Analysis Of Clinical,radiological And Pathological Characteristics With Early Lung Adenocarcinoma With Pulmonary Subsolid Nodules

Objective: The correlation between clinical data,radiological characteristics,pathological diagnosis,subtype and invasion degree of 625 patients with Subsolid Nodules(SSNs)of lung was retrospectively analyzed to provide theoretical basis for screening,early diagnosis and treatment of early lung adenocarcinoma and selection of the best time for operation.Methods: The clinical,radiological data and pathological diagnosis information of patients with pulmonary nodules diagnosed as lung adenocarcinoma were retrospectively collected from the First Affiliated Hospital of Anhui Medical University from June 2019 to December 2022.General clinical data(size,density,age,disease history,serum tumor markers,etc.)were obtained from medical records.Radiological data(such as the location of nodules,single nodule /double nodules,the proportion of solid nodules,spiculation,etc.).According to the new international multidisciplinary classification of lung adenocarcinoma,the patients were divided into three groups according to the degree of invasion: Atypical adenomatous hyperplasia(AAH)and Adenocarcinomas in situ(AIS),Minimally Invasive adenocarcinomas(MIA)and Invasive adenocarcinomas(IAC).The IAC group was further divided into four subgroups according to different subtypes: lepidic predominant invasive adenocarcinoma(LPA),acinar predominant invasive adenocarcinoma(APA),papillary predominant invasive adenocarcinoma(PPA),solid predominant invasive adenocarcinoma(SPA),micropapillary predominant invasive adenocarcinoma(MPA).SPSS 25.0 was used to analyze the data of different categories.Univariate analysis was used to analyze the correlation between the clinical data and radiological data of nodules corresponding to different pathological types.Binary Logistic regression analysis was used to analyze the relevant data in univariate analysis,and to explore a single risk factor that can distinguish lung adenocarcinoma with different degrees of invasion.Results:1.General clinical and radiological data of 625 patients with pulmonary solid nodules were collected.According to pathological types,126 patients(20.16%)in the AAH and AIS groups,281 patients(44.96%)in the MIA group,and 218 patients(34.88%)in the IAC group were classified.There were 36 cases(16.51%)in the LPA group,105 cases(48.17%)in the APA group,27 cases(12.39%)in the PPA group,1 case(0.46%)in the MPA group,0 cases(0%)in the SPA group,and 49 cases(22.48%)with unknown subtypes according to different subtypes of IAC.2.Univariate analysis of the correlation between general clinical data and pathological types of 625 patients showed that age,cough,expectoration,CEA,CYFRA21-1 and D-dimer in the three groups were statistically significant(P<0.05).Further analysis of the correlation between the clinical data of IAC group and the four subtypes showed that CEA(P=0.048)was significantly different among the four groups.3.Univariate analysis of correlation between imaging data and pathological types showed that,Nodular size,nodular long diameter,foliation sign,size of solid component in nodules,size of solid component in nodules long diameter,proportion of solid component in nodules,pleural pulling,burr sign,vacuole sign,regular boundary or not,clear boundary or not were statistically significant differences among the three groups(P<0.05).Further analysis of the correlation between the radiological data of IAC group and the four subtypes showed that the location of pulmonary subsolid nodules(P<0.01)was statistically different among the four groups.4.Further univariate analysis of the relationship between the distribution of nodule size,long diameter and other factors and the pathological types of SSNs and different subtypes of IAC showed that there were statistically significant differences in the distribution of nodule size,long diameter,solid component size,long diameter of solid component and the proportion of solid component among the three pathological types(P<0.01).There were significant differences in the size of nodules and the length diameter of the solid component of nodules in the four subtypes of IAC(P<0.01).5.Binary Logistic regression analysis showed that the length of the nodule ≥10mm,the size of the solid component in the nodule≥8mm and the presence of pleural traction were statistically significant with the invasion of lung adenocarcinoma.Conclusions: Pulmonary subsolid nodules are often pathologically manifested as early lung adenocarcinoma-like lesions.The older the patient,the higher the cough,expectoration,CEA,CYFRA21-1 and D-dimer levels,the larger the nodule,the longer the diameter of the nodule,and the larger the solid component of the nodule.The larger the proportion of lobulation sign,spiculation sign,pleural traction,vacuole sign,irregular and unclear boundary,and solid component in the nodule,the higher the degree of pathological infiltration may be,which have a certain value for the differential diagnosis of the three groups.CEA level and nodule location are valuable for the identification of three subtypes of IAC.The long diameter of the nodule≥10mm,the size of the solid component in the nodule≥8mm,and the presence of pleural traction may be the decisive factors for judging the type of lung adenocarcinoma,which should be paid attention to in the daily follow-up of pulmonary nodules.