A comparative study on computed tomographic and pathologic features between preinvasive lesions and invasive adenocarcinoma presented as pulmonary ground-glass opacity nodules_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

GE Xiahui ¹ ,  GUAN Wenbin ² , HAN Fengfeng ¹ , LIU Song ¹ , SUN Jinyuan ¹ , LI Huimin ³ ,  GUO Xuejun ¹

1. Department of Respiratory Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P. R. China;
2. Department of Pathology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P. R. China;
3. Department of Radiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P. R. China;

Corresponding author：

GUAN Wenbin, Email: celiceli02@126.com; GUO Xuejun, Email: snowgen@126.com

Keywords：

Pulmonary ground-glass opacity; Features of computed tomography; Pathology; Preinvasive lesion; Invasive adenocarcinoma; Vascular bundle sign

DOI：

10.7507/1671-6205.201703010

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To improve our recognition of ground-glass opacity (GGO) through analyzing the imaging and pathological features of patients with focal GGO lung nodule. Methods Thirty patients with focal GGO nodule were assigned into a preinvasive lesion group, a minimally invasive adenocarcinoma (MIA) group, and an invasive adenocarcinoma (IAC) group. The imaging features were retrospectively analyzed and pathological features by histological Masson staining, collagen Ⅳ staining and Vitoria blue staining were also compared among three groups. Furthermore, the relationship between pathology and imaging characteristics was studied too. Results Among 30 patients with focal GGO nodule, preinvasive lesions, MIA and IAC respectively occurred in 13, 3 and 14 cases. Size of nodules and solid portion were highest in the IAC group, middle in the MIA group, and lowest in the preinvasive lesion group. Similarly, signs of lobulation, spiculation and air bronchogram were seen mostly in the IAC group, and least in preinvasive lesion group. The spatial relationship between GGO nodules and supplying blood vessels was analyzed, and Type Ⅲ was more commonly seen in the IAC group with comparison to type Ⅱ more likely seen in the preinvasive lesion group. Moreover, collagen Ⅳ and Vitoria blue staining indicated that reticular fibers and collagenous fibers lessened around tumor tissue in the IAC group, whereas collagenous fibers proliferation and fibrous scar were shown by Masson staining in the IAC group. In CT-pathologic comparison, type Ⅲ supplying blood vessels were mostly seen in the IAC patients with obvious fibrous scar. Conclusions Persistent focal GGO nodules with larger size and higher percent of solid component are signs of malignancy. In tumor progression process, tumor cells break the reticular fibers and collagenous fibers in alveolar wall, then stimulate fibroblast hyperplasia and secrete collagenous fibers, thereby develop the central fibrous scar in tumor tissue, which might be the pathologic foundation of vascular bundle sign.

Citation： GE Xiahui, GUAN Wenbin, HAN Fengfeng, LIU Song, SUN Jinyuan, LI Huimin, GUO Xuejun. A comparative study on computed tomographic and pathologic features between preinvasive lesions and invasive adenocarcinoma presented as pulmonary ground-glass opacity nodules. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(6): 561-566. doi: 10.7507/1671-6205.201703010 Copy

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8.	Lee KH, Goo JM, Park SJ, et al. Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thoracic Oncol, 2014, 9(1): 74-82.
9.	Fan L, Liu SY, Li QC, et al. Multidetector CT features of pulmonary focal ground-glass opacity: differences between benign and malignant. Br J Radiol, 2012,85(1015), 897-904.
10.	Takaashima S, Maruyama Y, Hasegawa M, et al. CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern. AJR, 2003, 180(3): 817-826.
11.	肖时满, 张玉, 强金伟, 等. 超高分辨率 CT(UHRCT)鉴别肺原位腺癌(AIS)与微浸润腺癌(MIA). 复旦学报(医学版), 2014,41(3): 285-290.
12.	秦福兵, 陆友金. 纯磨玻璃结节定量 CT 鉴别肺浸润性腺癌与浸润前病变和微浸润腺癌. 中国医学计算机成像杂志, 2016,22(1): 22-26.
13.	Gao F, Li M, Ge XJ, et al. Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels. Eur Radiol, 2013, 23(12): 3271-3277.

1. Saito H, Kameda Y, Masui K, et al. Correlations between thin-section CT findings, histopathological and clinical findings of small pulmonary adenocarcinomas. Lung Cancer, 2011, 71(2) : 137-143.
2. Austin JH, Garg K, Aberle D, et al. Radiologic implications of the 2011 classification of adenocarcinoma of the lung. Radiology, 2013, 266(1):62-71.
3. Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/American thoracic society/European respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2):244-285.
4. 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.
5. Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinomasubtype predict patient survival? A clinicopathologic study based on the new International association for the study of lung cancer /American thoracic society/European respiratory society international multidisciplinary lung adenocarcinoma classification. J Thoracic Oncol, 2011, 6(9): 1496-1504.
6. Warth A, Stenzinger A, von Brünneck AC, et al. Interobserver variability in the application of the novel IASLC /ATS /ERS classification for pulmonary adenocarcinomas. Eur Respir J, 2012,40(5): 1221-1227.
7. Eguchi T, Yoshizawa A, Kawakami S, et al. Tumor size and computed tomography attenuation of pulmonary pure ground-glass nodules are useful for predicting pathological invasiveness. PLos One, 2014, 9(5): e97867.
8. Lee KH, Goo JM, Park SJ, et al. Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thoracic Oncol, 2014, 9(1): 74-82.
9. Fan L, Liu SY, Li QC, et al. Multidetector CT features of pulmonary focal ground-glass opacity: differences between benign and malignant. Br J Radiol, 2012,85(1015), 897-904.
10. Takaashima S, Maruyama Y, Hasegawa M, et al. CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern. AJR, 2003, 180(3): 817-826.
11. 肖时满, 张玉, 强金伟, 等. 超高分辨率 CT(UHRCT)鉴别肺原位腺癌(AIS)与微浸润腺癌(MIA). 复旦学报(医学版), 2014,41(3): 285-290.
12. 秦福兵, 陆友金. 纯磨玻璃结节定量 CT 鉴别肺浸润性腺癌与浸润前病变和微浸润腺癌. 中国医学计算机成像杂志, 2016,22(1): 22-26.
13. Gao F, Li M, Ge XJ, et al. Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels. Eur Radiol, 2013, 23(12): 3271-3277.

Chinese Journal of Respiratory and Critical Care Medicine

A comparative study on computed tomographic and pathologic features between preinvasive lesions and invasive adenocarcinoma presented as pulmonary ground-glass opacity nodules

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