| Background and objectiveLung cancer is one of the malignant tumors which threatens human life and health.Its morbidity and mortality are both the highest in the world.About half of the patients with lung cancer die within one year after being diagnosed with lung cancer.With the development and popularization of MSCT,more and more SSNs were screened out.As the most common imaging manifestation of early lung adenocarcinoma,more and more attention were paid to SSNs.Because the prognosis of adenocarcinoma with different pathological types is very different,the accuracy of the MSCT evaluation of SSNs pathological subtype diagnosis and the accuracy of the degree of infiltration is very important for the selection of clinical treatment scheme and the judgment of prognosis.Based on the analysis of general clinical data,the image features of multislice computed tomography imaging(MSCT)and pathological characteristics of the pulmonary subsolid nodules with different pathological types,we aimed to find a simple parameters which can help radiologists make differential judgement on the possible pathological classification of the pulmonary subsolid nodules so as to better facilitate the selection of clinical treatment options.In addition,we'd like to find some independent risk factors which can help distinguish histological subtypes in lung adenocarcinoma to predict their prognosis.MethodsWe retrospectively analyzed the clinical data,MSCT imaging features and pathological features of 138 patients with lung adenocarcinoma confirmed by surgery in our hospital from June 2016 to December 2017.The patient's age,sex,smoking history,lesion location were recorded,the features of lobulation,spiculation,pleural tag/pleural indentation,bubble lucency/air bronchogram and relationships between SSNs and supplying blood vessels were analyzed on thin MSCT image combined with MPR and MIP images,the lesion's size and solid portion size were measured,and the solid proportion of SSNs was calculated.Based on the new classification of lung adenocarcinoma in 2015,in accordance with the infiltration,the postoperative pathological results were divided into three groups:preinvasive lesions(atipical adenomatous hyperplasia,AAH and adenocarcinoma in situ,AIS),minimally invasive(MIA)and invasive adenocarcinomas(IAC).The tumor's size,lymphatic invasion,visceral pleural invasion were recorded.Statistical analysis was performed using the one-way ANOVA for continuous variables and chi-square test for categorical variables.The differences in clinical data and CT signs of different pathological types of nodules were found to provide the basis for accurate preoperative diagnosis.At the same time,Logistic multiple regression was applied to analyze the variables with statistical differences in univariate analysis,so as to find an independent risk factor that could identify each pathological subtype and prognosis of lung adenocarcinoma.P<0.05 was considered statistically significant.Results1.In the general clinical data,among the 149 SSNs cases,there was significant differences in age(P<0.01)in AAH/AIS group,MIA group and IAC group.There was no statistically significant differences in sex(P=0.76),smoking history(P=0.47),and location of lesions(P=0.22)among the three groups.In the pGGO group,there was significant differences in age(P<0.01)among the three groups,there were no significant differences in sex(P=0.17),smoking history(P=0.146)and lesion location(P=0.07)among the three groups.In the mGGO group,there were no significant differences in age(P=0.82),sex(P=0.45),smoking history(P=0.29),and location of lesions(P=0.91)among these three groups.In the LPA group,APA group,and PPA group,there were no significant differences in age(P=0.072),sex(P=0.232),smoking histoy(P=0.050),and location of lesions(P=0.746).2.In the image data of the nodules,in the 149 cases of SSNs,there were significant differences in lesion size(P<0.01),distribution of lesion size(P<0.01),lobulation(P<0.01),pGGO/mGGO(P<0.01)and spiculation(P=0.02)in the AAH/AIS group,MIA group and IAC group.There were no significant differences in bubble lucency(P=0.17)and pleural tag/pleural indentation(P=0.11)among the three groups.In the pGGO group,there were significant differences in lesion size(P<0.01),distribution of lesion size(P<0.01),and bubble lucency(P=0.02)among the AAH/AIS group,MIA group and IAC group,there were no significant differences in lobulation(P=0.20),spiculation(P=0.06),and pleural tag/pleural indentation(P=0.55)among the three groups.In the mGGO group,there was significant differences in lesion size(P<0.01),distribution of lesion size(P<0.01),pleural tag/pleural indentation(P=0.04),solid portion size(P<0.01),and solid proportion(P=0.02)among the three groups,while there were no significant differences in lobulation sign(P=0.41),spiculation(P=0.22),and bubble lucency(P=0.47).In the 79 cases of IAC group,there were statistically significant differences in pGGO/mGGO(p<0.01)and lobulation sign(P<0.01)in the LPA group,APA group and PPA group.There was no statistically significant differences in lesion size(P=0.400),distribution of lesion size(P=0.38),spiculation(P=0.06),bubble lucency(P=0.95)and pleural reaction(P=0.38)among the three IAC subtypes.In the mGGO group,there was significant difference in solid proportion among the three