Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China.
Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China.
Eur Radiol. 2022 Jan;32(1):174-183. doi: 10.1007/s00330-021-08115-1. Epub 2021 Jun 16.
This study aimed to discuss whether a diameter of 3 cm is a threshold for diagnosing lung adenocarcinomas presenting with radiological pure ground-glass mass (PGGM, pure ground-glass opacity > 3 cm) as adenocarcinomas in situ or minimally invasive adenocarcinomas (AIS-MIAs). Another aim was to identify CT features and patient prognosis that differentiate AIS-MIAs from invasive adenocarcinomas (IACs) in patients with PGGMs.
From June 2007 to October 2015, 69 resected PGGMs with HRCT and followed up for ≥ 5 years were included in this study and divided into AIS-MIA (n = 13) and IAC (n = 56) groups. Firth's logistic regression model was performed to determine CT characteristics that helped distinguish IACs from AIS-MIAs. The discriminatory power of the significant predictors was tested with the area under the receiver operating characteristics curve (AUC). Disease recurrence was also evaluated.
Univariable and multivariable analyses identified that the mean CT attenuation (odds ratio: 1.054, p = 0.0087) was the sole significant predictor for preoperatively discriminating IACs from AIS-MIAs in patients with PGGMs. The CT attenuation had an excellent differentiating accuracy (AUC: 0.981), with the optimal cut-off value at -600 HU (sensitivity: 87.5%; specificity: 100%). Additionally, no recurrence was observed in patients manifesting with PGGMs > 3 cm, and the 5-year recurrence-free survival and overall survival rates were both 100%, even in cases of IAC.
This study demonstrated that PGGMs > 3 cm could still be AIS-MIAs. When PGGMs are encountered in clinical practice, the CT value may be the only valuable parameter to preoperatively distinguish IACs from AIS-MIAs.
• Patients with pure ground-glass opacity > 3 cm in diameter are rare but can be diagnosed as adenocarcinomas in situ or minimally invasive adenocarcinomas. • The mean CT attenuation is the sole significant CT parameter that differentiates invasive adenocarcinoma from adenocarcinoma in situ or minimally invasive adenocarcinoma in patients with pure ground-glass opacity > 3 cm. • Lung adenocarcinoma with pure ground-glass opacity > 3 cm has an excellent prognosis, even in cases of invasive adenocarcinoma.
本研究旨在探讨直径 3cm 是否可作为诊断影像学纯磨玻璃密度（PGGM，纯磨玻璃密度＞3cm）肺腺癌为原位腺癌或微浸润腺癌（AIS-MIA）的阈值。另一个目的是确定 CT 特征和患者预后，以区分 PGGM 患者中 AIS-MIA 与浸润性腺癌（IAC）。
本研究纳入了 2007 年 6 月至 2015 年 10 月期间接受 HRCT 检查并随访≥5 年的 69 例切除的 PGGM，分为 AIS-MIA（n=13）和 IAC（n=56）组。采用 Firth 逻辑回归模型确定有助于区分 IAC 和 AIS-MIA 的 CT 特征。采用受试者工作特征曲线下面积（AUC）检验显著预测因子的判别能力。还评估了疾病复发情况。
单变量和多变量分析确定，平均 CT 衰减值（比值比：1.054，p=0.0087）是术前区分 PGGM 患者 IAC 和 AIS-MIA 的唯一显著预测因子。CT 衰减值具有极好的区分准确性（AUC：0.981），最佳截断值为-600HU（灵敏度：87.5%；特异性：100%）。此外，PGGM ＞3cm 的患者未见复发，5 年无复发生存率和总生存率均为 100%，即使是 IAC 也是如此。
本研究表明，PGGM ＞3cm 仍可为 AIS-MIA。在临床实践中遇到 PGGM 时，CT 值可能是术前区分 IAC 和 AIS-MIA 的唯一有价值的参数。
直径＞3cm 的纯磨玻璃密度患者罕见，但可诊断为原位腺癌或微浸润腺癌。
平均 CT 衰减值是区分 3cm 以上纯磨玻璃密度患者中浸润性腺癌与原位腺癌或微浸润腺癌的唯一显著 CT 参数。
直径＞3cm 的纯磨玻璃密度肺腺癌预后极好，即使是浸润性腺癌也是如此。
