title: Air bronchogram: A potential indicator of epidermal growth factor receptor mutation in pulmonary subsolid nodules.
abstract: Evaluation of pulmonary subsolid nodule is a longstanding clinical problem. We aimed to validate the computed tomography (CT) features correlating with pathological invasiveness and to explore any imaging findings associated with epidermal growth factor receptor (EGFR) mutation in lung adenocarcinoma.
  
  
  
  A total of 204 patients with pathologically proven stage IA adenocarcinoma who had preoperative CT and data on EGFR status were enrolled in this retrospective study. Quantitative CT features including tumor size and solid volume proportion (SVP) were measured on multiplanar reconstructed images. Pathological analysis was stratified into adenocarcinoma in situ and minimally invasive adenocarcinoma (AIS/MIA), and invasive adenocarcinomas (IAs).
  
  
  
  There were 93 AIS/MIA and 111 IAs. EGFR mutation was detected in 109 (53.4%) cases. In radiopathological analysis, IAs were significantly in larger tumor size (15.8mm vs. 10.9mm), higher SVP (18.3% vs. 1.1%) and more likely to present air bronchogram, vascular invasion, lobulated/irregular shape, non-smooth margin and pleural tag than AIS/MIA. The multivariate logistic regression indicated that tumor size (OR=1.337) and SVP (OR=1.198) were significant differentiating factors of IAs from AIS/MIA. In radiogenomic analysis, EGFR status differed in tumor size, air bronchogram and margin. The multivariate logistic regression disclosed that the presence of an air bronchogram (OR=3.451) was significantly associated with EGFR mutation after adjustment for age, gender and smoking status.
  
  
  
  In subsolid nodules, tumor size and SVP were significant predictors of pathological invasiveness. In addition, the presence of air bronchogram was suggestive of activated EGFR mutation.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Radiology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
authors.forename: Jingyun
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Radiology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
authors.forename: Adiilah K
authors.initials: AK
authors.lastname: Soodeen-Lalloo
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Radiology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
authors.forename: Sen
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Jia
authors.affiliation: Lung Cancer Diagnosis and Treatment Center, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China. Electronic address: tongjifeike@sina.com.
authors.forename: Ke
authors.initials: K
authors.lastname: Fei
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China. Electronic address: jgnwp@aliyun.com.
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
mesh_terms: D000368:Aged; D004252:DNA Mutational Analysis; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000235:genetics / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D066246:ErbB Receptors
keywords: Epidermal growth factor receptor; Imaging; Invasiveness; Lung adenocarcinoma; Subsolid nodule