Predicting malignancy: subsolid nodules detected on LDCT in a surgical cohort of East Asian patients

Abstract

Background: Due to widespread use of low-dose computed tomography (LDCT) screening, increasing number of patients are found to have subsolid nodules (SSNs). The management of SSNs is a clinical challenge and primarily depends on CT imaging. We seek to identify risk factors that may help clinicians determine an optimal course of management. Methods: We retrospectively reviewed the characteristics of 83 SSN lesions, including 48 pure groundglass nodules and 35 part-solid nodules, collected from 83 patients who underwent surgical resection. Results: Of the 83 SSNs, 16 (19.28%) were benign and 67 (80.72%) were malignant, including 23 adenocarcinomas in situ (AIS), 16 minimally invasive adenocarcinomas (MIA), and 28 invasive adenocarcinomas (IA). Malignant lesions were found to have significantly larger diameters (P<0.05) with an optimal cut-off point of 9.24 mm. Significant indicators of malignancy include female sex (P<0.05), air bronchograms (P<0.001), spiculation (P<0.05), pleural tail sign (P<0.05), and lobulation (P<0.05). When compared with AIS/MIA combined, IA lesions were found to be larger (P<0.05) with an optimal cutoff of 12 mm, and have a higher percentage of part-solid nodules (P<0.001), pleural tail sign (P<0.001), air bronchograms (P<0.05), and lobulation (P<0.05). Further multivariate analysis found that lesion size and spiculation were independent factors for malignancy while part-solid nodules were associated with IA histology. Conclusions: East Asian females are at risk of presenting with a malignant lesion even without history of heavy smoking or old age. Nodule features associated with malignancy include larger size, air bronchograms, lobulation, pleural tail sign, spiculation, and solid components. A combination of patient characteristic and LDCT features can be effectively used to guide management of patients with SSNs.

Clinical and CT Radiomics Nomogram for Preoperative Differentiation of Pulmonary Adenocarcinoma From Tuberculoma in Solitary Solid Nodule

“…Patients with LAC had a higher age of onset than tuberculosis patients, which could be caused by decreased immunity, cell damage caused by long-term chronic disease, or an increased risk of genetic errors in the old. Malignant nodule was more likely to have a lobulated sign because of invasive growth of malignant cells in the pulmonary interstitium, which was consistent with previous research ( 26 , 27 ). Vacuole sign refers to the presence of a small air-like low-density shadow within the nodule with smooth edges and no more than 5 mm.…”

Differential diagnosis of benign and malignant patchy ground-glass opacity by thin-section computed tomography

“…d VR image shows that the lesion is located among the blood vessels (white arrows). GGO, ground-glass opacity; mGGO, mixed ground-glass opacity; VR, volume rendering [23][24][25][26][27][28][29]. In this study, malignant GGOs were also more frequently found in old and female patients.…”

“…Previous studies found that the lesion size was a good indicator of malignant GGNs or invasiveness [1,19,20,23,[31][32][33]. Smaller nodules are commonly benign, while larger ones tend to be malignant [1,19,23,31].…”

Radiomics Methods to Differentiate Metastasis and Primary Lung Cancer of Breast Cancer Patients in PET/CT

“…As previous research proved that LDCT has a very good ability in the identification of lung lesions [Error! Bookmark not defined., 23,24] . And in our study, LDCT has a thinner scan thickness, and its resolution is higher than that of CT and PET images, so it can display more details, and extracting an modeling better of radiomics features.…”