Comparative Analysis Of CT Features Of Lung Ground Glass Nodules In Microinvasive And Invasive Adenocarcinoma

Objective: Based on the postoperative pathology of micro invasive carcinoma(MIA)and invasive adenocarcinoma(IAC),compare and analyze the signs of pulmonary ground glass nodules,by High-resolution Computed Tomography(HRCT),in micro invasive adenocarcinoma and invasive adenocarcinoma.Explor the ground glass nodules' CT features of the two group to understand the characteristics further,and judge the deference of them exactly,which could guide adjuvant therapy beter for clinical.Methods: The study collected the patients from January 2016 to December 2016,who were diagnosed in the Second Affiliated Hospital of Dalian Medical University of general thoracic surgery department two,and all the patients used the computed tomography in the hospital,who had pulmonary ground glass nodules and the postoperative pathology were confirmed micro invasive cancer and invasive adenocarcinoma.All images are used by SOMATOM Definition AS 64,uniform scanning range :from the apex of lung to the top of diaphragm.The original acquisition parameters: tube voltage 120 KV,tube current 150 m A,thickness 8mm,interval 8mm or thickness 10 mm,interval 10 mm.HRCT reconstruction parameters,thickness 1mm,interval 1mm.Lung windownumerical value: the window width 1200 HU,window level-600HU;mediastinal window numerical value: the window width 400 HU,window level: 40 HU.Data collected by two senior radiologists for imaging analysis of the characteristics of ground glass nodules.The postoperative pathology were performed in 10% formalin(formaldehyde)to be fixed,and made into paraffin embedded slides and then would be stained by HE.If necessary,immunohistochemical examination would be used to affirm the diagnosis.The final diagnosis was determined by two pathological doctors(pathological results according to the new classification of lung adenocarcinoma standard).Finally,using SPSS 17.0 software statistical analysis of the collecteddata.All the pathological results' CT features for the diagnosis of micro invasive adenocarcinoma and invasive adenocarcinoma : GGN properties,location,lesion size,solid components(solid size and solid composition),shape,boundary,lobulation,spiculation,pleural indentation,air bronchogram,vacuole sign are analyzed.Count data use?2 test or Fisher test,measurement data use T test.The factors which are meaningful are used to analysis bymultivariate logistic to find out the risk factors.The size of the lesions and the solid component,we use receiver operating characteristic curve(ROC curve)to find the best cut-off value,and calculate the area under the curve to evaluate its diagnostic value.The P < 0.05 said there is a statistically significant difference between two groups.Results: Among 73 patients,there have 83 cases of GGNs,pathological results of micro invasive adenocarcinoma are 37 cases,accounted for 44.6%;invasive adenocarcinoma are 46 cases,accounting for 55.4%.Univariate analysis showed the P value that lesion size(p=0.00),GGN properties(p=0.003),shape(p=0.037),lobulation(p=0.049),spiculation(p= 0.022)are all less than 0.05,which has statistical significance.From the two groups of single factor analysis,we select the meaningful factors for multivariate analysis.At the results,lesion size(P=0.000),GGN properties(P=0.015),spiculation(P=0.022)have statistical significance.ROC curve analysis of lesion size: the size of the lesion area under the curve was 0.823,the lesions size of the optimal cut-off point is 11.50 mm,the sensitivity is 78.3%,specificity is 73.0%. Compared the solid component of m GGNs lesions in the two groups,micro invasive adenocarcinoma in the average size of the solid component(mm)is 2.50 + 1.008,the solid component proportion(%)is 23.99 + 5.737;the average invasive adenocarcinoma solid component size(mm)is 4.90 + 1.412,the solid component proportion(%)is 35.55 + 3.861.The solid component size(P=0.00)and the solid component ratio(P=0.00)was statistically significant in this two groups.Multivariate analysis of solid component size(P=0.004),the solid component ratio(P=0.048)were statistically significant.The analysis of the solid component size and solid composition for ROC curve: the area under the curve for the size of the solid component is 0.925.The cut-off point of the solid component size is 3.25 mm,the sensitivity is 88.6%,the specificity is 77.8%;the proportion of olid components' area under the curve is 0.912,the proportion of solid components of the optimal cut-off point is 28.1%,the sensitivity is 90.9%,the specificity is 85.2%.Conclusion: The research based on comparative analysis of ground glass nodules' CT signs of micro invasive adenocarcinoma and invasive adenocarcinoma showed that the lesion size,GGN properties,spiculation have difference which has statistically significant in this two groups by multivariate analysis.Especially for the lesions' diameter larger than 11.50 mm,with solid components,with lobulated sign and burr sign of the lesions,are more likely to be invasive adenocarcinoma.The solid composition and the proportion ratio have the difference which has statistical significance between the two group in ground glass nodules.The content of solid component is greater than 3.25 mm,and the proportion of the solid component is greater than 28.1% are tend to be invasive adenocarcinoma.Therefore,by distinguishing the two groups of ground glass nodules' scanning CT features,it provides some help for differential diagnosis of micro invasive adenocarcinoma and invasive adenocarcinoma in the clinical work.