Use of CT radiomics to differentiate minimally invasive adenocarcinomas and invasive adenocarcinomas presenting as pure ground-glass nodules larger than 10 mm

Abstract Thin-section computed tomography (TSCT) imaging biomarkers are uncertain to distinguish progressive adenocarcinoma from benign lesions in pGGNs. The purpose of this study was to evaluate the usefulness of TSCT characteristics for differentiating among transient (TRA) lesions, atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) presenting as pure ground-glass nodules (pGGNs). Between January 2016 and January 2018, 255 pGGNs, including 64 TRA, 22 AAH, 37 AIS, 108 MIA and 24 IAC cases, were reviewed on TSCT images. Differences in TSCT characteristics were compared among these five subtypes of pGGNs. Logistic analysis was performed to identify significant factors for predicting MIA and IAC. Progressive pGGNs were more likely to be round or oval in shape, with clear margins, air bronchograms, vascular and pleural changes, creep growth, and bubble-like lucency than were non-progressive pGGNs. The optimal cut-off values of the maximum diameter for differentiating non-progressive from progressive pGGNs and IAC from non-IAC were 6.5 mm and 11.5 mm, respectively. For the prediction of IAC vs. non-IAC and non-progressive vs. progressive adenocarcinoma, the areas under the receiver operating characteristics curves were 0.865 and 0.783 for maximum diameter and 0.784 and 0.722 for maximum CT attenuation, respectively. The optimal cut-off values of maximum CT attenuation were −532 HU and −574 HU for differentiating non-progressive from progressive pGGNs and IAC from non-IAC, respectively. Maximum diameter, maximum attenuation and morphological characteristics could help distinguish TRA lesions from MIA and IAC but not from AAH. So, CT morphologic characteristics, diameter and attenuation parameters are useful for differentiating among pGGNs of different subtypes.

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HRCT texture analysis for pure or part-solid ground-glass nodules: distinguishability of adenocarcinoma in situ or minimally invasive adenocarcinoma from invasive adenocarcinoma

Japanese Journal of Radiology ◽

10.1007/s11604-017-0711-2 ◽

2017 ◽

Vol 36 (2) ◽

pp. 113-121 ◽

Cited By ~ 9

Author(s):

Takuya Yagi ◽

Motohiko Yamazaki ◽

Riuko Ohashi ◽

Rei Ogawa ◽

Hiroyuki Ishikawa ◽

...

Keyword(s):

Minimally Invasive ◽

Texture Analysis ◽

Ground Glass ◽

Adenocarcinoma In Situ ◽

Invasive Adenocarcinoma ◽

Solid Ground ◽

Minimally Invasive Adenocarcinoma ◽

Ground Glass Nodules

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Radiomic signature based on CT imaging to distinguish invasive adenocarcinoma from minimally invasive adenocarcinoma in pure ground-glass nodules with pleural contact

Cancer Imaging ◽

10.1186/s40644-020-00376-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yining Jiang ◽

Siyu Che ◽

Shuangchun Ma ◽

Xinyan Liu ◽

Yan Guo ◽

...

Keyword(s):

