Thin-section computed tomography-histopathologic comparisons of pulmonary focal interstitial fibrosis, atypical adenomatous hyperplasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma with pure ground-glass opacity.
OBJECTIVE
To retrospectively compare focal interstitial fibrosis (FIF), atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), and minimally invasive adenocarcinoma (MIA) with pure ground-glass opacity (GGO) using thin-section computed tomography (CT).


METHODS
Sixty pathologically confirmed cases were reviewed including 7 cases of FIF, 17 of AAH, 23of AIS, and 13 of MIA. All nodules kept pure ground glass appearances before surgical resection and their last time of thin-section CT imaging data before operation were collected. Differences of patient demographics and CT features were compared among these four types of lesions.


RESULTS
FIF occurred more frequently in males and smokers while the others occurred more frequently in female nonsmokers. Nodule size was significant larger in MIA (P<0.001, cut-off value=7.5mm). Nodule shape (P=0.045), margin characteristics (P<0.001), the presence of pleural indentation (P=0.032), and vascular ingress (P<0.001) were significant factors that differentiated the 4 groups. A concave margin was only demonstrated in a high proportion of FIF at 85.7% (P=0.002). There were no significant differences (all P>0.05) in age, malignant history, attenuation value, location, and presence of bubble-like lucency.


CONCLUSIONS
A nodule size >7.5mm increases the possibility of MIA. A concave margin could be useful for differentiation of FIF from the other malignant or pre-malignant GGO nodules. The presence of spiculation or pleural indentation may preclude the diagnosis of AAH.
Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China. Electronic address: smjsh@hotmail.com.
Ming-Jue
MJ
Si
Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China. Electronic address: taoxiaofeng1963@hotmail.com.
Xiao-Feng
XF
Tao
Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China. Electronic address: 715376158@qq.com.
Guang-Ye
GY
Du
Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China. Electronic address: caill_00@163.com.
Ling-Ling
LL
Cai
Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China. Electronic address: hanhongxiu@hotmail.com.
Hong-Xiu
HX
Han
Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China. Electronic address: liangxizish@hotmail.com.
Xi-Zi
XZ
Liang
Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China. Electronic address: zhaojiangmin1962@hotmail.com.
Jiang-Min
JM
Zhao
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D065311:Adenocarcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology*; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000473:pathology*; D013902:Radiography, Thoracic / Q000379:methods; D012189:Retrospective Studies
Adenocarcinoma in situ; Atypical adenomatous hyperplasia; Focal interstitial fibrosis; Minimally invasive adenocarcinoma; Pure ground-glass opacity; Thin-section CT