Multi‐slice computed tomography characteristics of solitary pulmonary ground‐glass nodules: Differences between malignant and benign

Abstract

BackgroundGround‐glass nodules (GGNs), which are possible precursors of lung cancer, attract increasing attention. Many studies have attempted to identify the characteristic imaging features of GGNs for their qualitative diagnosis; however, the comprehension of GGNs remains controversial. We performed this study to identify imaging characteristics helpful to the differential diagnosis of solitary GGNs.MethodsWe retrospectively evaluated 112 solitary GGNs resected from 112 patients, pathologically examined after surgical resection. Imaging features of the GGNs, such as size, shape, a solid component, lobulation, spiculation, vascular convergence sign, pleural tag, and air cavity density, were assessed. Differences between malignant and benign nodules were analyzed using binary logistic regression analysis.ResultsOf the 112 GGNs, 82 were malignant and 30 were benign. A solid component, vascular convergence sign, and a larger diameter were risk factors for malignancy, with a sensitivity, specificity, and accuracy of 93.9%, 60.0%, and 84.8%, respectively. Lobulation, spiculation, air cavity densities, and pleural tags were also important indicators of malignancy, with positive predictive values of 93.5%, 83.3%, 91.7%, and 87.2%, respectively.Conclusion GGNs with a solid component, vascular convergence sign, and a larger diameter are highly suggestive of malignancy. The possibility of a neoplasm should also be considered in the case of GGNs that show lobulation, spiculation, air cavity densities, or pleural tags. To obtain a comprehensive and accurate analysis of the nodules, three‐dimensional reconstruction is highly recommended.

Primary solid lung cancerous nodules with different sizes: computed tomography features and their variations

“…It may be because a nodule becomes more regular with an increase in size, and the limitation of the surrounding structure becomes more obvious. Lobulation, spiculation, pleural retraction, and vascular convergence are considered common signs of malignancy in lung cancer [6,[20][21][22][23][24][25]. However, for smaller nodules, traction and invasion of surrounding blood vessels and tissues, as well as tumor and peritumoral fibrosis were not obvious.…”

“…Based on their density features on computed tomography (CT) images, cancerous nodules can be generally divided into solid and subsolid nodules, each with significantly different morphological and pathological features [3]. Several studies have been conducted on the differential diagnosis of benign and malignant subsolid nodules [4][5][6][7][8] and the solid ones [9][10][11][12][13]. Compared with subsolid lung cancerous nodules, the solid ones have a worse prognosis because of their rapid growth [14][15][16] and earlier metastases [16][17][18][19].…”

“…Among the various CT features, spiculation, lobulation, vascular convergence, and pleural retraction have been associated with malignancy in lung cancer [6,[20][21][22][23][24][25]; therefore, they are helpful in differentiating benign from malignant nodules. However, these features are usually absent in smaller nodules, making their diagnosis challenging.…”

Single-stage nonintubated uniportal thoracoscopic resection of synchronous bilateral pulmonary nodules after coil labeling

“…[10] GGNs with solid component, lobulation, spiculation, air cavity densities, pleural tags, vascular convergence sign, and a larger diameter on CT images are highly suggestive of malignancy. [11] When pure GGNs are greater than 15 mm in diameter with nodularity, or have high pixel attenuation (>−472 HU), the nodules are more likely to be invasive adenocarcinomas. [12] Besides, the risk factors of malignancy include nodule size>20 mm, age >60 years old, prior cancer history, current tobacco use, asbestos exposure, and speculated nodules.…”

Computed tomography‐guided hook wire localization facilitates video‐assisted thoracoscopic surgery of pulmonary ground‐glass nodules

“…A part‐solid GGN presents with both ground glass and solid components. Pathologically, GGNs often correspond to precancerous lesions, early‐stage adenocarcinoma, or even metastasized tumors . Researchers have reported a GGN malignancy rate of 59%–73% .…”