lesions.
Arc concave sign on TSCT is caused by interlobular septal displacement. The degree of arc concave sign can reflect the invasiveness of pGGNs. Invasive lesions can be effectively distinguished from preinvasive lesions by the presence of deep arc concave sign, irregular shape, the largest diameter > 10.1 mm and maximum density > -502 HU in pGGNs ≤ 20 mm.
本研究旨在探讨浸润性肺腺癌的危险因素，尤其报告并验证我们新发现的弧形凹陷征在预测纯磨玻璃结节（pGGN）侵袭性方面的应用。
回顾性纳入 2015 年 1 月至 2018 年 8 月间经病理证实的 302 例直径≤20mm 的 pGGN 患者（141 例为非浸润性病变，165 例为浸润性病变）。弧形凹陷征定义为薄层 CT（TSCT）上病灶边缘的光滑凹陷部分。弧形凹陷征的程度用弧形弦距与弦长比（AC-R）表示；深度弧形凹陷征定义为 AC-R 大于最佳截断值。采用 Logistic 回归分析确定侵袭性的独立危险因素。
306 个 pGGN 中有 65 个（21.2%）出现弧形凹陷征，深度弧形凹陷征（AC-R>0.25）在浸润性病变中更为常见（P=0.008）。在显微镜下，在肿瘤表面发现了小叶间隔的移位。多变量分析表明，不规则形状（OR，3.558；95%CI：1.374-9.214）、存在深度弧形凹陷征（OR，3.336；95%CI：1.013-10.986）、最大直径>10.1mm（OR，4.607；95%CI：2.584-8.212）和最大密度>-502HU（OR，6.301；95%CI：3.562-11.148）是侵袭性病变的显著独立危险因素。
TSCT 上的弧形凹陷征是由小叶间隔移位引起的。弧形凹陷征的程度可以反映 pGGN 的侵袭性。在直径≤20mm 的 pGGN 中，通过存在深度弧形凹陷征、不规则形状、最大直径>10.1mm 和最大密度>-502HU，可以有效地将浸润性病变与非浸润性病变区分开来。
