| Objective: To investigate the relationship of epidermal growth factor receptor(EGFR)mutation in peripheral lung adenocarcinoma with quantitative CT of ground-glass opacity(GGO)and pathological features.Materials and Methods: CT and clinical data of 245 patients with peripheral lung adenocarcinoma confirmed by postoperative pathology were retrospectively analyzed.There were 75 males and 170 females,the age arranged from 27 to 81 years old and the average age was 60.3.Amplification refractory mutation system(ARMS)was applied to detect the mutation of EGFR gene,including exon 18 missense mutation,exon19 deletion mutation,exon 20 insertion mutation and exon 21 missense mutation.Histological subtypes were classified according to 2015 WHO classification of lung adenocarnoma.The percentage of GGO volume were measured by using post-processing workstation on Siemens Somatom Definition Flash CT and all lesions were divided into four types: GGO greater than 0% and less than or equal to 25%(typeⅠ),GGO greater than 25% and less than or equal to 50%(type Ⅱ),GGO greater than 50% and less than or equal to 75%(type Ⅲ),GGO greater than 75% and less than or equal to 100%(typeⅣ).According to the maximum diameter of tumor,all lesions were divided into six groups:1.0 cm or smaller,greater than 1.0 cm and less than or equal to 1.5 cm,greater than 1.5 cm and less than or equal to 2.0 cm,greater than 2.0 cm and less than or equal to2.5 cm,greater than 2.5 cm and less than or equal to 3.0 cm,and greater than 3.0cm.Distribution of EGFR mutation according to sex,smoking status,histologic subtype,tumor diameter and classification of GGO volume percentage on CT was analyzed by using χ2 test,there was a statistical significance when P was less than0.05.Two-sided χ2 trend test was used to assess the correlation between distribution of EGFR mutation and the classification of GGO volume percentage on CT,there was statistically significant when P was less than 0.01.Results:EGFR mutation and exon 21 missense mutation were significantly more frequent in women(81.2%,50.6%)than men(65.3%,36.0%),P<0.05.EGFR mutation and exon 21 missense mutation were also significantly more frequent in nonsmokers(81.0%,51.5%)than smokers(55.6%,22.2%),P<0.05.There was a correlation of pathological features with EGFR mutation.The frequency of EGFR mutation in invasive mucinous adenocarcinoma(0%)was lower than other subtypes(79.2%),P<0.05.Exon 21 missense mutation was more frequent in lepidic predominant adenocarcinomas(65.8%)than other subtypes(37.3%),P < 0.05.The frequency of exon 19 missense mutation in lepidic predominant adenocarcinomas(13.2%)was lower than other subtypes(29.0%),P<0.05.There was no significant difference between the maximum diameter of tumor and EGFR mutation,P > 0.05.There was a correlation of the classification of GGO volume percentage with exon 21 missense and exon 19 deletion mutation,P<0.05.The frequency of exon 21 missense mutation in type Ⅳ(57.7%)was higher than typeⅠ(29.6%)(P <0.0083),but there were no statistically significant differences between any other two types.The frequency of exon 19 delete mutation in type Ⅱ(40.9%)was higher than typeⅣ(15.3%)(P<0.0083),but there were no statistically significant differences between any other two types.A significant trend of prevalence of exon 21 and 19 mutation with GGO volume percentage on CT was found(P<0.01).Conclusion: The sex,smoking status,pathologic characteristics and GGO volume percentage on CT may be useful indicators to predict EGFR mutation in peripheral lung carcinoma with ground-glass opacity.EGFR mutaton and exon 21 mutation were significantly more frequent in women and nonsmokers.EGFR mutation was very little in invasive mucinous adenocarcinoma and exon 21 missense mutation was significantly more frequent in lepidic predominant adenocarcinomas.Exon 21 missense mutation is more often found as GGO volume percentage on CT increases,and exon 19 delete mutation is more often found as GGO volume percentage on CT decreases. |
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