CT features of pulmonary nodules in predicting histological subtypes of adenocarcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GU Xinlei ¹ , LIU Zhan ² , SHAO Weipeng ² , FENG Hongxiang ³ , ZHANG Zhenrong ³ , SUN Hongliang ⁴ ,  LIU Deruo ³

1. Department of Thoracic Surgery, Peking University International Hospital, Beijing, 102206, P. R. China;
2. Department of General Thoracic Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, P. R. China;
3. Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, 100029, P. R. China;
4. Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, P. R. China;

Corresponding author：

LIU Deruo, Email: deruoliu@vip.sina.com

Keywords：

Lung nodules; adenocarcinoma; new WHO classification; computed tomography

DOI：

10.7507/1007-4848.202106072

Video：

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Objective To assess the accuracy of CT features of lung nodules (≤3 cm) in predicting the accuracy of the pathological subtype and degree of infiltration of adenocarcinoma. Methods We retrospectively analyzed the clinical data of 333 patients with non-cavitary pulmonary nodules diagnosed as adenocarcinoma by surgery and pathology in the China-Japan Friendship Hospital from 2011 to 2018, including 108 males and 225 females, aged 16-82 (59.57±10.16) years. The basic clinical data and CT characteristics of the patients were recorded. Results When the average CT value was ≥−507 Hu, the maximum diameter of the lung window was ≥14.5 mm, and the solid component ratio was ≥5.0%, it indicated more likely the invasive adenocarcinoma (IAC). The higher the average CT value of the nodule, the larger the maximum diameter of the lung window, and the more solid components, the higher the degree of infiltration. CT morphological features (including burrs, lobes, vascular signs, bronchial signs, pleural stretch or depression signs) were more common in IAC. Among them, burrs were more common in acinar adenocarcinoma and papillary adenocarcinoma. In invasive adenocarcinoma, the higher the risk of recurrence of the pathological subtype, the greater the average CT value. When the average CT value of IAC was >−106 Hu, and the proportion of solid components was ≥70.5%, the histological subtypes were more inclined to micropapillary/solid predominant adenocarcinoma. Conclusion The evaluation of CT features of lung nodules can improve the predictive value of histopathological types of lung adeno- carcinoma, thereby optimizing clinical treatment decisions and obtaining more ideal therapeutic effects.