Minimally Invasive ◽

Roc Curve ◽

Ct Imaging ◽

Ground Glass ◽

Invasive Adenocarcinoma ◽

Discriminative Performance ◽

Minimally Invasive Adenocarcinoma ◽

Radiomics Signature ◽

Ground Glass Nodules ◽

Pleural Contact

Abstract Background Pure ground-glass nodules (pGGNs) with pleural contact (P-pGGNs) comprise not only invasive adenocarcinoma (IAC), but also minimally invasive adenocarcinoma (MIA). Radiomics recognizes complex patterns in imaging data by extracting high-throughput features of intra-tumor heterogeneity in a non-invasive manner. In this study, we sought to develop and validate a radiomics signature to identify IAC and MIA presented as P-pGGNs. Methods In total, 100 patients with P-pGGNs (69 training samples and 31 testing samples) were retrospectively enrolled from December 2012 to May 2018. Imaging and clinical findings were also analyzed. In total, 106 radiomics features were extracted from the 3D region of interest (ROI) using computed tomography (CT) imaging. Univariate analyses were used to identify independent risk factors for IAC. The least absolute shrinkage and selection operator (LASSO) method with 10-fold cross-validation was used to generate predictive features to build a radiomics signature. Receiver-operator characteristic (ROC) curves and calibration curves were used to evaluate the predictive accuracy of the radiomics signature. Decision curve analyses (DCA) were also conducted to evaluate whether the radiomics signature was sufficiently robust for clinical practice. Results Univariate analysis showed significant differences between MIA (N = 47) and IAC (N = 53) groups in terms of patient age, lobulation signs, spiculate margins, tumor size, CT values and relative CT values (all P < 0.05). ROC curve analysis showed, when MIA was identified from IAC, that the critical value of tumor length diameter (TLD) was1.39 cm and the area under the ROC curve (AUC) was 0.724 (sensitivity = 0.792, specificity = 0.553). The critical CT value on the largest axial plane (CT-LAP) was − 597.45 HU, and the AUC was 0.666 (sensitivity = 0.698, specificity= 0.638). The radiomics signature consisted of seven features and exhibited a good discriminative performance between IAC and MIA, with an AUC of 0.892 (sensitivity = 0.811, specificity 0.719), and 0.862 (sensitivity = 0.625, specificity = 0.800) in training and testing samples, respectively. Conclusions Our radiomics signature exhibited good discriminative performance in differentiating IAC from MIA in P-pGGNs, and may offer a crucial reference point for follow-up and selective surgical management.

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CT Characteristics for Predicting Invasiveness in Pulmonary Pure Ground-Glass Nodules

American Journal of Roentgenology ◽

10.2214/ajr.19.22381 ◽

2020 ◽

Vol 215 (2) ◽

pp. 351-358 ◽

Cited By ~ 1

Author(s):

Zhi-gang Chu ◽

Wang-jia Li ◽

Bin-jie Fu ◽

Fa-jin Lv

Keyword(s):

Ground Glass ◽

Ground Glass Nodules

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Diffuse Cystic Metastases in the Lung after Nivolumab Treatment in a Patient with Non-Small Cell Lung Cancer: A Case Report

Case Reports in Oncology ◽

10.1159/000513426 ◽

2021 ◽

pp. 34-38

Author(s):

Satoshi Muto ◽

Yuki Ozaki ◽

Takuya Inoue ◽

Naoyuki Okabe ◽

Yuki Matsumura ◽

...

Keyword(s):

Lung Adenocarcinoma ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Lung Metastases ◽

Sialyl Lewis X ◽

Ground Glass ◽

Cystic Lesions ◽

Positron Emission ◽

Ground Glass Nodules

Although diffuse cysts in the lung can be found in many diseases, they are uncommon in metastatic lung adenocarcinoma. They are even more unusual after the administration of immune checkpoint inhibitors. A case of lung adenocarcinoma that developed diffuse cysts in the lungs during treatment with nivolumab is reported. The patient was a 60-year-old woman with postoperative recurrent lung adenocarcinoma in mediastinal lymph nodes and pleural dissemination. After first-line treatment with cisplatin, pemetrexed, and bevacizumab, computed tomography (CT) showed disease progression. Treatment was then switched to nivolumab. After 5 courses of nivolumab, CT showed multiple ground-glass nodules in her lungs. After 4 more courses of nivolumab, the ground-glass nodules increased in size, and cystic air spaces appeared in their centers. The patient did not have any symptoms. Laboratory tests showed no evidence of infection or nivolumab-induced pneumonitis. Sialyl Lewis X-i antigen increased, and positron emission tomography showed abnormal uptake of 18F-fluorodeoxyglucose in these lesions. Considering this evidence, the cystic lesions were diagnosed as multiple lung metastases. Various differential diagnoses should be considered when diffuse cystic lesions are found in the lungs after the administration of immune checkpoint inhibitors.

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