Significance of intra-nodular vessel sign in differentiating benign and malignant pulmonary ground-glass nodules

Abstract

Background The presence of pulmonary vessels inside ground-glass nodules (GGNs) of different nature is a very common occurrence. This study aimed to reveal the significance of pulmonary vessels displayed in GGNs in their diagnosis and differential diagnosis. Results A total of 149 malignant and 130 benign GGNs confirmed by postoperative pathological examination were retrospectively enrolled in this study. There were significant differences in size, shape, nodule-lung interface, pleural traction, lobulation, and spiculation (each p < 0.05) between benign and malignant GGNs. Compared with benign GGNs, intra-nodular vessels were more common in malignant GGNs (67.79% vs. 54.62%, p = 0.024), while the vascular categories were similar (p = 0.663). After adjusting the nodule size and the distance between the nodule center and adjacent pleura [radius–distance ratio, RDR], the occurrences of internal vessels between them were similar. The number of intra-nodular vessels was positively correlated with nodular diameter and RDR. Vascular changes were more common in malignant than benign GGNs (52.48% vs. 18.31%, p < 0.0001), which mainly manifested as distortion and/or dilation of pulmonary veins (61.19%). The occurrence rate, number, and changes of internal vessels had no significant differences among all the pre-invasive and invasive lesions (each p > 0.05). Conclusions The incidence of internal vessels in GGNs is mainly related to their size and the distance between nodule and pleura rather than the pathological nature. However, GGNs with dilated or distorted internal vessels, especially pulmonary veins, have a higher possibility of malignancy.

Differential Diagnosis of Nonabsorbable Inflammatory and Malignant Subsolid Nodules with a Solid Component ≤5 mm

“…Unlike inflammatory PSNs, we found that the solid component in malignant PSNs predominantly appeared as an irregular shape with a scattered or eccentric distribution, which was consistent with previous results. 25–28 We also found that the intra-nodular vessel sign which could be evaluated only in SSNs was frequently observed in both groups, which was in agreement with the findings of Gao et al 3 and Fu et al 29 who showed that intra-nodular vessels can be observed in both inflammatory and malignant nodules. Furthermore, Gao et al 3 , 30 indicated that abnormal changes of the blood vessels passing through the nodules are highly suggestive of malignancy.…”

Quantitative evaluation of density variability in the lesion–lung boundary zone to differentiate pulmonary subsolid nodules

“…With the widespread use of multidetector computed tomography (CT) for lung cancer screening, the detection of incidental pulmonary nodules, especially subsolid nodules (SSNs), has become viable (1)(2)(3)(4). SSNs can be classified into part-solid nodules (PSNs) and pure ground-glass nodules (pGGNs) based on whether they contain solid components (5)(6)(7)(8).…”

“…Many studies have been conducted on the differentiation between benign and neoplastic SSNs, but these have mainly been based on the morphological characteristics of SSNs, such as lobulation, spiculation, border, margin, vacuole, air bronchogram, and pleural indentation (1,(12)(13)(14)(15). Although these studies demonstrated that neoplastic SSNs tended to have more lobulation, spiculation, air bronchogram, or pleural indentation compared to benign SSNs, some of these features were also common in benign SSNs.…”

A novel nomogram model combining CT texture features and urine energy metabolism to differentiate single benign from malignant pulmonary nodule

“…Therefore, the accurate diagnosis of lung nodules is particularly important. Although conventional CT features are helpful in identifying benign and malignant nodules, there is still some controversy as to which morphological features are valuable for the differential diagnosis of pulmonary nodules ( 6 ).…”