Preoperative Prediction Of Ki-67 Labeling Index By Three-dimensional Ct Image Parameters For Differential Diagnosis Of Ground-Glass Opacity(GGO)

The aim of this study was to predict Ki-67 labeling index(LI)preoperatively by three-dimensional(3D)CT image parameters for pathologic assessment of GGO nodules.Diameter,total volume(TV),the maximum CT number(MAX),average CT number(AVG)and standard deviation of CT number within the whole GGO nodule(STD)were measured by 3D CT workstation.By detection of immunohistochemistry and Image Software Pro Plus 6.0,different Ki-67 LI were measured and statistically analyzed among preinvasive adenocarcinoma(PIA),minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC).Receiver operating characteristic(ROC)curve,Spearman correlation analysis and multiple linear regression analysis with cross-validation were performed to further research a quantitative correlation between Ki-67 labeling index and radiological parameters.Diameter,TV,MAX,AVG and STD increased along with PIA,MIA and IAC significantly and consecutively.In the multiple linear regression model by a stepwise way,we obtained an equation: prediction of Ki-67 LI=0.022*STD+0.001* TV+2.137(R=0.595,R's square=0.354,p<0.001),which can predict Ki-67 LI as a proliferative marker preoperatively.Diameter,TV,MAX,AVG and STD could discriminate pathologic categories of GGO nodules significantly.Ki-67 LI of early lung adenocarcinoma presenting GGO can be predicted by radiologic parameters based on 3D CT for differential diagnosis.Part ? The Expression of ki-67 in Ground-glass Opacity(GGO)and its Relation with P53,EGFR,CEA.Objective: By exploring the expression-labeling index of ki-67 in the GGO of different pathologic categories of early lung adenocarcinoma and trying to find the respective correlation of ki-67 with P53,EGFR and CEA for researching clinical and pathological significances of ki-67 labeling index to diagnosis and therapy of early lung adenocarcinoma.Method: According to established including and excluding criteria,we have rigorously filtrated 254 cases diagnosed as GGO hospitalized in department of thoracic surgery of Shanghai General Hospital affiliated to Shanghai Jiao Tong University during 2012 and 2015.The clinical history,CT information,blood routine examination,blood tumor markers and pathology material were exhaustively collected and retrospectively analyzed.Results: The expression-labeling index of ki-67 was gradually increased from Benign group(ki-67 LI=0.76±1.24,n=66),AAH(ki-67 LI=2.67±1.64,n=27),AIS(ki-67 LI=3.73±1.90,n=11),MIA(ki-67 LI=5.61±3.53,n=108),to IAC(ki-67 LI=10.63± 10.69,n=42),which is exactly the evolution progression of early lung adenocarcinoma;The correlation coefficient were 0.386(p53,p<0.001)?0.227(EGFR,p=0.024)and 0.441(CEA,p<0.001)respectively;By ROC curve analysis,we got the AUC and optimal cut-off points of ki-67 with regarding to differentiation of GGO and the variation of thresholds along the progression of early lung adenocarcinoma;The number and the percentage of blood monocyte of the patients with malignant GGO were lower than these of benign group.Conclusions: There are significant statistical differences among GGOs of different pathologic categories with respect to the expression-labeling index of ki-67 that gradually increased in the early lung adenocarcinoma progression,which could provide referential basis for discrimination of pathological categories and differentiation of early lung adenocarcinoma and be regarded as prognostic factors.To some extent,the existence of positive correlations of ki-67 with P53,EGFR and CEA could provide further relative researches with referential basis.Part ? The application and value of three-dimensional reconstruction technology in the differential diagnosis and surgical treatment of ground-glass opacityObjective: To explore and discuss the applicable value of three-dimensional CT reconstruction technology in diagnosis and surgical treatment of early lung adenocarcinoma manifested as ground-glass opacity in chest CT screen.Method: According to established including and excluding criteria,we have rigorously filtrated 188 cases diagnosed as GGO hospitalized in department of thoracic surgery of Shanghai General Hospital affiliated to Shanghai Jiao Tong University during October 2012 and October 2015.Clinical history materials,relative radiological parameters based on three-dimensional CT reconstruction and pathological materials were retrospectively analyzed through ROC curve for researching pathological diagnostic value and optimal threshold value of aforesaid parameters in different pathological categories of GGO.Moreover,108 cases have been followed up by CT scan every three months after which Volume-doubling time(VDT)has been calculated and compared and analyzed among different pathological groups.Result: There were 67 males and 121 females in all 108 cases;Mean age was 57.46±6.52 years(ranged from 26 to 83 years);Mean diameter(p<0.001),total volume(TV)(p<0.001),the maximum CT attenuation(MAX)(p<0.001)and standard deviation of distribution of CT attenuation within the whole GGO(STD)(p=0.015)of malignant group were significantly larger than those of benign group;No significant difference of average CT attenuation(AVG)(p=0.094)existed;The AUCs in ROC curve analysis were just 0.64~0.80 when differentiated benign group from AIS,benign group from MIA and AAH from MIA in comparison with 0.70~0.95 when it comes to differentiating benign group and AAH from IAC;Moreover,the optimal threshold values were 13.5~15.5mm in diameter,400~600mm3 in TV,-110~20 Hu in MAX and 120~160 in STD;The mean VDTs were 865±111.33 days?464.67±44.40 days and 238.36±76.71 days for AAH,MIA and IAC respectively(AAH/MIA P<0.001,MIA/IAC P=0.003).Conclusion: Relative radiological parameters of GGO based on three-dimensional CT reconstruction,including mean diameter,TV,MAX and STD,and VDT calculated from following up,could provide reference for discriminating GGO availably;Surgery would be recommended when parameters higher than their respective optimal threshold,while followed up by CT when lower;Combined utilization of HRCT and three-dimensional reconstruction technology has a remarkable clinical practical value for localized and quantitative diagnosis of GGO.Part ? Preoperative Prediction of Ki-67 Labeling Index By Three-dimensional CT Image Parameters for Differential Diagnosis Of Ground-Glass Opacity(GGO)The aim of this study was to predict Ki-67 labeling index(LI)preoperatively by three-dimensional(3D)CT image parameters for pathologic assessment of GGO nodules.Diameter,total volume(TV),the maximum CT number(MAX),average CT number(AVG)and standard deviation of CT number within the whole GGO nodule(STD)were measured by 3D CT workstation.By detection of immunohistochemistry and Image Software Pro Plus 6.0,different Ki-67 LI were measured and statistically analyzed among preinvasive adenocarcinoma(PIA),minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC).Receiver operating characteristic(ROC)curve,Spearman correlation analysis and multiple linear regression analysis with cross-validation were performed to further research a quantitative correlation between Ki-67 labeling index and radiological parameters.Diameter,TV,MAX,AVG and STD increased along with PIA,MIA and IAC significantly and consecutively.In the multiple linear regression model by a stepwise way,we obtained an equation: prediction of Ki-67 LI=0.022*STD+0.001* TV+2.137(R=0.595,R's square=0.354,p<0.001),which can predict Ki-67 LI as a proliferative marker preoperatively.Diameter,TV,MAX,AVG and STD could discriminate pathologic categories of GGO nodules significantly.Ki-67 LI of early lung adenocarcinoma presenting GGO can be predicted by radiologic parameters based on 3D CT for differential diagnosis.