title: Value of CT Characteristics in Predicting Invasiveness of Adenocarcinoma Presented as Pulmonary Ground-Glass Nodules.
abstract: BackgroundLess invasive adenocarcinomas (LIAs) of the lung, including adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA), are indications of sublobar resection and has a 5-year disease-free survival rate of almost 100% after surgery. By distinguishing invasive adenocarcinoma from LIA with computed tomography (CT) characteristics, it is possible to determine the extent of resection and prognosis for patients with ground-glass nodules (GGNs) before surgery.MethodsWe reviewed CT and pathological findings of 728 GGNs in 645 consecutive patients who received curative lung resection in a single center. Only AIS, MIA, and invasive adenocarcinoma were included. Characteristics of CT, including maximum diameter of the lesion (Lmax) and maximum diameter of the consolidation (Cmax), were assessed thoroughly.ResultsMultivariate logistic regression showed that largerLmax(p< 0.001) and nonsmooth margin (p= 0.001) were independent factors for invasive adenocarcinoma in pure GGNs (pGGNs). The optimal cut-off value ofLmaxwas 12.0 mm. In mixed GGNs (mGGNs), multivariate analysis revealed that largerLmax(p< 0.001), largerCmax(p= 0.032), and vacuole sign (p= 0.007) were predictive factors for invasive adenocarcinoma, and the area under curve of regression model was 0.866. The optimal cut-off values ofLmaxandCmaxwere 15.4 and 5.8 mm, respectively. No node metastasis was found in 295 patients who had at least three stations of mediastinal lymph nodes dissected.ConclusionIn pGGNs, largerLmax(>12.0 mm) and nonsmooth margin were reliable predictors for invasive adenocarcinoma. In mGGNs, lesions with largerLmax(>15.4 mm), largerCmax(>5.8 mm), and vacuole sign were more likely to be invasive adenocarcinoma.
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors: Hongdou
authors: H
authors: Ding
authors: Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors: Jingyun
authors: J
authors: Shi
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors: Xiao
authors: X
authors: Zhou
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors: Dong
authors: D
authors: Xie
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors: Xiao
authors: X
authors: Song
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors: Yang
authors: Y
authors: Yang
authors: Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors: Zhongliu
authors: Z
authors: Liu
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors: Haifeng
authors: H
authors: Wang
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D016017:Odds Ratio; D018579:Patient Selection; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult