Predicting the histological invasiveness of pulmonary adenocarcinoma manifesting as persistent pure ground-glass nodules by ultra-high-resolution CT target scanning in the lateral or oblique body position
Predicting the histological invasiveness of pulmonary adenocarcinoma manifesting as persistent pure ground-glass nodules by ultra-high-resolution CT target scanning in the lateral or oblique body position
复制标题
侧位或斜位超高分辨率CT靶扫描预测持续性纯磨玻璃结节肺腺癌的组织学侵袭性
DOI：
10.21037/qims-20-1378
复制
发表时间：
2021-09-01
影响因子：
2.8
通讯作者：
Yu, Hong
中科院分区：
文献类型：
--
作者：
Ren, Hua;Liu, Fufu;Yu, Hong
背景资料：超高分辨率计算机断层扫描（U-HRCT）提高了图像质量，可以显示疾病状态和肺解剖的详细特征。本研究的目的是回顾性检查U-HRCT靶扫描是否在侧卧位或斜位G扫描可以预测表现为纯磨玻璃样结节（pGGNs）的肺腺癌的组织学侵袭性。2015年1月至2016年12月，回顾性分析了260例患者的306个病理证实的pGGN，这些患者接受了术前G扫描方案。使用正交多平面重组（MPR）图像手动比较和分析浸润前病变[非典型腺瘤性增生（AAH）和原位腺癌（AIS）]和浸润性肺腺癌[微创腺癌（MIA）和浸润性腺癌（IAC）]的U-HRCT表现。建立逻辑回归模型以确定可以预测pGGN侵袭性的变量。结果：213例肺浸润前病变（AAH 59例，AIS 154例）和93例浸润性肺腺癌（MIA 53例，IAC 40例）中，AAH和AIS的诊断率分别为99.7%和99.7%。与浸润前病变相比，浸润性腺癌的直径更大（13.5 vs. 9.3 mm，P=0.000），平均衰减更高（-571 vs. -613 HU，P=0.002），代表性衰减较高（-475 vs. -547 HU，P=0.000），相对衰减较低（-339 vs. -292 HU，P=0.000）和异质性频率更高（P=0.001）、支气管充气征（P=0.000）、气泡透亮征（P=0.000）和胸膜凹陷征（P=0.000）。多因素Logistic回归分析显示，直径较大（OR = 1.328，95%CI：1.208-1.461，P=0.000）和代表性密度较高（OR = 1.005，95%CI：1.003-1.007，P=0.000）是浸润性肺腺癌的显著预测因素。浸润性肺腺癌的最大直径的最佳临界值为大于10 mm（敏感性为66.7%;特异性为72.8%）。最大直径和代表性衰减是预测侵袭性的重要参数。
Background: Ultra-high-resolution computed tomography (U-HRCT) has improved image quality for displaying the detailed characteristics of disease states and lung anatomy. The purpose of this study was to retrospectively examine whether U-HRCT target scanning in the lateral or oblique body position (protocol G scan) could predict histological invasiveness of pulmonary adenocarcinoma manifesting as pure groundglass nodules (pGGNs).Methods: From January 2015 to December 2016, 260 patients with 306 pathologically confirmed pGGNs who underwent preoperative protocol G scans were retrospectively reviewed and analyzed. The U-HRCT findings of preinvasive lesions [atypical adenomatous hyperplasias (AAH) and adenocarcinomas in situ (AIS)] and invasive pulmonary adenocarcinomas [minimally invasive adenocarcinomas (MIA) and invasive adenocarcinomas (IAC)] were manually compared and analyzed using orthogonal multiplanar reformation (MPR) images. The logistic regression model was established to determine variables that could predict the invasiveness of pGGNs. Receiver operating characteristic (ROC) curve analysis was performed to evaluate their diagnostic performance.Results: There were 213 preinvasive lesions (59 AAHs and 154 AISs) and 93 invasive pulmonary adenocarcinomas (53 MIAs and 40 IACs). Compared with the preinvasive lesions, invasive adenocarcinomas exhibited a larger diameter (13.5 vs. 9.3 mm, P=0.000), higher mean attenuation (-571 vs. -613 HU, P=0.002), higher representative attenuation (-475 vs. -547 HU, P=0.000), lower relative attenuation (-339 vs. -292 HU, P=0.000) and greater frequencies of heterogeneity (P=0.001), air bronchogram (P=0.000), bubble lucency (P=0.000), and pleural indentation (P=0.000). Multiple logistic analysis revealed that larger diameter [odds ratio (OR), 1.328; 95% CI: 1.208-1.461; P=0.000] and higher representative attenuation (OR, 1.005; 95% CI: 1.003-1.007; P=0.000) were significant predictive factors of invasive pulmonary adenocarcinomas from preinvasive lesions. The optimal cut-off value of the maximum diameter for invasive pulmonary adenocarcinomas was larger than 10 mm (sensitivity, 66.7%; specificity, 72.8%).Conclusions: The imaging features based on protocol G scanning can effectively help predict the histological invasiveness of pGGNs. The maximum diameter and representative attenuation are important parameters for predicting invasiveness.