CT Feature And Quantitative Analysis Of Pure Ground-glass Nodule For The Prediction Of Lung Adenocarcinoma Pathology Classification

Purpose The predictive value of the pathological grading of lung adenocarcinoma was discussed through the CT feature and quantitative analysis of lung pure glass nodules.Method Clinical data and CT images of 121 cases(126 lesions)with CT anifestations of the lung adenocarcinoma with the pure ground-glass nodule(pGGN)confirmed by surgery pathology were retrospectively analyzed.The pathological results were divided into three groups including the atypical adenomatous hyperplasia(AAH)/ adenocarcinoma insitu(AIS),minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC).The indexes of the mean size,the maximum diameter,mean CT value,the maximum CT value and lesion morphology(circular/round,irregular shape),edge(burr,lobule),internal(air bubble,air bronchogenic sign),vascular sign(blood vessel crossing,vascularization/distortion/agglomeration change),and chest film depression were compared and analyzed.The measurement datas satisfies the normal distribution,comparisons among the three groups were finished by the single factor analysis of the variance,and the T-test is adopted between the two groups(AAH/AIS and MIA or MIA and IAC).The counting datas were tested by Pearson chi-square and Fisher methods.and then compared between the two groups(AAH/AIS and MIA or MIA and IAC).The measurement datas with statistical significance and counting datas were analyzed by the method of two groups of logistic regression,respectively,and then the prediction probability value was saved.The ROC were plotted using the prediction probability,mean size,the maximum diameter,mean CT value,and the maximum CT value.Furthermore,the threshold value,sensitivity and specificity between each two groups were obtained.Results The onset age and sex of pGGN were not statistically significant in the three groups(P = 1.00,P = 0.107).The mean size,the maximum diameter,mean CT value and the maximum CT value of the nodules were significantly different among the three groups of AAH / AIS,MIA,IAC and different between the two groups(AAH/AIS and MIA or MIA and IAC)(P < 0.05).There were significant differences in lesion morphology,lobulation,spiculation,air bronchogram,vascular changes and pleural depression among the three groups,while the spinous processes,vacuoles,vascular passage,and tumor-lung interface were not statistically significant(P> 0.05).There were significant differences in air-containing space,spiculation and air bronchogram sign between AAH/AIS and MIA.There were significant differences in lobulation,spiculation and pleural indentation between MIA and IAC.Binomial Logistic regression analysis was used to analyze the statistically significant indexes and the predicted probability value was saved.The regression model between AAH/AIS and MIA was logit(P)=1.123 0.251X1 0.006X3-1.294X71.The second regression model between MIA and IAC was logit(P)=-2.183 0.259X2 0.005X3.The ROC was plotted using the testing variables including the prediction probabilities of the regression analysis,mean size,the maximum diameter,mean CT value and the maximum CT value.Between AAH/AIS and MIA,the area under the curve were 0.855,0.738,0.734,0.754 and 0.743.Between MIA and IAC,the area under the curve were 0.838,0.757,0.783,0.681 and 0.664.Conclusion The application of CT features and measurement datas of pGGN in predicting the pathological classification of lung adenoma is better than the independent discriminant of single factor,and has a good predictive value for the pathological classification of lung adenocarcinoma of pGGN.