title: Oncological Characteristics of Radiological Invasive Adenocarcinoma with Additional Ground-Glass Nodules on Initial Thin-Section Computed Tomography: Comparison with Solitary Invasive Adenocarcinoma.
abstract: We aimed to evaluate the oncological outcomes of radiological invasive adenocarcinoma with additional ground-glass nodules (AGGNs) on initial thin-section computed tomography (CT).
  
  
  
  We examined 473 patients with surgically resected clinical stage IA lung adenocarcinoma showing a radiological invasive appearance on thin-section CT. Radiological invasiveness was defined as a solid tumor with a consolidation tumor ratio of at least 0.5 but no greater than 1.0 on thin-section CT.
  
  
  
  Ninety patients (19%) had dominant invasive adenocarcinoma (DA) with AGGNs, whereas 383 (81%) had solitary invasive adenocarcinoma (SA). DA showed a significantly lower maximum standardized uptake value of (18)F-fluorodeoxyglucose on positron emission tomography (p = 0.0086), higher frequency of radiological part solid tumor (p = 0.0232) and histological lepidic predominant tumor (p = 0.0015), and lesser presence of nodal involvement (p = 0.0350) and lymphovascular invasion (p = 0.0001) than with SA. Surgically resected AGGNs were shown to be pathologically atypical adenomatous hyperplasia in 17% of patients, adenocarcinoma in situ in 53%, and minimally invasive adenocarcinoma in 21%. Furthermore, the 5-year overall survival of DA with AGGNs was better than that of SA, and the difference was significant (92.2% versus 79.9%, p = 0.0323). On the basis of a multivariate analysis, tumor size, maximum standardized uptake value, and consolidation status of DA/SA were significant prognostic factors of survival for all patients (p = 0.0039, 0.0236, and 0.0385, respectively), whereas the presence of AGGNs was not associated with poor overall survival (p = 0.4809).
  
  
  
  DA accompanied by AGGNs showed an oncologically less invasive nature compared with SA. Presence of AGGNs is not related to poor prognosis, and is neither indicative of an advanced stage nor a contraindication to surgical resection in patients with clinical stage IA radiological invasive adenocarcinoma.
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Aritoshi
authors.initials: A
authors.lastname: Hattori
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Takamochi
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Shiaki
authors.initials: S
authors.lastname: Oh
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: kjsuzuki@juntendo.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Additional ground-glass nodules; Invasive adenocarcinoma; Lung cancer; Survival