HRCT texture analysis for pure or part-solid ground-glass nodules: distinguishability of adenocarcinoma in situ or minimally invasive adenocarcinoma from invasive adenocarcinoma

Jpn J Radiol. 2018 Feb;36(2):113-121. doi: 10.1007/s11604-017-0711-2. Epub 2017 Dec 22.


Purpose: To distinguish between adenocarcinoma in situ (AIS)-minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) showing pure or part-solid ground-glass nodules (GGNs) by high-resolution computed tomography (HRCT) texture analysis.

Materials and methods: This retrospective study included 101 consecutive patients with 115 pure or part-solid GGNs ≤ 3 cm diameter, which were surgically resected and pathologically diagnosed with AIS, MIA, or IAC (48 AIS-MIA and 67 IAC) between April 2011 and March 2015. Each tumor was manually segmented on axial CT images, and the following texture features were calculated: volume, mass, mean CT value, variance, skewness, kurtosis, entropy, uniformity, and percentile CT numbers (10th, 25th, 50th, 75th, 90th, 95th percentiles). The differences between AIS-MIA and IAC were statistically evaluated using univariate, multivariate, and receiver operating characteristic analysis.

Results: Compared with IAC, AIS-MIA had significantly greater skewness, kurtosis, and uniformity, whereas in the other parameters, AIS-MIA demonstrated significantly lower values than those of IAC. Multivariate analysis revealed that independent differentiators were the 90th percentile CT numbers (P < 0.001) and entropy (P = 0.005) with an excellent accuracy (area under the curve, 0.90).

Conclusions: The 90th percentile CT numbers and entropy can accurately distinguish AIS-MIA from IAC.

Keywords: Adenocarcinoma in situ; Ground-glass nodule; High-resolution computed tomography; Minimally invasive adenocarcinoma; Texture analysis.

MeSH terms

  • Adenocarcinoma / diagnostic imaging*
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Adenocarcinoma in Situ / diagnostic imaging
  • Adenocarcinoma in Situ / pathology
  • Adenocarcinoma in Situ / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Diagnosis, Differential
  • Female
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • ROC Curve
  • Retrospective Studies
  • Tomography, X-Ray Computed / methods*