Citation： GU Xinlei, LIU Zhan, SHAO Weipeng, FENG Hongxiang, ZHANG Zhenrong, SUN Hongliang, LIU Deruo. CT features of pulmonary nodules in predicting histological subtypes of adenocarcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 684-692. doi: 10.7507/1007-4848.202106072 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	赫捷, 李霓, 陈万青, 等. 中国肺癌筛查与早诊早治指南(2021, 北京). 中华肿瘤杂志, 2021, 43(3): 243-268.
3.	Yotsukura M, Asamura H, Motoi N, et al. Long-term prognosis of patients with resected adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung. J Thorac Oncol, 2021, 16(8): 1312-1320.
4.	Wang Y, Zheng D, Luo J, et al. Risk stratification model for patients with stage Ⅰ invasive lung adenocarcinoma based on clinical and pathological predictors. Transl Lung Cancer Res, 2021, 10(5): 2205-2217.
5.	Mäkinen JM, Laitakari K, Johnson S, et al. Histological features of malignancy correlate with growth patterns and patient outcome in lung adenocarcinoma. Histopathology, 2017, 71(3): 425-436.
6.	Moreira AL, Ocampo PSS, Xia Y, et al. A grading system for invasive pulmonary adenocarcinoma: A proposal from the international association for the study of lung cancer pathology committee. J Thorac Oncol, 2020, 15(10): 1599-1610.
7.	Suzuki K, Watanabe S, Wakabayashi M, et al. A nonrandomized phase Ⅲ study of sublobar surgical resection for peripheral ground glass opacity dominant lung cancer defined with thoracic thin-section computed tomography (JCOG0804/WJOG4507L). 2017 ASCO Annual Meeting Abstract No:8561. J Clin Oncol, 2017, 35(suppl15): 8561.
8.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
9.	中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肿瘤学分会肺癌临床诊疗指南 (2021版). 中华医学杂志, 2021, 101(23): 1725-1757.
10.	张鹏举, 李天然, 陶雪敏, 等. 磨玻璃结节早期贴壁生长为主型浸润性肺腺癌与其他病理亚型的CT特征分析. 中华放射学杂志, 2021, 55(7): 739-744.
11.	Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol, 2016, 34(4): 307-313.
12.	北京医学会胸外科分会, 中国医疗保健国际交流促进会胸外科分会. 基于高分辨CT影像学指导≤2cm磨玻璃结节肺癌手术方式胸外科专家共识(2019版). 中国胸心血管外科临床杂志, 2020, 27(4): 395-400.
13.	孙巍, 林冬梅. Ⅰ期浸润性肺腺癌磨玻璃成分定量分析及其与附壁样生长成分的相关性研究. 中华肿瘤杂志, 2017, 39(4): 269-273.
14.	顾鑫蕾, 张真榕, 刘德若. 肺磨玻璃影CT特征与腺癌组织病理学相关性研究进展. 中华胸心血管外科杂志, 2018, 34(12): 760-763.
15.	Travis WD, Brambilla E, Nicholson AG, et al. The 2015 world health organization classification of lung tumors: Impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
16.	郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
17.	Bai C, Choi CM, Chu CM, et al. Evaluation of pulmonary nodules: Clinical practice consensus guidelines for Asia. Chest, 2016, 150(4): 877-893.
18.	牛荣, 王跃涛, 邵晓梁, 等. 18F-脱氧葡萄糖PET联合HRCT的预测模型在实性成分比例≤0.5的早期肺腺癌浸润性诊断中的应用. 中华放射学杂志, 2020, 54(12): 1173-1178.
19.	Cheng X, Zheng D, Li Y, et al. Tumor histology predicts mediastinal nodal status and may be used to guide limited lymphadenectomy in patients with clinical stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2018, 155(6): 2648-2656.
20.	Chan EG, Chan PG, Mazur SN, et al. Outcomes with segmentectomy versus lobectomy in patients with clinical T1cN0M0 non-small cell lung cancer. J Thorac Cardiovasc Surg, 2021, 161(5): 1639-1648.
21.	Santus P, Franceschi E, Radovanovic D. Sublobar resection: Functional evaluation and pathophysiological considerations. J Thorac Dis, 2020, 12(6): 3363-3368.
22.	MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
23.	刘莉, 吴宁, 周丽娜, 等. 亚实性结节血管及支气管异常与肺腺癌类病变侵袭性的相关性分析. 中华放射学杂志, 2019, 53(11): 987-991.
24.	余永强. 三维CT定量联合定性参数的logistic回归模型对纯磨玻璃结节侵袭程度的临床预测价值. 中华放射学杂志, 2021, 55(1): 34-39.
25.	Gao F, Sun Y, Zhang G, et al. CT characterization of different pathological types of subcentimeter pulmonary ground-glass nodular lesions. Br J Radiol, 2019, 92(1094): 20180204.
