| Objective: Solitary pulmonary ground-glass nodule(GGN)may be the relatively specific early imaging manifestations of lung cancer,especially lung adenocarcinoma.The purpose of this study is to explore the risk factors of lung adenocarcinoma in solitary GGN and to provide an effective reference for the early diagnosis of lung adenocarcinoma by retrospective analysis of the clinical,pathological,imaging,and tumor data in those solitary GGN patients with a clear pathology.Methods: Clinical data of 87 patients admitted to the department of Thoracic Surgery,first affiliated hospital of Wannan Medical College from April 2018 to December 2019 who underwent the surgical removal of the nodule were collected.Patients were classified into adenocarcinoma group and benign group according to their histopathological characteristics.The general clinical characteristics(gender,age,history of smoking,family history of malignant tumor,and lung underlying diseases),CT imaging features(nodule diameter,nodule location,proportion of solid components,spicule sign,lobulation sign,pleural indentation sign,vascular bundle sign,air bronchogram sign),tumor marker characteristics(CEA,NSE,SCC,CYFRA21-1)and histopathology type were compared and analyzed.Meanwhile,subgroups analysis were performed for nodules of different diameters.Results:1.There were 67 patients with adenocarcinoma including 13 cases of adenocarcinoma in situ,14 cases of microinvasive adenocarcinoma,and 40 cases of invasive adenocarcinoma;20 patients with benign disease involving 7 cases of atypical adenoma-like hyperplasia,1 case of hamartoma,5 cases of inflammatory pseudotumor,4 cases of tuberculosis,2 cases of sclerosing hemangioma,and 1 case of fungal infection in 87 patients with solitary GGN undergoing surgical resection.Invasive adenocarcinoma(59.7%)was the most common type of adenocarcinoma,while atypical adenoma-like hyperplasia was most common in benign lesions(35.0%).2.There were no significant difference between adenocarcinoma and benign groups in general clinical features involving age(P=0.105),gender(P=0.708),smoking history(P=0.299),family history of malignant tumors(P=0.165),lung underlying diseases(emphysema,P=0.299,interstitial lung disease,P=0.459,old pulmonary tuberculosis,P=0.352)and tumor markers(P=0.066).Univariate analysis of CT characteristics showed that the average diameter [(14.10±4.70)mm in adenocarcinoma group vs(8.69± 2.63)mm in benign group](P < 0.01),spicule sign(P=0.034),lobulation sign(P=0.045)and pleural indentation sign(P<0.01)were significantly different between the two groups,however,no statistical difference were seen regarding the position of nodules(P=0.147),proportion of solid components(P=0.114),vascular bundle sign(P=0.194)and air bronchogram sign(P=0.870)between the two groups.Subgroup analysis with a diameter of 8 mm as the boundary found that there were 15 cases with a diameter of ≤8 mm(6 cases in the adenocarcinoma and 9 cases in the benign group),and 72 cases with > 8 mm(61 cases in the adenocarcinoma,11 cases in benign group),which indicated there was with statistically significant(P<0.01).Furthermore,analysis of the imaging manifestations of patients with adenocarcinoma in situ,microinvasive adenocarcinoma and invasive adenocarcinoma with an 8 mm boundary showed that the difference with respect to spicule sign,lobulation sign and pleural indentation sign were no statistically significant.3.Multivariate Logistic regression analysis showed that the spicule sign(OR=8.085,P=0.049),pleural indentation sign(OR=15.405,P=0.010),and the diameter of nodule >8 mm(OR=8.318,P=0.001)were independent risk factors for lung adenocarcinoma,while the lobulation sign(P=0.061)had no significant predictive value for lung adenocarcinoma.Analysis of ROC curves for nodules > 8 mm showed that the cut-off value for diagnosis of lung adenocarcinoma was 12.25 mm,the area under the curve was 0.858(0.769-0.947),the sensitivity was 97.44%,and the specificity was 35.90%.Conclusions:1.Lung invasive adenocarcinoma is the most common histological subtype in malignant solitary GGN.2.Spicule sign,pleural indentation sign and the diameter of nodule > 8 mm can be used as predictors for lung adenocarcinoma.When the diameter of solitary GGN exceeds12.25 mm,it has a better predictive value for lung adenocarcinoma.3.For solitary GGN with diameter ≤ 8 mm,the diagnosis of lung adenocarcinoma cannot be completely excluded,the possibility of malignancy should be highly vigilant especially when GGN presents with spicule sign,pleural indentation sign and other signs. |
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