Significance of intra-nodular vessel sign in differentiating benign and malignant pulmonary ground-glass nodules

Abstract Background The presence of pulmonary vessels inside ground-glass nodules (GGNs) of different nature is a very common occurrence. This study aimed to reveal the significance of pulmonary vessels displayed in GGNs in their diagnosis and differential diagnosis. Results A total of 149 malignant and 130 benign GGNs confirmed by postoperative pathological examination were retrospectively enrolled in this study. There were significant differences in size, shape, nodule-lung interface, pleural traction, lobulation, and spiculation (each p < 0.05) between benign and malignant GGNs. Compared with benign GGNs, intra-nodular vessels were more common in malignant GGNs (67.79% vs. 54.62%, p = 0.024), while the vascular categories were similar (p = 0.663). After adjusting the nodule size and the distance between the nodule center and adjacent pleura [radius–distance ratio, RDR], the occurrences of internal vessels between them were similar. The number of intra-nodular vessels was positively correlated with nodular diameter and RDR. Vascular changes were more common in malignant than benign GGNs (52.48% vs. 18.31%, p < 0.0001), which mainly manifested as distortion and/or dilation of pulmonary veins (61.19%). The occurrence rate, number, and changes of internal vessels had no significant differences among all the pre-invasive and invasive lesions (each p > 0.05). Conclusions The incidence of internal vessels in GGNs is mainly related to their size and the distance between nodule and pleura rather than the pathological nature. However, GGNs with dilated or distorted internal vessels, especially pulmonary veins, have a higher possibility of malignancy.

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Pathological Examination and Differential Diagnosis of Pulmonary Ground-Glass Opacities by CT-Guided Percutaneous Needle Biopsy

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3522 ◽

2021 ◽

Vol 11 (3) ◽

pp. 912-920

Author(s):

Yong Li ◽

Yanxin Sun ◽

Jingqi Han ◽

Hualong Yu ◽

Chuanyu Zhang ◽

...

Keyword(s):

Differential Diagnosis ◽

Needle Biopsy ◽

Ground Glass ◽

Bronchioloalveolar Carcinoma ◽

Pathological Examination ◽

Special Treatment ◽

Percutaneous Needle Biopsy ◽

Pulmonary Tissue ◽

Ct Guided ◽

Sensitivity Specificity

In order to explore the pathological examination and differential diagnosis of pulmonary ground-glass opacities (GGO) with CT-guided percutaneous needle biopsy (CTPNB), this study retrospectively analyzed the medical records of 120 cases of patients who were diagnosed with pulmonary GGO and underwent CTPNB in a hospital designated by this study from December 2014 to December 2018. The results showed that all the 120 cases of patients were successfully punctured at one time and obtained sufficient tissue specimens with the puncture success rate and diagnostic accuracy both of 100%, being able to make a clear qualitative diagnosis. Among them, 30 cases were malignant lesions including 14 cases of bronchioloalveolar carcinoma and 16 cases of metastatic carcinoma; 90 cases were benign lesions including 52 cases of hematogenous pulmonary tuberculosis, 14 cases of sarcoidosis, 12 cases of silicosis and coal workers’ pneumoconiosis, 6 cases of interstitial pneumonia, 4 cases of alveolar proteinosis, and 2 case of allergic pneumonia. The complications of the 120 patients during the treatment included 8 cases of pneumothorax with an incidence of 6.67% (8/120), in which 2 case had the pulmonary tissue compression rate of about 25% and the other cases had no obvious perceived symptoms and required no special treatment, and 10 cases of hemoptysis with an incidence of 8.33% (10/120), whose symptoms disappeared after the treatment with batroxobin, and had no serious symptoms such as air embolism complication. The sensitivity, specificity, and accuracy of CTPNB in the diagnosis of malignant pulmonary GGO were 83.67% (82/98), 100% (22/22), and 86.67% (104/120), respectively, without statistically significant differences in diagnostic efficacy (P > 0.05). In summary, the CTPNB for the diagnosis of malignant pulmonary GGO has high sensitivity, specificity, and accuracy, and the CTPNB is also the simplest and most important approach to obtain effective pathological examinations and differential diagnoses of pulmonary GGO, which has simple operation, high accuracy and few complications, and has high application value for the qualitative diagnosis of pulmonary GGO.

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Three-dimensional substructure measurements for the differential diagnosis of ground glass nodules

BMC Pulmonary Medicine ◽

10.1186/s12890-017-0438-y ◽

2017 ◽

Vol 17 (1) ◽

Author(s):

Mingzheng Peng ◽

Gang Yu ◽

Chengzhong Zhang ◽

Cuidi Li ◽

Jinwu Wang

Keyword(s):

Differential Diagnosis ◽

Three Dimensional ◽

Ground Glass ◽

Ground Glass Nodules

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

European Journal of Radiology ◽

10.1016/j.ejrad.2021.109772 ◽

2021 ◽

pp. 109772

Author(s):

Ziqi Xiong ◽

Yining Jiang ◽

Siyu Che ◽

Wenjing Zhao ◽

Yan Guo ◽

...

Keyword(s):

Minimally Invasive ◽

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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