Correlation Between Epidermal Growth Factor Receptor Gene Mutation And Pathological And CT Characters In Lung Adenocarcinoma

Objective:The mutation of epidermal growth factor receptor gene in lung adenocarcinoma of lung adenocarcinoma was detected by real-time PCR.To investigate the correlations between epidermal growth factor receptor(EGFR)gene mutations and clinicopathological features and CT feature in patients with lung adenocarcinoma confirmed by surgery.Methods:Retrospective collections of 82 cases who receive treatments in department of thoracic surgery Tangshan Gongren Hospital between June 1,2015 and May 31,2017.All patients underwent high resolution CT examination within 2 weeks before surgery,in which 35 lesions underwent CT perfusion.postoperative pathology was reviewed by two attending pathologists,according to the 2015 WHO lung tumor classification diagnosed lung adenocarcinoma.EGFR gene was detected in all lesions.40 male cases,42 female cases.Age range 40-82,average age 59.68±9.39 years,median age61.39 cases aged under 60,43 cases aged over 60.25 Cases with smoking history,57 cases without smoking history.2 lesions in 5 of 82 patients,altogether 87 lesions.58 lesions in right lung,29 lesions in left lung.Clinical staging was 60 cases in I,11 cases in II,11 cases in III and 0 cases in IV.77lesions Less than or equal to 3 cm in diameter,4 lesions greater than 3 cm and less than or equal to 5 cm in diameter,6 lesions greater than 5 cm in diameter.38 lesions with pleural invasion,49 lesions without pleural invasion.16 Cases with lymph node metastasis,66 cases without lymph node metastasis.tissue credit types 47 mainly with adnexal growth pattern,25 mainly with adenoid growth pattern,9 mainly with solid growth pattern,6 mainly with papillary growth pattern.The correlation between EGFR gene,density of lesion,Lobar sign,cavity,pleural sag,Burr,pleural sag and enlarged lymph node were statistically analyzed.The relationship between Time To Peak(TTP),blood volume(BV)and Peak Enhancement Intensity(PEI)in lung perfusion scanning and EGFR gene was analyzed.The counting data was statistically analyzed with the?~2 test and Fisher's exact test.The measurement data was tested by independent sample t text,rank sum test are used for the measurement data that do not conform to normal distribution.A P<0.05 was regarded as statistical significant.Results:1.Among 87 lesions in 82 patients,EGFR mutations were found in 40patients,44 lesions,patient mutation rate was 48.78%(40/82),lesion mutation rate was 50.57%(44/87).The types of mutations were mainly 21 exon point mutation and 19 exon point missing mutation.2.The mutation rate of 32.00%(8/25)in smoking patients and 56.14%(32/57)in nonsmoking patients was statistically significant,P=0.044.The mutation rate of 51.28%(20/39)in patients aged under 60 and 46.51%(20/43)in patients aged over 60 was no statistically significant difference,P=0.666.The mutation rate of 45.00%(18/40)in male patients and 52.38%(22/42)in female patients was no statistically significant difference,P=0.504.The mutation rate of 46.55%(27/58)in right lung and 58.62%(17/29)in left lung was no statistically significant difference,P=0.289.3.The mutation rate of 63.16%(24/38)with pleural invasive lesions and38.78%(19/49)without pleural invasive lesions was statistically significant,P=0.024.The mutation rate of 50%(8/16)in right lung with lymph node metastasis and 48.48%(32/66)without lymph node metastasis was no statistically significant difference,P=0.913.The mutation rate of single lesion was 46.75%(36/77)and that of double lesion was 80%(4/5),there was no statistically significant difference,P=0.196.The mutation rate of clinical staging phase I patients was 53.33%(32/60),27.27%(3/11)in Phase II and45.45%(5/11)in Phase III,there was no statistically significant difference,P=0.275.The mutation rate of mainly adnexal growth pattern was 48.94%,mainly adenoid growth pattern was 64.00%(16/25),mainly solid growth pattern was 22.22%(2/9),mainly papillary growth pattern was 50%(3/6),there was no statistically significant difference,P=0.182.4.CT findings of lung adenocarcinoma showed that the mutation rate of pure glass density was 36.36%(12/33)and that of solid ingredients was59.26%(32/54),the difference is statistically significant,P=0.038.The mutation rate of spurs was 63.89(23/36)and that of hairless spines was41.76%(21/51),the difference is statistically significant,P=0.037.The mutation rate of pleural indentation was 60.71%(34/56)and that of non-pleural indentation was 32.26%(10/31),the difference is statistically significant,P=0.011.The mutation rate with lobulation was 54.05%(20/37)and that without lobulation was 48.00%(24/50),there was no statistically significant difference,P=0.577.The mutation rate with cavitation was 71.42%(5/7)and that without cavitation was 48.75%(39/80),there was no statistically significant difference,P=0.434.CT revealed regional lymphadenectasis mutation rate was 54.55%(12/22),no regional lymphadenectasis mutation rate was 46.67%(27/60),there was no statistically significant difference,P=0.527.5.The difference between the positive and negative groups of TTP was statistically significant,t=2.418,P=0.022.The difference of BV between two groups was statistically significant,P=0.035.PEI difference between the two groups was no statistically significant,P=0.817.Conclusion:1.The mutation rate of EGFR gene in smoking patients was high compared with nonsmoking patients.2.The mutation rate of EGFR gene in patients with lung adenocarcinoma treated by surgical resection was high in patients with a diameter less than or equal to 3 cm,the mutation rate of lesion invasion of pleura was high compared with absence of pleura invasion.3.The EGFR gene mutation in lung adenocarcinoma patients with surgical resection was high in solid component density,segmental sign and pleural depression;In pulmonary perfusion imaging,TTP and BV were helpful to predict EGFR gene mutation.