The Study Of Correlation Between HRCT Image Features Of Lung Ground-glass Nodules And Histological Type Of Lung Adenocarcinoma And EGFR Gene Detection

Part Ⅰ:Correlation between HRCT image features of lung ground-glass nodules and histological type of lung adenocarcinoma[Objective]The study is to analyze the image features of high resolution CT(HRCT)on pulmonary ground-glass nodules and to compare with histological type of lung adenocarcinoma.To assess the valuable effection of HRCT on differential diagnosis of histological type in lung adenocarcinoma and provide a theoretical basis for the treatment of lung adenocarcinoma.[Materials and Methods]The chest(Somatom Definition,Siemens)examination was performed in our hospital from October 2014 to October 2017.In addition,HRCT detected at least one pathologically confirmed with GGN in the lungs,and a total of 129 patients were included.There were 42 males and 87 females with an average age of 56.8 years.HRCT imaging features of GGN were analyzed.Signs include:lesion size(mean diameter),CT value(average CT value and relative CT value),lesion morphology,margin,interface,internal structure(vocule sign or air bronchogram,bronchial truncation)and adjacent structures(pleural concavity,vessel convergence).Above of HRCT image features were compared with the pathological results(AAH,AIS,MIA,I AC group)and pathological subtype(lepidic type,acinar type,papillary type).SPSS21.0 statistical software was used for data analysis.[Results]There was no significant difference in lesion morphology and gender between the AAH group,AIS group,the MIA group and the IAC group(P>0.05).The difference between AAH,AIS,MIA and IAC in age was statistically significant(P<0.05).The difference between the four groups were statistically significant in lesion margin,interface,internal structure(vocule sign or air bronchogram,bronchial truncation)and adjacent structures(pleural concavity,vessel convergence)(P<0.05).In the quantitative features of GGN,lesion size,CT value(average CT value and relative CT value),the difference between the four groups were statistically significant(P<0.001).According to the pathological subtype of lung adenocarcinoma,(lepidic type,acinar type,papilla type)were found statistically significant in the internal structure(vocule sign or air bronchogram),vessel convergence and CT value(average CT value and relative CT value)(P<0.05).Comparison of average CT value:the CT value of papillary adenocarcinoma was higher than the lepidic type and the acinar type(P<0.05);the CT value of acinar adenocarcinoma was higher than the lepidic type(P<0.05).Comparison of CT value:only papilla type and acinar type adenocarcinoma was statistically significant(P<0.05).[Conclusion]The HRCT image features of GGN(including lesion margin,interface,vocule sign or air bronchogram,bronchial truncation,pleural depression and vessel convergence)can be used as a reliable basis for the differential diagnosis of AAH,AIS,MIA and IAC.In addition,vocule sign or air bronchogram and vessel convergence,average CT value and relative CT value differences can be used as an important reference to identify IAC pathological subtype.Part Ⅱ:Correlation between EGFR gene detection and histological type of lung adenocarcinoma and HRCT imaging signs[Objective]To analyze EGFR gene mutation in patients with GGN of lung adenocarcinoma,and to compare with histological type of lung adenocarcinoma.To investigate the correlation between HRCT imaging signs with EGFR gene mutation,and the valuable effection of HRCT on differential diagnosis of histological subtype of lung adenocarcinoma.[Materials and Methods]During the period from October 2014 to October 2017,The chest(Somatom Definition,Siemens)CT was performed in our hospital.At least one lung GGN was detected by HRCT,which was pathologically confirmed and tested for EGFR.A total of 67 patients(24 males and 43 females)were included with an average age of 58.3 years.There were non-smokings in 47 cases and smokers in 20 cases.There were 9 cases with a clear family history and 58 cases without it.Gene detection was divided into EGFRwild-type group and EGFR mutant-type group.HRCT imaging included:lesion size(mean diameter),lesion morphology,margin,interface and internal structure(vocule sign or air bronchogram),adjacent structures(pleural concavity,vessel convergence),CT value(mean CT value and relative CT value),etc.The type(AIS,MIA and IAC)and the subtype(lepidic type,acinar type and papillary type)of lung adenocarcinoma were included.To observe the relationship between the HRCT imaging signs on GGN and histological type of lung adenocarcinoma with EGFR gene mutations.SPSS21.0 statistical software was used for data analysis.[Results]A total of 67 patients(30 cases in EGFR wild-type group and 37 cases in EGFR mutant-type group)were included.There were 27 female patients(27/37)and 31 non-smoking patients(31/37)in EGFR mutant-type group,it was statistically significance in gender and non-smoking(P<0.05).There was no statistical significance between the histological type(AIS,MIA,IAC)and family history with EGFR gene mutation(P>0.05).EGFR gene mutations were mostly focused on the exon 19 mutation(14/37)and the exon 21 mutation(22/37),accounted for more than 90%of the total mutation rate;only 1 case of point mutation in exon 20.There was no statistical significance between gender and the point of EGFR gene mutation(P>0.05).Comparing with the HRCT imaging signs of the two groups(EGFR wild-type group and EGFR mutant-type group),(vocule sign or air bronchogram)and vessel convergence were statistically significance(P<0.05);there was no statistical significance on age,lesion size and morphology,margin,interface,adjacent structures(pleural concavity)and CT value(P>0.05).EGFR gene mutation frequently occur in the pathologic subtype of lung adenocarcinoma dominated by acinar type(P<0.05)and there was statistical significance between EGFR wild-type group with papillary type of lung adenocarcinoma(P<0.05).There was no significant statistical significance between the lepidic type and EGFR gene mutation(P>0.05).[Conclusion]The mutation of EGFR often occurred in women and non-smoking patients.Mutations majorly concentrated on the lack of exon 19 mutations and exon 21 point mutations,both of which are approximately more than 90%of the total mutation rate.The imaging findings of the two groups(vocule sign and air bronchogram,vessel convergence)were statistically significance.EGFR gene mutations often been found in the acinar type and EGFR wild-type often occured in papillary type of lung adenocarcinoma.