group,whereas there were no statistically significant differences in lesion size(P=0.37),distribution of lesion size(P=0.41),solid portion size(P=0.485),lobulation(P=0.06),spiculation(P=0.06)and pleural reaction(P=0.17).In pGGO group,there was no statistically significant difference in distribution of lesion size(P=0.13)among the three pathological subtypes.In AAH/AIS group,there were 8 cases(32.0%),14 cases(56.0%),and 0 cases(0%),3 cases(12.0%),respectively in ? type-? type of vascular relationship;in MIA group,there were 22 cases(48.89%),12 cases(26.67%),1 case(2.22%),10 cases(22.22%),respectively in ? type-? type of vascular relationship;in IAC group there were 4 cases(8.86%),8 cases(10.13%),19 cases(24.05%),45 cases(56.96%)respectively in I type-IV vascular relationship.According to the statistical analysis,the results showed that there was significant difference in the composition ratio of nodules and vascular relationship among the three groups was statistically significant(P<0.01).Furthermore,149 cases of SSNs were divided into pGGO and mGGO groups for statistical classification of nodules and vascular relationship.The results showed that the difference in the composition of nodules and vascular relationship was statistically significant among the three groups,with P values all less than 0.01.In IAC group,there were 2 cases(6.45%),6 cases(19.35%),10 cases(32.26%)and 13(41.94%)in I type-IV type blood relationship respectively in LPA group;there were 5 cases(12.20%),2 cases(4.88%),8 cases(19.51%)and 26 cases(63.41%)in I type-? type vascular relationship respectively in the APA group;there were 0 cases(0%),and 0 cases(0%),1 case(14.29%)and 6 cases(85.71%)respectively in I type-? vascular relationship in PPA group.Statistical analysis showed that there was no statistically significant difference among the three subtypes in the composition ratio of nodules and vascular relationship(P=0.09).3.In the pathological features of nodules,the tumor size of SSNs was(0.78±0.38)cm,(0.98±0.45)cm,and(1.77±0.68)cm,respectively;and the proportion of lymph node metastasis was 0,0,and 2.52%,respectively;and the proportion of pleural invasion was 0,2.22%,and 1.26%,respectively in the AAH/AIS group,MIA group and IAC group.The tumor size was statistically significant differences among the three groups(P<0.01).There were no sinigficant differences in proportion of lymph node metastasis(p=0.28)and proportion of pleural invasion(P=0.64).In pGGO group,there was significant difference in tumor size among the three groups(P<0.01);there were no significant differences in lymph node metastasis(P= 1.00),and pleural invasion(P=1.00).In mGGO group,there was statistically significant difference in tumor size among the three groups(P<0.01);there were no significant differences in lymph node metastasis(P=0.78),and pleural invasion(p=0.89).In the IAC group,the tumor size of SSNs was(1.69±0,58 cm,(1.84±0.76)cm and(1.73±0.61)cm respectively in the LAP group,APA group and PPA group.The proportion of lymph node metastasis was 0,2.44%,and 14.29%,respectively.The rate of pleural invasion was 3.23%,0,and 0,respectively.There were no statistically significant differences in the tumor size(P=0.310),lymph node metastasis(P=0.17)and pleural invasion(P=0.38)among the three subtypes,.In the mGGO group,there were no statistically significant differences in tumor length(P=0.54),lymph node metastasis(P=0.24),and pleural invasion(P=0.25)among the three group.4.The variables with statistical differences were taken as independent variables,MIA group and IAC group as dependent variables,and AAH/AIS group as reference group for multivariate Logistic regression analysis.The results showed that lesion size was no more than 1.0cm(MIA group:RR=0.048,95%CI:0.008-0.288,P=0.001;IAC group:RR=0.047,95%CI:0.007-0.294,P=0.001)and the proportion of solid components was no more than 50%(MIA group:RR=3.518,95%ci:1.039-11.913,P=0.043;IAC group RR=6.023,95%CI:1.609-22.545,P=0.008),which was statistically significant in relation to dependent variable;however,there was no statistically significant correlation between these independent variables(age,lobulation,spiculation,relationship between nodule and vessel,and tumor size)and dependent variables(P>0.05).Conclusions1.Univariate analysis suggested that age,lesion size,classification of nodules,lobulation,spiculation,the classification between SSNs and vascular relationship,and tumor size were of certain value for the differential diagnosis of AAH/AIS,MIA and IAC groups.In pGGO,age,lesion size,bubble lucency,the classification between pGGO and vascular relationship,and tumor size were of certain value for the differential diagnosis of the three groups.In mGGO,lesion size,solid portion,the proportion of solid components,pleural tag/pleural indention,the classification of mGGO and vascular relationship and tumor size are of certain value for the differential diagnosis of the three groups.Nodular classification,and proportion of solid components are valuable for the identification of three subtypes of IAC group.2.Multivariate Logistic regression analysis suggested that an important determinant of the prognosis of lung adenocarcinoma when the lesion size was no more than 1.Ocm and the proportion of solid components was no more than 50.0%. |
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