Thin-section computed tomography–histopathologic comparisons of pulmonary focal interstitial fibrosis, atypical adenomatous hyperplasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma with pure ground-glass opacity

Si, Ming-Jue; Tao, Xiaofeng; Du, Guangye; Cai, Lingling; Han, Hongxiu; Liang, Xizi; Zhao, Jing

doi:10.1016/j.ejrad.2016.07.012

Cited by 51 publications

(38 citation statements)

References 29 publications

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“…In our study, the maximum diameter greater than 16.1 mm indicated IA independently, and this was similar with previous study (5)(6)(7)(8)23,24). 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.…”

Section: Discussionsupporting

confidence: 78%

“…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)(6)(7)(8). While another study (25) reported that no significant morphologic differences were observed in pGGNs, including bubble lucency, lobulation, spiculation and pleural retraction.…”

Section: Discussionmentioning

confidence: 86%

“…Analysis of pulmonary pure ground-glass nodule in enhanced dual energy CT imaging for predicting invasive adenocarcinoma: comparing with conventional thin-section CT imaging 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)(5)(6)(7)(8)(9).…”

Section: Original Articlementioning

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: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 86%

Section: Original Articlementioning

confidence: 99%

See 1 more Smart Citation

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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“…Consistently, one group also found that ages are comparable between AIS and MIA patients but showed correlation with the occurrence of IAC [11]. In contrast, it was also reported that age and smoking showed no obvious correlation with lung adenocarcinoma types [12]. Our results implied that more treatment should be adopted to inhibit tumor invasion for elder patients.…”

Section: Discussionsupporting

confidence: 84%

Features Based on Thin-section Computed Tomography Identify the Type of lung Adenocarcinoma

Li¹,

Zheng²,

Liu³

et al. 2020

Preprint

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Background: To investigate whether thin-section computed tomography (TSCT) features may efficiently guide the invasiveness basedclassification of lung adenocarcinoma. Methods: Totally, 316 lung adenocarcinoma patients (from 2011-2015) were divided into three groups: 56 adenocarcinoma in situ (AIS), 98 minimally invasive adenocarcinoma (MIA), and 162 invasive adenocarcinoma (IAC) according their pathological results. Their TSCT features, including nodule pattern, shape, pleural invasion, solid proportion, border, margin, vascular convergence, air bronchograms, vacuole sign, pleural indentation, diameter, solid diameter, and CT values of ground-glass nodules (GGN) were analyzed. Pearson’s chi-square test, Fisher’s exact test and One-way ANOVA were adopted tocomparebetweengroups. Receiver operating characteristic (ROC) analysis wereperformedto assess its value for prediction and diagnosis. Results: Patients with IAC were significantly elder than those in AIS or MIA group,and more MIA patients had a smoking history than AIS and IAC. No recurrence happened in the AIS and MIA groups, while 4.3% recurrences were confirmed in the IAC group. As for TSCT variables, we found AIS group showed dominantly higher 91.07%PGGN pattern and 87.50% round/oval nodules than that in MIA and IAC group. In contrast, MIA group showed more cases with undefined border and vascular convergence than AIS and IAC group. Importantly, IAC group uniquely showed higher frequency of pleural invasion compared with MIA and AIS group. The majority of patients (82.1%) in IAC group showed ≥ 50% solid proportion. We found diameter and solid diameter of the lesions were notably larger in the IAC group compared with AIS and MIA groupin quantitative aspect. In addition, for MGGNs, the CT values of ground-glass opacity (GGO) and ground-glass opacity solid portion (GGO-solid) were both higher in the IAC group than AIS and MIA. Finally, we also observed that smooth margin took a dominant proportion in the AIS group while most cases in the IAC group had a lobulate margin. Patients in MIA and IAC group shared higher level of air bronchograms and vacuole signs than AIS group. Conclusions: The unique features in different groups identified by TSCT had diagnosis value for lung adenocarcinoma.

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“…According to many articles in the eld, the incidence of these two signs in IAC is higher than that in non-IAC, which is consistent with the consequences of our investigation. It shows that air bronchogram sign and tumor vascular sign have important signi cance in the differential diagnosis between IAC and non-IAC [19] .…”

Section: Discussionmentioning

confidence: 97%

Control Study between CT Signs and Pathological Subtypes and Differentiation Degree in Lung Adenocarcinoma

Duan¹,

Shan²,

Bo³

et al. 2019

Preprint

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Background: To study the relationship between CT signs and pathological subtypes and differentiation degree in lung adenocarcinoma.Methods: We retrospectively reviewed 394 cases’ CT images of lung adenocarcinoma and compared the diversity of images among PIL, MIA and IAC, as well as differentiation degrees of IAC by Kruskal-Wall test and X2 test.Results: There was no statistical difference of CT sign between PIL and MIA (P＞0.05). There are statistical differences among size and density of PIL, MIA and IAC (P＜0.01); the incidences of pleura traction sign, spicule sign, lobulation sign, tumor vascular sign, bronchial cut-off sign, air bronchogram sign and cavity sign in IAC were higher than the other two groups (P＜0.05); there was no statistical difference of vacuole sign among PIL, MIA and IAC (P＞0.05). There are statistical differences among size and density of three differentiated subgroups (P＜0.01); the incidences of pleura traction sign, spicule sign, tumor vascular sign, bronchial cut-off sign and cavity sign in poorly differentiated subgroup were highest (P＜0.01); the incidence of air bronchogram sign in highly differentiated subgroup was higher than moderately and poorly differentiated subgroup while incidence of lobulation sign was the lowest in three subgroups above (P＜0.05) ; there was no statistical difference of vacuole sign among three differentiated subgroups (P＞0.05).Conclusions: CT signs of lung adenocarcinoma are closely related to pathological subtypes and differentiation degrees，which would have great value to help predict tumor types and make treatment plans in clinical.

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Thin-section computed tomography–histopathologic comparisons of pulmonary focal interstitial fibrosis, atypical adenomatous hyperplasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma with pure ground-glass opacity

Cited by 51 publications

References 29 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

Features Based on Thin-section Computed Tomography Identify the Type of lung Adenocarcinoma

Control Study between CT Signs and Pathological Subtypes and Differentiation Degree in Lung Adenocarcinoma

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