Value of TSCT Features for Differentiating Preinvasive and Minimally Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as Subsolid Nodules Smaller Than 3 cm

Hailin Wang; Qiaoyou Weng; Junguo Hui; Shiji Fang; Xulu Wu; Weibo Mao; Minjiang Chen; Liyun Zheng; Zufei Wang; Zhongwei Zhao; Limin Zhou; Jianfei Tu; Min Xu; Yuan Huang; Jiansong Ji

doi:10.1016/j.acra.2019.05.005

Value of TSCT Features for Differentiating Preinvasive and Minimally Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as Subsolid Nodules Smaller Than 3 cm

Acad Radiol. 2020 Mar;27(3):395-403. doi: 10.1016/j.acra.2019.05.005. Epub 2019 Jun 11.

Authors

Hailin Wang¹, Qiaoyou Weng¹, Junguo Hui¹, Shiji Fang¹, Xulu Wu¹, Weibo Mao², Minjiang Chen¹, Liyun Zheng¹, Zufei Wang¹, Zhongwei Zhao¹, Limin Zhou¹, Jianfei Tu¹, Min Xu¹, Yuan Huang³, Jiansong Ji⁴

Affiliations

¹ Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China.
² Department of Pathology, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, China.
³ Department of Pathology, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, China. Electronic address: zjlshuangyuan@126.com.
⁴ Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China. Electronic address: lschrjjs@163.com.

PMID: 31201034
DOI: 10.1016/j.acra.2019.05.005

Abstract

Background: To distinguish preinvasive (adenocarcinoma in situ/atypical adenomatous hyperplasia) and minimally invasive adenocarcinoma (MIA) from invasive adenocarcinoma (IA) appearing as solitary subsolid nodules (SSNs) less than 3 cm based on thin-section computed tomography (TSCT) features to guide therapeutic approaches.

Methods: A total of 154 lesions that were histopathologically confirmed to have pre/minimally invasive adenocarcinoma (hereafter pre/MIA) and IA presenting as part-solid nodules (PSNs) or pure ground-glass nodules (pGGNs) were retrospectively reviewed. The TSCT features, including diameter, area, CT value, shape, air bronchogram, margins, and location, were compared and assessed. Receiver operating characteristic analyses were conducted to determine the cut-off values for the qualitative variables and their diagnostic performances.

Results: Of 154 nodules, 89 IA, 53 MIA, eight adenocarcinoma in situ, and four atypical adenomatous hyperplasia lesions were found. Univariate and multivariate logistic regression of the pre/MIA and IA lesions were compared and analyzed among PSNs and pGGNs. Among pGGNs, a significant difference was found in the area (p = 0.004, odds ratio [OR] = 0.124, 95% confidence interval [CI] = 0.300-0.515) between the pre/MIA and IA groups. In PSNs, significant differences were found in the diameter (p = 0.001, OR = 0.171, 95% CI = 0.063-0.467) and CT value (p = 0.001, OR = 0.996, 95% CI = 0.993-0.998) between the pre/MIA and IA groups. According to the corresponding receiver operating characteristic curves, the optimal cut-off tumor area in pGGNs to differentiate pre/MIA from IA was 0.595 cm². A higher CT value of the lesion (≥ -298.500 HU) and a larger diameter (≥1.450 cm) in PSNs were significantly associated with IA.

Conclusion: Imaging features from TSCT contribute to distinguishing pre/MIA from IA in solitary subsolid nodules and may contribute to guide the clinical management of these lesions.

Keywords: Subsolid nodule; distinguish; imaging features; thin-section computed tomography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma* / diagnostic imaging
Female
Humans
Lung Neoplasms* / diagnostic imaging
Neoplasm Invasiveness
ROC Curve
Retrospective Studies
Tomography, X-Ray Computed