Analysis Of Related Factors Of Pleural Indentation And Visceral Pleural Invasion Of Pulmonary Adenocarcinoma With Pure Ground-glass Nodules Within 10mm From Pleura

Part ? Analysis of related factors of pleural indentation of lung adenocarcinoma with pure glass ground nodule within 10mm from pleuraObjective To analyze the related factors of pleural indentation of lung adenocarcinoma with pure glass ground nodule(pGGN)on the clinical,imaging and pathological aspects.Methods From January 2016 to October 2018,lesions which showed pGGN on chest CT examinations and within 10 mm of pleura were selected.All lesions were pathologically confirmed to be lung adenocarcinoma after surgical resection.According to the existence of pleural indentation on CT images,lesions were divided into two groups:pleural indentation group and no pleural indentation group.The clinical features such as sex,age,family history of tumor,clinical symptoms,CT features such as the size,CT value and distance to the pleural,pathological subtypes[pre-invasive lung adenocarcinoma(AAH+AIS+MIA),invasive lung adenocarcinoma(ILA)],immunohistochemistry[HER-1(EGFR),HER-2,Ki-67]of pGGN were analyzed.Statistics was used to compare the differences between the two groups.Qualitative data were analyzed by using chi-square test and Fisher's exact test;quantitative data were analyzed by using t test and rank sum test.Statistically significant quantitative data were used to determine the optimal threshold and the specificity and sensitivity of the diagnosis.Multivariate logisitic regression analysis was used for the statistically significant factors on univariate analysis,and the OR value of the relevant factors and 95%CI were obtained.Quantitative data multivariate ROC curve was made to judge the sensitivity and specificity of the comprehensive diagnosis.Correlation factors of pGGN lung adenocarcinoma with pleural indentation were obtained.Results A total of 174 lesions met the inclusion criteria,including 91 lesions with pleural indentation and 83 lesions without pleural indentation.Univariate analysis showed that there were no significant differences in family history,clinical symptoms,and HER-1(EGFR)between the two groups(P>0.05).The differences between the two groups were statistically significant in gender(?2=4.499,P=0.035),age(Z=-2.316,P=0.021),pGGN size(Z=-4.337,P<0.001),CT value(t=-2.821,P=0.005),distance to the pleura(Z=-7.735,P<0.001),pathological subtypes(? 2=20.366,P<0.001),HER-2(? 2=15.767,P<0.001),Ki-67(Z=-2.083,P=0.037).Multivariate logisitic regression analysis showed that there were no significant differences in gender,age,and Ki-67 between the two groups(P>0.05).The differences of pGGN size,CT value,distance to the pleural,pathological subtypes and HER-2 group were statistically significant(P<0.05),and its OR value and 95%CI were 1.157(1.063-1.261),1.005(1.001-1.010),0.524(0.427-0.643),3.749(1.277-11.010)and 2.655(1.318-5.350),respectively.Conclusion pGGN size,CT value and distance to the pleural,pathological subtypes and HER-2 are independent risk factors for lung adenocarcinoma with pleural indentation within 10 mm of the pleura.Part ? Analysis of related factors of visceral pleural invasion of lung adenocarcinoma with pure glass ground nodule within 10mm from pleuraObjective To analyze the related factors of pure ground glass nodule(pGGN)lung adenocarcinoma with visceral pleural invasion(VPI)on the clinical,imaging,pathological aspects and to provide information for the clinical management.Methods From January 2016 to October 2018,lesions showed pGGN on chest CT examination and with pleural indentation within 10 mm of the pleura were included in this study.All lesions were pathologically confirmed lung adenocarcinoma after surgical resection.According to the existence of VPI under a microscope,all lesions were divided into VPI positive group and VPI negative group.The clinical features such as sex,age,family history of tumor,clinical symptoms and CT features such as the size,CT value,distance to the pleura of pGGN,pleural indentation types(linear,triangular and flat types),pathological subtypes(pre-microinvasion adenocarcinoma and invasive lung adenocarcinoma),immunohistochemistry(HER-1,HER-2,Ki-67)were retrospectively analyzed.Statistics was used to compare the differences between the two groups.Qualitative data were analyzed by using chi-square test and Fisher's exact test;quantitative data were analyzed by using t test and rank sum test.Statistically significant quantitative data were used to determine the optimal cut-off value and the specificity and sensitivity of the diagnosis.Statistically significant factors on univariate analysis were included in multivariate logisitic regression analysis,and the OR value of the relevant factors and 95%CI were obtained.Finally,the risk factors of visceral pleural infiltration of pGGN lung adenocarcinoma within 10 mm of the pleura were obtained.Results A total of 91 lesions met the study inclusion criteria,including 31 lesions with VPI and 60 lesions without VPI.Univariate analysis showed that there were significant differences in distance to the pleura and pleural indentation types between the two groups(P<0.05).There were no significant differences in clinical features(gender,age,family history of tumors and clinical symptoms),CT features(pGN size,CT value),pathological subtypes and immunohistochemistry between the two groups(P>0.05).Multivariate logistic regression analysis showed that there was a significant difference in pleural indentation type between the two groups(P=0.026<0.05),and the OR value was 5.683 with the 95%CI(1.266-26.345).Conclusion The type of pleural indentation is the main risk factor of visceral pleural invasion in pGGN lung adenocarcinoma within 10 mm of pleura.