Persistent Pure Ground-Glass Opacity Lung Nodules ≥ 10 mm in Diameter at CT Scan

Lim, Hyun Ju; Ahn, S.D.; Lee, Kyung Soo; Han, Joungho; Shim, Young Mog; Woo, Sook‐Young; Kim, Jae‐Hun; Yie, Miyeon; Lee, Ho Yun; Yi, Chin A

doi:10.1378/chest.12-2987

Cited by 221 publications

(203 citation statements)

References 20 publications

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“…In univariate analysis, we found that smaller tumor size and larger GGO proportion were significantly associated with indolent and less aggressive tumors. Similarly, there were several studies also found that the size and mass of the nodule are determinants of invasive adenocarcinoma (8,(16)(17)(18). While, recently an observation found that in patients with tumors smaller than 3 cm, DFS was significantly associated with solid tumor size, but not with whole tumor size in early stage tumors (9).…”

Section: Discussionmentioning

confidence: 86%

Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma

Miao¹,

Zhang²,

Zou³

et al. 2017

Transl. Lung Cancer Res.

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Section: Discussionmentioning

confidence: 86%

Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma

Miao¹,

Zhang²,

Zou³

et al. 2017

Transl. Lung Cancer Res.

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“…And when using a threshold of greater or equal to16.1 mm for size measurement and enhanced monochromatic CT number of 140 keV greater or equal to −476.4 HU together, the diagnostic capacity and sensitivity for IA increased. This means that size and CT number in enhanced monochromatic image at 140 keV were complementary parameters for the diagnosis of IA.Regarding the morphologic CT features of pGGNs, in previous study, an internal air bronchogram (5,8,24) or pleural retraction (6,7) are associated with invasiveness of GGNs or even pGGNs (5-8). While another study (25) reported that no significant morphologic differences were observed in pGGNs, including bubble lucency, lobulation, spiculation and pleural retraction.…”

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confidence: 92%

Analysis of pulmonary pure ground-glass nodule in enhanced dual energy CT imaging for predicting invasive adenocarcinoma: comparing with conventional thin-section CT imaging

Zhang

Tang

et al. 2017

J. Thorac. Dis.

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Background: To investigate the value of dual energy computed tomography (DECT) parameters (including iodine concentration and monochromatic CT numbers) for predicting pure ground-glass nodules (pGGNs) of invasive adenocarcinoma (IA).Methods: A total of 55 resected pGGNs evaluated with both unenhanced thin-section CT (TSCT) and enhanced DECT scans were included. Correlations between histopathology [adenocarcinoma in situ (AIS), minimally IA (MIA), and IA] and CT scan characteristics were examined. CT scan and clinicodemographic data were investigated by univariate and multivariate analysis to identify features that helped distinguish IA from AIS or MIA.Results: Both normalized iodine concentration (NIC) of IA and slope of spectral curve [slope(k)] were not significantly different between IA and AIS or MIA. Size, performance of pleural retraction and enhanced monochromatic CT attenuation values of 120-140 keV were significantly higher for IA. In multivariate regression analysis, size and enhanced monochromatic CT number of 140 keV were independent predictors for IA. Using the two parameters together, the diagnostic capacity of IA could be improved from 0.697 or 0.635 to 0.713.Conclusions: DECT could help demonstrate blood supply and indicate invasion extent of pGGNs, and monochromatic CT number of higher energy (especially 140 keV) would be better for diagnosing IA than lower energies. Together with size of pGGNs, the diagnostic capacity of IA could be better. Several researches have used thin-section CT (TSCT) to distinguish IA from the preinvasive adenocarcinoma or MIA in terms of CT number and morphologic characteristics such as size, margin, bubble lucency, and solid proportion, and have indicated that the solid proportion has correlation with the degree of invasion of ground-glass nodules (GGNs) (4-9).Sometimes, GGNs would have no solid component, which are named pure GGNs (pGGNs). Most pGGNs tend to be preinvasive (1), while approximately 20-40% of pGGNs are pathologically malignant (10). Because of the limited resolution (0.2-0.3 mm) of CT images, stromal or myofibroblastic invasion of 5 mm or smaller in MIA or even IA greater than 5 mm in size may manifest as pGGN on high resolution CT (5). It has been proved that CT attenuation of IA is higher than its precursors (11), but there is no consensus over the cutoff of CT attenuation to indicate pGGN of IA. One study suggests that pGGNs with mean CT attenuation >−472 Hounsfield unit (HU) are more likely to be IA, with sensitivity of 75% and specificity of 81% (12). Angiogenesis is a fundamental process in the development of tumors, but enhancement characteristics of GGNs are often very difficult to assess because of low cellularity, and there are few researches about the enhancement characteristics of GGNs. Li et al. (13) found that the solid proportion of some GGNs (mostly in MIA or IA) would increase after contrast enhancement, and it could help for diagnosis of GGNs.Gemstone spectral imaging (GSI) analysis software is a specific tool in dual energy computed...

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“…This group of tumors are correlated with a favorable prognosis after surgical resection. However, evidence suggests that other more invasive, non-lepidic growth patterns of adenocarcinoma such as acinar and papillary have presented as GGO nodules (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological characteristics and prognosis of non-lepidic invasive adenocarcinoma presenting as ground glass opacity nodule

Moon¹,

Sung²,

Lee³

et al. 2016

J. Thorac. Dis.

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Background: Ground glass opacity (GGO) generally associated with the lepidic component of lung adenocarcinoma. However, in some cases, GGO nodules have been associated with invasive adenocarcinomas, where a lepidic component is minimal or absent. The purpose of this study is to evaluate the clinicopathological characteristics and prognosis of non-lepidic invasive adenocarcinoma presenting as GGO nodules. Methods: We reviewed computed tomography (CT) images from 168 patients diagnosed with non-lepidic invasive adenocarcinoma classified as stage T1N0M0 (≤3 cm) who underwent curative anatomical resection.Tumors were classified according to radiologic features: 31 were GGO predominant (Group A) and 137 were solid predominant (Group B). The clinicopathological findings and recurrence free survival were used as outcome measures. Results: The mean percentages of micropapillary and solid component in tumor was higher in Group B than Group A (P<0.001) Pleural invasion and lymphatic invasion were more frequently seen in Group B.The presence of tumors with a micropapillary component was higher in Group B (P=0.040). The 3-year recurrence-free survival was lower in Group B than Group A (80.4% vs. 100%, P=0.019). Risk factors for recurrence such as presence of a micropapillary component and lymphatic invasion were more frequently seen in Group B. Conclusions: Non-lepidic invasive adenocarcinoma presenting as GGO has fewer risk factors and better prognosis when compared with those presenting as solid tumors. Therefore, the presence of GGO on chest CT is a good prognostic indicator for lung cancer irrespective of histomorphologic classification.

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Persistent Pure Ground-Glass Opacity Lung Nodules ≥ 10 mm in Diameter at CT Scan

Cited by 221 publications

References 20 publications

Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma

Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma

Analysis of pulmonary pure ground-glass nodule in enhanced dual energy CT imaging for predicting invasive adenocarcinoma: comparing with conventional thin-section CT imaging

Clinicopathological characteristics and prognosis of non-lepidic invasive adenocarcinoma presenting as ground glass opacity nodule

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