Correlation Between Imaging Features of Pure Ground-glass Opacities and Pathological Subtypes of Lung Minimally Invasive Adenocarcinoma and Precursor Lesions

Overview

Journal Sci Rep

Specialty Science

Date 2025 Mar 4

PMID 40038390

Authors

Yanqiu Zhu

Cui Yan

Wenjie Tang

Yani Duan

Xiuzhen Chen

Yunxu Dong

Yuefei Guo

Weimin Liu

Jie Qin

Affiliations

Soon will be listed here.

Abstract

This study aimed to investigate the relationship between imaging features of pure ground-glass opacities (pGGOs) and the pathological subtypes of minimally invasive adenocarcinoma (MIA) and precursor lesions. A retrospective analysis was conducted on data from 1521 patients diagnosed with GGOs as lung adenocarcinoma or precursor lesions between January 2015 and March 2021. The pGGOs were categorized into atypical adenomatous hyperplasia (AAH) / adenocarcinoma in situ (AIS) and MIA groups. Clinical information and CT imaging features were collected. Statistical analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis were performed. A total of 127 patients with 139 pGGOs were included. Maximum radiodensity, minimum radiodensity, mean radiodensity, variance, and skewness showed significant differences between the two groups. Maximum radiodensity and maximum cross-sectional area were identified as risk factors for pathology. The logistic regression model yielded an area under the curve (AUC) of 0.747 (95% CI, 0.666-0.816) for predicting pathological subtypes. The intensity features of pGGOs were found to be significantly different between AAH/AIS and MIA groups. Maximum radiodensity and skewness were independent risk factors for pathology. However, these features did not exhibit satisfactory diagnostic efficiency.

References

Church T, Black W, Aberle D, Berg C, Clingan K, Duan F . Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 2013; 368(21):1980-91. PMC: 3762603. DOI: 10.1056/NEJMoa1209120. View

Wilshire C, Louie B, Horton M, Castiglioni M, Aye R, Farivar A . Comparison of outcomes for patients with lepidic pulmonary adenocarcinoma defined by 2 staging systems: A North American experience. J Thorac Cardiovasc Surg. 2016; 151(6):1561-8. DOI: 10.1016/j.jtcvs.2016.01.029. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Xiang W, Xing Y, Jiang S, Chen G, Mao H, Labh K . Morphological factors differentiating between early lung adenocarcinomas appearing as pure ground-glass nodules measuring ≤10 mm on thin-section computed tomography. Cancer Imaging. 2015; 14:33. PMC: 4331838. DOI: 10.1186/s40644-014-0033-x. View

Warth A, Muley T, Meister M, Stenzinger A, Thomas M, Schirmacher P . The novel histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification system of lung adenocarcinoma is a stage-independent predictor of survival. J Clin Oncol. 2012; 30(13):1438-46. DOI: 10.1200/JCO.2011.37.2185. View

Hansell D, Bankier A, MacMahon H, McLoud T, Muller N, Remy J . Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008; 246(3):697-722. DOI: 10.1148/radiol.2462070712. View

Wang X, Wang L, Zhang W, Zhao H, Li F . Can we differentiate minimally invasive adenocarcinoma and non-invasive neoplasms based on high-resolution computed tomography features of pure ground glass nodules?. PLoS One. 2017; 12(7):e0180502. PMC: 5500348. DOI: 10.1371/journal.pone.0180502. View

Zeng H, Chen W, Zheng R, Zhang S, Ji J, Zou X . Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries. Lancet Glob Health. 2018; 6(5):e555-e567. DOI: 10.1016/S2214-109X(18)30127-X. View

Travis W, Brambilla E, Nicholson A, Yatabe Y, Austin J, Beasley M . The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol. 2015; 10(9):1243-1260. DOI: 10.1097/JTO.0000000000000630. View

10.

Chu Z, Li W, Fu B, Lv F . CT Characteristics for Predicting Invasiveness in Pulmonary Pure Ground-Glass Nodules. AJR Am J Roentgenol. 2020; 215(2):351-358. DOI: 10.2214/AJR.19.22381. View

11.

Kamiya A, Murayama S, Kamiya H, Yamashiro T, Oshiro Y, Tanaka N . Kurtosis and skewness assessments of solid lung nodule density histograms: differentiating malignant from benign nodules on CT. Jpn J Radiol. 2013; 32(1):14-21. DOI: 10.1007/s11604-013-0264-y. View

12.

Honda Y, Oka S, Chikaishi Y, Inoue M, Yoshida J, Yasuda D . Mediastinal lymph node metastases in lung cancer presenting as pure ground-glass nodules: A surgical case report. Int J Surg Case Rep. 2020; 70:5-7. PMC: 7183094. DOI: 10.1016/j.ijscr.2020.03.021. View

13.

Zhan Y, Peng X, Shan F, Feng M, Shi Y, Liu L . Attenuation and Morphologic Characteristics Distinguishing a Ground-Glass Nodule Measuring 5-10 mm in Diameter as Invasive Lung Adenocarcinoma on Thin-Slice CT. AJR Am J Roentgenol. 2019; 213(4):W162-W170. DOI: 10.2214/AJR.18.21008. View

14.

Yoshizawa A, Sumiyoshi S, Sonobe M, Kobayashi M, Fujimoto M, Kawakami F . Validation of the IASLC/ATS/ERS lung adenocarcinoma classification for prognosis and association with EGFR and KRAS gene mutations: analysis of 440 Japanese patients. J Thorac Oncol. 2012; 8(1):52-61. DOI: 10.1097/JTO.0b013e3182769aa8. View

15.

Russell P, Wainer Z, Wright G, Daniels M, Conron M, Williams R . Does lung adenocarcinoma subtype predict patient survival?: A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung.... J Thorac Oncol. 2011; 6(9):1496-504. DOI: 10.1097/JTO.0b013e318221f701. View

16.

Qi L, Xue K, Li C, He W, Mao D, Xiao L . Analysis of CT morphologic features and attenuation for differentiating among transient lesions, atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive and invasive adenocarcinoma presenting as pure ground-glass nodules. Sci Rep. 2019; 9(1):14586. PMC: 6786988. DOI: 10.1038/s41598-019-50989-1. View

17.

Kim H, Lee H, Choi Y, Choi S, Choi H, Lee J . Assessment of intratumoral heterogeneity of oncogenic driver mutations in surgically-resected lung adenocarcinoma: implications of percutaneous biopsy-based molecular assay for target-directed therapy. Anticancer Res. 2014; 34(2):707-14. View

18.

Li X, Ren F, Wang S, He Z, Song Z, Chen J . The Epidemiology of Ground Glass Opacity Lung Adenocarcinoma: A Network-Based Cumulative Meta-Analysis. Front Oncol. 2020; 10:1059. PMC: 7386063. DOI: 10.3389/fonc.2020.01059. View

19.

Jia M, Yu S, Cao L, Sun P, Gao H . Clinicopathologic Features and Genetic Alterations in Adenocarcinoma In Situ and Minimally Invasive Adenocarcinoma of the Lung: Long-Term Follow-Up Study of 121 Asian Patients. Ann Surg Oncol. 2020; 27(8):3052-3063. DOI: 10.1245/s10434-020-08241-y. View

20.

Travis W, Brambilla E, Riely G . New pathologic classification of lung cancer: relevance for clinical practice and clinical trials. J Clin Oncol. 2013; 31(8):992-1001. DOI: 10.1200/JCO.2012.46.9270. View