| Background:Primary bronchogenic carcinoma(lung cancer)is a malignant tumor originating from bronchial mucosa or glands.Lung cancer is now the leading cause of tumor-related death in the world.Since the 1970 s,the incidence of lung adenocarcinoma has increased rapidly and has now replaced squamous cell carcinoma as the most common pathological type.Ground glass nodule(GGN)refers to the increased density in the lung with clear or unclear boundary on computed tomography(CT),and the lesion density is not enough to cover the walking blood vessels and bronchus,which is one of the main judgment bases for the clinical diagnosis of lung adenocarcinoma.GGN may be malignant tumor,benign tumor,inflammation,pulmonary interstitial disease or pulmonary lymph nodes.The prognosis of lung cancer depends on early detection,early diagnosis and early treatment.With the development of imaging technology,spiral CT is applied in the screening of lung cancer,and it can detect small lesions earlier.The specificity,sensitivity and accuracy are significantly higher than that of chest X-ray.More and more ground glass nodules of lung are detected,but the benign and malignant nodules are mixed and difficult to distinguish.In recent years,the application of various CT parameters in the diagnosis of GGN has been paid more and more attention.At present,there are few studies on the proportion of the volume of opaque components involved in ground glass in lung and the pathological classification of lung adenocarcinoma,and there are few studies on the proportion of the volume of solid components involved in CT signs,the maximum diameter of solid components and the proportion of the volume of solid components involved in the pathological classification of lung adenocarcinoma.Objective:To explore the correlation between CT signs,the maximum diameter of solid components,and the proportion of the volume of solid components in GGN with preinvasive lesion,micro invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC),and to understand the characteristics of different types of ground glass nodules,which are clinical lung.The pathological classification of adenocarcinoma provides the basis for diagnosis.Method:174 patients with pulmonary ground glass nodules and pathologically diagnosed pulmonary adenocarcinoma who were treated in Huaihe hospital of henan university from January 2015 to October 2019 were selected as the study subjects.According to the results of pathological examination,the patients were divided into three groups,including atypical adenomatous hyperpl.There were 41 patients with Asia(AAH)and in situ adenocarcinoma(AIS),59 with MIA and 74 with IAC.Statistics by two professional imaging physician review all of the patients with tumor site,tumor diameter,maximum diameter of solid component,solid composition grinding ingredients CT value and the proportion of the volume of the solid component in the ground glass shadow.And shape,edge,morphology,lobulation sign,vacuole sign,burr indications,pleural indentation sign,vascular cluster sign,air bronchogram,calcification and other imaging characteristics of ground glass composition.To compare the differences of imaging characteristics among the three groups,logistic multifactorial regression analysis was used to analyze the statistical significance of imaging features in ground glass opacity of the lung of the three groups,and to study the correlation between the indicators of ground glass opacity of the lung and pathological types of lung adenocarcinoma.The ROC curve was drawn to confirm the best cut-off value for pathological classification of lung adenocarcinoma.Results:1.In AIS/AAH group,the diameter of tumors was(1.03±0.32)cm,the maximum diameter of solid components was(0.20±0.11)cm,percentage of solid volume(17.56±5.53)% and the CT value of ground glass components was(-575.43±114.38)HU.In MIA group,the diameter of tumors was(1.21±0.46)cm,the maximum diameter of solid components was(0.39±0.24)cm,percentage of solid volume(30.58±7.91)% and the CT value of ground glass components was(-505.06±133.43)HU.In IAC group,the diameter of tumors was(1.65±0.58)cm,the maximum diameter of solid component was(0.96±0.51)cm,percentage of solid volume(42.47±6.37)% and