Ground-glass Nodule Lung Adenocarcinoma:The Correlations Between HRCT Features And Pathological Classification And Epidermal Growth Factor Receptor Mutations

Part ? HRCT evaluation of Invasive Pulmonary Adenocarcinomas and Preinvasive Lesions Appearing as pureGround-glass nodulesObjectiveExplore the HRCT features of pure ground-glass nodules(pGGNs)including invasive pulmonary adenocarcinomas(IPA)and preinvasive lesions,in order to obtain a more accurate clinical evaluation.MethodsFrom January 2011 to March 2017,176 pure ground-glass nodules,clinically suspected as lung adenocarcinoma,were pathologically confirmed in 164 patients and were included in this study.Image evaluation should include:the relationship between lesion location,lesion size,lesion morphology,lesion edge,lesion boundary,lesion internal characteristics,and the relationship with the pleura,bronchus and blood vessels.To identify different CT signs of preinvasive and invasive lesions,we used logistic regression analysis and receiver operating characteristic(ROC)curve analysis.ResultsThere were 85 pre-invasive lesions and 91 invasive lesions in all 176 pGGNs.There were significant differences in lesion size,morphology,margin,border,pleural retraction and the relationship with bronchus and blood vessels between IPAs and preinvasive lesions(p<0.05).Multivariate analysis revealed that in the identification of pure ground glass nodules preinvasive lesions and invasive disease,the lesion edge burr identification was of significant value(p =0.006).The lesion edge burr to the diagnosis of invasive disease sensitivity,specificity were 26.4%;97.6%.Lesion size was a significant differentiator of preinvasive lesions from IPAs,but not the characteristic(sensitivity,54.9%;specificity,70.6%),the optimal critical value size for preinvasive lesions was less than 10 mm.A logistic predictive model was established based on the size,shape,margins,borders of the nodule,the presence or absence of pleural depression,and the relationship with the bronchus and blood vessels.The ROC curve analysis was performed.The results showed that the sensitivity of the model in identifying the lesions of the two groups was 57.1%,the specificity is as high as 92.9%.ConclusionComprehensive analysis of HRCT signs of pure ground glass nodules in the lung is not comprehensive enough to evaluate the size of nodules alone.A comprehensive consideration of the above factors,especially burrs,vascular relations and size,is helpful and complementary in judging the nature of pure ground glass nodules,as early as possible to identify infiltrative lesions in pure glass nodules.Part ? The correlation between HRCT features with epidermal growth factor receptor mutations in Ground-glass nodules lung adenocarcinomaObjectiveObjective To investigate the relationship between EGFR gene mutation and imaging features in patients with lung adenocarcinoma ground glass nodules on HRCT,and to evaluate the EGFR mutation by imaging methods.MethodsFrom January 2011 to March 2017,98 patients with ground glass nodular lung adenocarcinoma were diagnosed and retrospectively analyzed.Histological specimens were obtained and mutations in exon 18-21 of EGFR gene were detected.Patients were divided into two groups:EGFR gene mutation group and wild group.The gender,age,the history of smoking,lesion location,lesion size,the density of ground glass and its content of nodules,lesion morphology,lesion edge,lesion boundary,lesion internal characteristics and the relationship with pleura,bronchus and blood vessels were recorded.Using statistical methods to compare two groups of lesions in clinical features,imaging characteristics and its correlation with EGFR mutations.ResultsAmong the 98 patients,there were 31 cases(31.6%)of exon mutation and 67 cases(68.4%)of non-mutation.There were no significant differences in gender,age,the history of smoking,lesion location,morphology,margin,border,pleural indentation,and the relationship with bronchus and blood vessels between the EGFR gene mutation group and the wild group(p>0.05).The incidence of vesicle signs or honeycomb signs in the mutation group was higher than that in the wild group(p =0.011).The size of EGFR gene mutation group in pure ground glass nodule lung adenocarcinoma was higher than that in wild group(p =0.042),Logistic regression analysis showed that the optimal threshold value of the EGFR mutation group and the wild group was 8.65mm.ConclusionHRCT signs can predict EGFR gene mutation to a certain extent in lung adenocarcinoma with ground glass nodules.