Quantitative CT analysis of pulmonary ground-glass opacity nodules for distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma: the added value of using iodine mapping

Son, Ji Ye; Lee, Ho Yun; Kim, Jae‐Hun; Han, Joungho; Jeong, Ji Yun; Lee, Kyung Soo; Kwon, O Jung; Shim, Young Mog

doi:10.1007/s00330-015-3816-y

Cited by 116 publications

(71 citation statements)

References 31 publications

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“…However, there are few previous researches assessing the amount of enhancement in pGGNs (14-16). Recently, Son et al (16) found that combining with texture analysis and DECT imaging, the heterogeneity within the tumors on the iodine-enhanced imaging was more obvious than virtual non-contrast (VNC) imaging, and could improve the power of diagnosing IA. However, texture analysis is a complicated and time-consuming analysis method, and is still not in common use now.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Using iodine decomposition imaging of DECT, some researchers have observed enhancement of GGNs (14)(15)(16). Because iodine concentration (IC) would not be affected by air in lesions, it is considered to reflect blood volume better than CT number in GGNs (14).…”

Section: Original Articlementioning

confidence: 99%

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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“…Indeed, in some cases, GGO nodules have been associated with non-lepidic invasive adenocarcinoma. For those reasons, recent studies have been conducted to ascertain the predictive factors for the presence of invasive adenocarcinoma when GGO nodules are present (19)(20)(21). We defined GGO-predominant nodules as those with a C/T ratio <0.5 and solid-predominant nodules as those with a C/T ratio ≥0.5.…”

Section: Discussionmentioning

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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“…Recently, the use of chest computed tomography (CT) for lung cancer screening and ground glass opacity (GGO) detection has increased. The persistent presence of GGO nodules on CT usually suggests the presence of lung adenocarcinoma or a precancerous lesion (2). Since GGO tumor is considered to have a lepidic pattern, which is noninvasive in many cases, a tumor with more GGO content generally has a better prognosis (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

et al. 2016

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Background: The prognosis of non-small cell lung cancer (NSCLC) presenting as a ground glass opacity (GGO) nodule is better than other types of lung cancer. The purpose of this study was to evaluate the necessity of mediastinal lymph node evaluation (MLE) in clinical N0 GGO-predominant NSCLC. Methods:We conducted a retrospective chart review of 358 patients treated for clinical N0 NSCLC that was found by curative resection to be 3 cm or smaller in size. We analyzed clinicopathological findings and survival among three groups with either GGO-predominant or solid-predominant tumor: no mediastinal lymph node evaluation (NoMLE) group, mediastinal lymph node sampling (MLS) group, and mediastinal lymph node dissection (MLND) group.Results: Except for sex, there were no differences in clinicopathological characteristics among the three groups with GGO-predominant tumor or solid-predominant tumor. There was no difference in the 5-year recurrence-free survival (RFS) rate among three groups in the GGO-predominant patients (100%, 92.9%, 93.8%, respectively; P=0.889). However, in the solid-predominant tumor group, the 5-year recurrence free survival of the NoMLE group was lower than in the MLND group (48.6% vs. 73.1%, P=0.007). MLE was not a significant risk factor for recurrence in GGO-predominant tumor [hazard ratio (HR) =1.021; P=0.987].GGO-predominant tumor [odds ratio (OR) =0.063; P=0.008] was identified as the sole parameter that significantly impacted nodal upstaging.Conclusions: MLE is not an essential procedure for clinical N0 NSCLC presenting as a 3 cm or smaller GGO-predominant nodule.

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Quantitative CT analysis of pulmonary ground-glass opacity nodules for distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma: the added value of using iodine mapping

Abstract: Quantitative analysis using DECT was used to distinguish invasive adenocarcinoma. Tumour mass and uniformity were independent predictors of invasive adenocarcinoma. Diagnostic performance was improved after adding iodine parameters to VNC parameters.

Cited by 116 publications

References 31 publications

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

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

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

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