the CT value of ground glass component was(-330.78±134.86)HU.There were significant differences in tumor diameter,maximum solid component diameter and ground glass component CT value between the three groups(P < 0.05).2.AAH/AIS group and MIA group jointly drew the maximum diameter ROC curve of solid components,MIA group and IAC group jointly drew the maximum diameter ROC curve of solid components.The best interception value of maximum diameter of solid components in AHH/AIS group and MIA group was 2.50 mm,the sensitivity was 86.50%,the specificity was 70.50%,the area under curve was 0.827,and the 95% CI interval was 0.754-0.890.The best interception value of the maximum diameter of solid components in MIA group and IAC group was 5.50 mm,sensitivity was 98.80%,specificity was 92.40%,area under curve was 0.950,and 95% CI interval was 0.908-0.992.3.The AAH/AIS group and MIA group jointly drew the ROC curve of the volume percentage of real components,and the MIA group and IAC group jointly drew the ROC curve of the volume percentage of real components.The best cut-off value of the volume percentage of solid components of AHH / AIS group and MIA group is 22.70%,sensitivity is 85.30%,specificity is 88.30%,AUC is 0.827,and 95% CI interval is 0.632 ? 0.766.The best cut-off value of volume percentage of solid components of MIA group and IAC group were 38.41%,sensitivity was 96.50%,specificity was 89.60%,AUC was 0.944,and 95% CI range was 0.899 ? 0.976.4.AAH/AIS group and MIA group jointly drew ROC curve of CT value of ground glass composition,MIA group and IAC group jointly drew ROC curve of CT value of ground glass composition.The best cut-off values of CT values of ground glass components in AHH/AIS and MIA groups were-581.49 HU,with sensitivity 80.30%,specificity 64.40%,area under curve 0.745,95% CI range 0.692-0.861.The best cut-off value of CT value of ground glass component in MIA group and IAC group was-464.80 HU,the sensitivity was 72.00%,the specificity was 61.40%,the area under curve was 0.771,and the 95% CI interval was 0.677-0.825.5.Comparing the imaging features of the three groups,26 cases(63.41%)with smooth margin,15 cases(38.59%)with rough margin,28 cases(68.29%)with clear margin,13 cases(31.71%)with blurred margin,and 22 cases(53.66%)with lobulation sign and 5 cases(12.20%)with air bronchogram as the main internal features,respectively,were found in AAH/AIS group.In MIA group,52 cases(88.14%)had smooth margin,7 cases(11.86%)had rough margin,50 cases(84.75%)had clear margin,9 cases(15.25%)had blurred margin,and the main internal features were lobulation sign 22 cases(37.29%),air bronchogram 10 cases(16.95%)and burr sign 6 cases(10.17%).The pleural indentation sign and vascular cluster sign were found in 3 cases(5.08%).In IAC group,54 cases(72.97%)had smooth margin,20 cases(27.03%)had rough margin,48 cases(64.86%)had clear margin and 26 cases(35.14%)had blurred margin.The internal features included lobulation sign,burr sign,air bronchogram,pleural indentation sign and vascular cluster sign except for vacuole sign 0 cases and calcification 2 cases(2.70%),were the main manifestations.Conclusions:1.CT value of ground glass component,maximum diameter of solid component and percentage of solid component can be used to identify pre-invasive lesions,micro-invasive adenocarcinoma and invasive adenocarcinoma.2.The diameter,foliation,burr,air bronchogram,pleural depression and vascular cluster of ground glass nodules are important for the prediction of invasive lung adenocarcinoma.3.It is suggested that AAH/AIS may be manifested when the maximum diameter of the solid component < 2.50 mm,the volume percentage of the solid component < 22.70% or the CT value of the ground glass component <-581.49HU;It is suggested that MIA may be manifested when 2.50 mm ? maximum diameter of solid component < 5.50 mm,22.70% ? volume percentage of solid component < 38.41% or-581.49 HU ? CT value of ground glass component <-464.80HU;It is suggested that IAC may be manifested when the maximum diameter of solid component was ? 5.50 mm,the volume percentage of solid component was ?38.41% or the CT value of ground glass-like nodules was ?-464.80 HU. |
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