26.	Yang YQ, Gao J, Jin M, et al. Abnormal air bronchogram within pure ground glass opacity lung adenocarcinoma: Value for predicting histopathologic subtypes. Chin J Radiol, 2017, 51(7): 489-492.
27.	Dai J, Yu G, Yu J. Can CT imaging features of ground-glass opacity predict invasiveness? A meta-analysis. Thorac Cancer, 2018, 9(4): 452-458.
28.	顾亚峰, 李琼, 刘士远. 肺亚实性结节CT定量测量的研究进展. 中华放射学杂志, 2017, 51(4): 317-320.
29.	吴芳, 蔡祖龙, 田树平, 等. 最大径≤1 cm的纯磨玻璃密度肺腺癌病理分类及CT征象特点分析. 中华放射学杂志, 2016, 50(4): 260-264.
30.	Kitami A, Sano F, Hayashi S, et al. Correlation between histological invasiveness and the computed tomography value in pure ground-glass nodules. Surg Today, 2016, 46(5): 593-598.
31.	She Y, Zhao L, Dai C, et al. Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study. Oncotarget, 2017, 8(10): 17229-17238.
32.	Zhou QJ, Zheng ZC, Zhu YQ, et al. Tumor invasiveness defined by IASLC/ATS/ERS classification of ground-glass nodules can be predicted by quantitative CT parameters. J Thorac Dis, 2017, 9(5): 1190-1200.
33.	Han L, Zhang P, Wang Y, et al. CT quantitative parameters to predict the invasiveness of lung pure ground-glass nodules (pGGNs). Clin Radiol, 2018, 73(5): 504.e1-504.e7.
34.	Fu F, Zhang Y, Wang S, et al. Computed tomography density is not associated with pathological tumor invasion for pure ground-glass nodules. J Thorac Cardiovasc Surg, 2021, 162(2): 451-459.
35.	Travis WD, Asamura H, Bankier AA, et al. The IASLC lung cancer staging project: Proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol, 2016, 11(8): 1204-1223.
36.	Yip R, Li K, Liu L, et al. Controversies on lung cancers manifesting as part-solid nodules. Eur Radiol, 2018, 28(2): 747-759.
37.	Sun F, Xi J, Zhan C, et al. Ground glass opacities: Imaging, pathology, and gene mutations. J Thorac Cardiovasc Surg, 2018, 156(2): 808-813.
38.	Zhang Y, Fu F, Chen H. Management of ground-glass opacities in the lung cancer spectrum. Ann Thorac Surg, 2020, 110(6): 1796-1804.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 赫捷, 李霓, 陈万青, 等. 中国肺癌筛查与早诊早治指南(2021, 北京). 中华肿瘤杂志, 2021, 43(3): 243-268.
3. Yotsukura M, Asamura H, Motoi N, et al. Long-term prognosis of patients with resected adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung. J Thorac Oncol, 2021, 16(8): 1312-1320.
4. Wang Y, Zheng D, Luo J, et al. Risk stratification model for patients with stage Ⅰ invasive lung adenocarcinoma based on clinical and pathological predictors. Transl Lung Cancer Res, 2021, 10(5): 2205-2217.
5. Mäkinen JM, Laitakari K, Johnson S, et al. Histological features of malignancy correlate with growth patterns and patient outcome in lung adenocarcinoma. Histopathology, 2017, 71(3): 425-436.
6. Moreira AL, Ocampo PSS, Xia Y, et al. A grading system for invasive pulmonary adenocarcinoma: A proposal from the international association for the study of lung cancer pathology committee. J Thorac Oncol, 2020, 15(10): 1599-1610.
7. Suzuki K, Watanabe S, Wakabayashi M, et al. A nonrandomized phase Ⅲ study of sublobar surgical resection for peripheral ground glass opacity dominant lung cancer defined with thoracic thin-section computed tomography (JCOG0804/WJOG4507L). 2017 ASCO Annual Meeting Abstract No:8561. J Clin Oncol, 2017, 35(suppl15): 8561.
8. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
9. 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肿瘤学分会肺癌临床诊疗指南 (2021版). 中华医学杂志, 2021, 101(23): 1725-1757.
10. 张鹏举, 李天然, 陶雪敏, 等. 磨玻璃结节早期贴壁生长为主型浸润性肺腺癌与其他病理亚型的CT特征分析. 中华放射学杂志, 2021, 55(7): 739-744.
11. Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol, 2016, 34(4): 307-313.
12. 北京医学会胸外科分会, 中国医疗保健国际交流促进会胸外科分会. 基于高分辨CT影像学指导≤2cm磨玻璃结节肺癌手术方式胸外科专家共识(2019版). 中国胸心血管外科临床杂志, 2020, 27(4): 395-400.
13. 孙巍, 林冬梅. Ⅰ期浸润性肺腺癌磨玻璃成分定量分析及其与附壁样生长成分的相关性研究. 中华肿瘤杂志, 2017, 39(4): 269-273.
