Objective To investigate the clinical and pathological characteristics, prognosis and treatment strategies of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA). Methods We retrospectively analyzed the clinical data of 489 patients with AIS and MIA in our hospital from January 2007 to August 2015. There were 122 males and 367 females with an average age of 26–78 (51±9) years. According to the pathological types, they were divided into the AIS group (246 patients) and the MIA group (243 patients). In the AIS group, there were 60 males and 186 females with an average age of 50±7 years. In the MIA group, there were 62 males and 181 females with an average age of 54±5 years. The clinicopathological features, surgical methods and prognosis of the two groups were compared. Results There were significant differences in age, value of carcino-embryonic antigen (CEA), nodule shape and nodule size between the AIS and MIA groups (P<0.05). AIS patients were mostly under the age of 60 years with the value of CEA in the normal range which often appeared as pure ground-glass opacity lung nodules <1 cm in diameter on the CT scan. MIA often appeared as mixed ground-glass nodules <1.5 cm in diameter, accompanied by bronchiectasis and pleural indentation. The 5-year disease-free survival rate of the AIS and MIA groups reached 100%, and there was no statistical difference in the prognosis between the two groups after subtotal lobectomy (pulmonary resection and wedge resection) and lobectomy, systematic lymph node dissection and mediastinal lymph node sampling. Conclusion The analysis of preoperative clinical and imaging features can predict the AIS and MIA and provide individualized surgery and postoperative treatment program.
ObjectiveTo evaluate the application value of three-dimensional (3D) reconstruction in preoperative surgical diagnosis of new classification criteria for lung adenocarcinoma, which is helpful to develop a deep learning model of artificial intelligence in the auxiliary diagnosis and treatment of lung cancer.MethodsThe clinical data of 173 patients with ground-glass lung nodules with a diameter of ≤2 cm, who were admitted from October 2018 to June 2020 in our hospital were retrospectively analyzed. Among them, 55 were males and 118 were females with a median age of 61 (28-82) years. Pulmonary nodules in different parts of the same patient were treated as independent events, and a total of 181 subjects were included. According to the new classification criteria of pathological types, they were divided into pre-invasive lesions (atypical adenomatous hyperplasia and and adenocarcinoma in situ), minimally invasive adenocarcinoma and invasive adenocarcinoma. The relationship between 3D reconstruction parameters and different pathological subtypes of lung adenocarcinoma, and their diagnostic values were analyzed by multiplanar reconstruction and volume reconstruction techniques.ResultsIn different pathological types of lung adenocarcinoma, the diameter of lung nodules (P<0.001), average CT value (P<0.001), consolidation/tumor ratio (CTR, P<0.001), type of nodules (P<0.001), nodular morphology (P<0.001), pleural indenlation sign (P<0.001), air bronchogram sign (P=0.010), vascular access inside the nodule (P=0.005), TNM staging (P<0.001) were significantly different, while nodule growth sites were not (P=0.054). At the same time, it was also found that with the increased invasiveness of different pathological subtypes of lung adenocarcinoma, the proportion of dominant signs of each group gradually increased. Meanwhile, nodule diameter and the average CT value or CTR were independent risk factors for malignant degree of lung adenocarcinoma.ConclusionImaging signs of lung adenocarcinoma in 3D reconstruction, including nodule diameter, the average CT value, CTR, shape, type, vascular access conditions, air bronchogram sign, pleural indenlation sign, play an important role in the diagnosis of lung adenocarcinoma subtype and can provide guidance for personalized therapy to patients in clinics.