MSCT Imaging Features Of Single Lung Ground Glass Micronodules On The Value Of Diagnosis And Invasive Prediction Of Lung Adenocarcinom

Part I:Diagnostic value of MSCT imaging features of single pulmonary ground-glass micronodules of lung adeonocarcinomaObjectives:To investigate the diagnosis prediction value of multi-slice computed tomography(MSCT)imaging features of single pulmonary ground-glass micro-nodules(<10 mm)among atypical adenomatoushyperplasia(AAH),adenocarcinoma in situ(AIS),minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC),especially the diagnosis value of maximal lesion diameter and CT density of GGN amomg lung preinvasive,microinvasive and invasive adenocarcinoma lesions.Methods:A retrospective analysis of thin-slice thoracic MSCT examination was performed in a total of 272 pathological confirmed single pulmonary GGN,including 31 AAH,64 AIS,153 MIA and 24 IAC,among which 60 were males and 212 were females,in The first affiliated hospital of Soochow University from January,2015 to December,2017.The age of patients ranged from 26 to 78 years,and the mean age were 51.71±10.77 years.Among them,AAH+AIS:31+64,153 MIA and 24 IAC.The image evaluation included:position,density,marginal dichotomous sign,marginal burr sign,marginal spinous sign,tumor-lung interface,vascular bundle,bronchial aeration sign,vacuole sign,vascular penetration,adjacent pleural changes,and these all were recorded.Software analysis was performed using SPSS 17 statistics.The difference of MSCT imaging features among AAH+AIS,MIA and IAC were analyzed by Chi-square test,maximal lesion diameter and CT density of GGN among AAH+AIS,MIA and IAC were analyzed by one-way ANOVA;differential diagnosis efficacy among AAH+AIS,MIA and IAC was analyzed by receiver operator characteristic curve(ROC),and the cut-off value,diagnostic sensitivity and specificity were calculated.P<0.05 were considered statistically significance.Results:Significant differences were found on the characteristics of lesion location,density,marginal lobulation sign,marginal burr,lung tumor interface,vascular bundle,bronchial aeration sign,vacuole sign,no inflation sign and vacuole sign and vascular penetration among the 3 group(all p<0.05),whereas no difference was found on the gender,age and the characteristics of pleural sag(all p>0.05).The optimal cut-off value of maximal transverse diameter of lesions in diagnosis of AAH+AIS and IAC,AAH+AIS and MIA,and AAH+AIS and MIA+IAC was respectively 7.70 mm(Sensitivity:0.917,Specificity:0.305),7.15 mm(Sensitivity:0.497,Specificity:0.379)and 7.15 mm(Sensitivity:0.554,Specificity:0.305).The optimal cut-off value of CT density of lesions in diagnosis of AAH+AIS and IAC,pre-invasion AAH+AIS and MIA,and AAH+AIS and MIA+IAC was respectively-539.5 HU(Sensitivity:1.00,Specificity:0.337),-562.5 HU(Sensitivity:0.778,Specificity:0.453)and-547.5HU(Sensitivity:0.746,Specificity:0.389).Conclusion:The MSCT imaging features of single pulmonary ground-glass micro-nodules(<10 mm)has important diagnosis value among AAH+AIS,MIA and IAC.Simultaneously,the maximum lesion diameter and CT density of GGN could be of good diagnosis efficacy among AAH+ AIS,MIA and IAC.Part II:Diagnostic prediction value of the internal bronchial and vascular structure of single pulmonary ground-glass micro-nodules(<10 mm)on the invasiveness of lung adenocarcinomaObjective:To investigate the diagnostic prediction value of the internal bronchial and vascular structure of single pulmonary ground-glass micro-nodules(<10 mm)on the invasiveness of the lesions.Methods:A retrospective analysis of thin-slice thoracic MSCT examination was performed in a total of 272 pathological confirmed single pulmonary GGN,including 31 AAH,64 AIS,153 MIA and 24 IAC,in The first affiliated hospital of Soochow University from January,2015 to December,2017.The types of GGN were classified into 4 types according to the relationship with adjacent blood vessels:type I,with blood vessels bypassing GGN;type II,intact blood vessels passing through GGN without distortional expansion;type III,blood vessels twisting and expanding within GGN;type IV,others complex vascular signs.The types of relationship with adjacent bronchus were divided into 3 types:type I,no bronchus or bronchus in the nodules bypassing the lesion;type II,small bronchus passed through the lesion with normal route;type III,small bronchi entered the lesion,and distorted,thickened,narrowed,expansion,truncation,etc.Statistical analysis was performed by Chi-square test on difference of internal bronchial and vascular structure among different pathological types of GGN.Results:Statistical significance was found between the different vascular types and the bronchial types(χ2=55.932,P=0.002).And,statistical significance was found between different vascular types,different bronchial types and different pathological types of AAH,AIS,MIA and IAC(x2=131.965,P<0.001).The sensitivity,specificity,positive predictive rate,negative predictive rate,and diagnostic accuracy of combined vascular and bronchial classification for pre-invasion(AAH+AIS)and invasive adenocarcinoma(MIA+IAC)were respectively 93.7%,86.9%,79.4%,96.2%and 89.2%.Conclusions:Elucidation of the internal bronchial and vascular structure of lung ground glass micronodules(<10 mm)has high diagnostic prediction value for invasiveness of lung adenocarcinoma.