14. 顾鑫蕾, 张真榕, 刘德若. 肺磨玻璃影CT特征与腺癌组织病理学相关性研究进展. 中华胸心血管外科杂志, 2018, 34(12): 760-763.
15. Travis WD, Brambilla E, Nicholson AG, et al. The 2015 world health organization classification of lung tumors: Impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 2015, 10(9): 1243-1260.
16. 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
17. Bai C, Choi CM, Chu CM, et al. Evaluation of pulmonary nodules: Clinical practice consensus guidelines for Asia. Chest, 2016, 150(4): 877-893.
18. 牛荣, 王跃涛, 邵晓梁, 等. 18F-脱氧葡萄糖PET联合HRCT的预测模型在实性成分比例≤0.5的早期肺腺癌浸润性诊断中的应用. 中华放射学杂志, 2020, 54(12): 1173-1178.
19. Cheng X, Zheng D, Li Y, et al. Tumor histology predicts mediastinal nodal status and may be used to guide limited lymphadenectomy in patients with clinical stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2018, 155(6): 2648-2656.
20. Chan EG, Chan PG, Mazur SN, et al. Outcomes with segmentectomy versus lobectomy in patients with clinical T1cN0M0 non-small cell lung cancer. J Thorac Cardiovasc Surg, 2021, 161(5): 1639-1648.
21. Santus P, Franceschi E, Radovanovic D. Sublobar resection: Functional evaluation and pathophysiological considerations. J Thorac Dis, 2020, 12(6): 3363-3368.
22. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
23. 刘莉, 吴宁, 周丽娜, 等. 亚实性结节血管及支气管异常与肺腺癌类病变侵袭性的相关性分析. 中华放射学杂志, 2019, 53(11): 987-991.
24. 余永强. 三维CT定量联合定性参数的logistic回归模型对纯磨玻璃结节侵袭程度的临床预测价值. 中华放射学杂志, 2021, 55(1): 34-39.
25. Gao F, Sun Y, Zhang G, et al. CT characterization of different pathological types of subcentimeter pulmonary ground-glass nodular lesions. Br J Radiol, 2019, 92(1094): 20180204.
26. Yang YQ, Gao J, Jin M, et al. Abnormal air bronchogram within pure ground glass opacity lung adenocarcinoma: Value for predicting histopathologic subtypes. Chin J Radiol, 2017, 51(7): 489-492.
27. Dai J, Yu G, Yu J. Can CT imaging features of ground-glass opacity predict invasiveness? A meta-analysis. Thorac Cancer, 2018, 9(4): 452-458.
28. 顾亚峰, 李琼, 刘士远. 肺亚实性结节CT定量测量的研究进展. 中华放射学杂志, 2017, 51(4): 317-320.
29. 吴芳, 蔡祖龙, 田树平, 等. 最大径≤1 cm的纯磨玻璃密度肺腺癌病理分类及CT征象特点分析. 中华放射学杂志, 2016, 50(4): 260-264.
30. Kitami A, Sano F, Hayashi S, et al. Correlation between histological invasiveness and the computed tomography value in pure ground-glass nodules. Surg Today, 2016, 46(5): 593-598.
31. She Y, Zhao L, Dai C, et al. Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study. Oncotarget, 2017, 8(10): 17229-17238.
32. Zhou QJ, Zheng ZC, Zhu YQ, et al. Tumor invasiveness defined by IASLC/ATS/ERS classification of ground-glass nodules can be predicted by quantitative CT parameters. J Thorac Dis, 2017, 9(5): 1190-1200.
33. Han L, Zhang P, Wang Y, et al. CT quantitative parameters to predict the invasiveness of lung pure ground-glass nodules (pGGNs). Clin Radiol, 2018, 73(5): 504.e1-504.e7.
34. Fu F, Zhang Y, Wang S, et al. Computed tomography density is not associated with pathological tumor invasion for pure ground-glass nodules. J Thorac Cardiovasc Surg, 2021, 162(2): 451-459.
35. Travis WD, Asamura H, Bankier AA, et al. The IASLC lung cancer staging project: Proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol, 2016, 11(8): 1204-1223.
36. Yip R, Li K, Liu L, et al. Controversies on lung cancers manifesting as part-solid nodules. Eur Radiol, 2018, 28(2): 747-759.
37. Sun F, Xi J, Zhan C, et al. Ground glass opacities: Imaging, pathology, and gene mutations. J Thorac Cardiovasc Surg, 2018, 156(2): 808-813.
38. Zhang Y, Fu F, Chen H. Management of ground-glass opacities in the lung cancer spectrum. Ann Thorac Surg, 2020, 110(6): 1796-1804.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

CT features of pulmonary nodules in predicting histological subtypes of adenocarcinoma

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