Radiomics features of ground glass nodules tailored different pathological grades of lung adenocarcinoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e23127-e23127
Author(s):  
C Zhang ◽  
Haoran Zhai ◽  
Lan He ◽  
Zai-Yi Liu ◽  
Yi-Long Wu ◽  
...  
Keyword(s):  
Smoking Status ◽  
Ground Glass ◽  
Low Grade ◽  
High Grade ◽  
Ratio Model ◽  
Intermediate Grade ◽  
Potential Predictor ◽  
Continuation Ratio ◽  
Radiomics Signature ◽  
Ground Glass Nodules

e23127 Background: Different pathological subtypes as well as different grades of adenocarcinoma based on the IASLC/ATS/ERS classification had been proven to be stage-independent predictor of survival. Radiomics features, as a novel analytic method, has been increasingly applied in variety cancer research and may be a potential predictor for preoperatively differentiating pathological grades of adenocarcinoma. Methods: Patients (pts) with radiological proved as solitary ground glass nodule were eligible in this study. Radiomics features derived from computed tomography (CT) images were extracted by Chinese Academy of Science. All pts will be categorized into three groups with lepidic predominance as low-grade, acinar and papillary predominance as intermediate-grade, micropapillary and solid predominance as high-grade. We used L1 penalized constrained continuation ratio model to select relevant radiomics features, and corresponding radiomics signature was constructed. Association between the radiomics signature and pathological grades of adenocarcinoma was explored using the Kruskal-Wallis test and C-index was performed to test the efficacy of differentiating. Results: 82 pts were included in this study. Low-grade, intermediate-grade and high-grade contained 15 (18.3%), 53 (64.6%), 14 (17.1%) pts respectively. 475 radiomics features were extracted from thin section CT image and 10 of them selected through L1 penalized constrained continuation ratio model composed radiomics signature which significantly associated with pathological grades (P < 0.0001). C-index for radiomics signature were 0.813 (95%CI 0.793-0.833). Since clinical characters including gender, age, smoking status, NSE, CEA and CYFRA21-1 were not associated with different grades of adenocarcinoma, we could not establish nomogram based on the radiomics signature and correlated clinical characters. Conclusions: Radiomics features only can be a potential predictor for preoperatively differentiating pathological grades of adenocarcinoma, which may be a more applicable clinical predictor for patients’ survival. Yet large sample sizes are warranted to confirm the results.

CT-based Radiomics Signature to Discriminate High-grade From Low-grade Colorectal Adenocarcinoma

2018 ◽  
Vol 25 (10) ◽  
pp. 1285-1297 ◽  
Author(s):  
Xiaomei Huang ◽  
Zixuan Cheng ◽  
Yanqi Huang ◽  
Cuishan Liang ◽  
Lan He ◽  
...  
Keyword(s):  
Colorectal Adenocarcinoma ◽  
Low Grade ◽  
High Grade ◽  
Radiomics Signature

scholarly journals Prognostic factors in non-Hodgkin lymphomas

2000 ◽  
Vol 118 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Karin Zattar Cecyn ◽  
José Salvador Rodrigues de Oliveira ◽  
Antônio Correia Alves ◽  
Maria Regina Regis Silva ◽  
José Kerbauy
Keyword(s):  
Prognostic Factors ◽  
Hodgkin Lymphoma ◽  
Low Grade ◽  
High Grade ◽  
Cns Involvement ◽  
Intermediate Grade ◽  
Non Hodgkin Lymphoma ◽  
Tumor Dissemination ◽  
Mediastinal Disease ◽  
Extranodal Disease

CONTEXT: In Hodgkin's disease, each clinical or pathologic stage can be related to the extent of the area involved and predicts the next anatomical region at risk for tumor dissemination. OBJECTIVE: To determine the best prognostic factors that could predict survival in non-Hodgkin lymphoma cases. DESIGN: A retrospective study. LOCATION: Department of Hematology and Transfusion Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina. PARTICIPANTS: 142 patients with non-Hodgkin lymphoma diagnosed between February 1988 and March 1993. MAIN MEASUREMENTS: Histological subset, Sex, Age, Race, B symptoms, Performance status, Stage, Extranodal disease, Bulk disease, Mediastinal disease, CNS involvement, BM infiltration, Level of DHL, Immunophenotype. RESULTS: In the first study (113 patients), the following variables had a worse influence on survival: yellow race (P<0.1); ECOG II, III e IV (P<0.1) and extranodal disease (P<0.1) for high grade lymphomas; constitutional symptoms (P<0.1), ECOG II, III e IV (P<0.1) and involvement of CNS (P<0.1) for intermediate grade and the subtype lymphoplasmocytoid (P=0.0186) for low grade lymphomas. In the second survey (93 patients), when treatment was included, the variables related to NHL survival were: CNS involvement (P<0.1) for high grade lymphomas, constitutional symptoms (P<0.1), ECOG II, III, IV (P=0.0185) and also CNS involvement (P<0.1) for the intermediate group. There were no variables related to the survival for low-grade lymphomas. CONCLUSIONS: The intermediate grade lymphomas were more compatible with data found in the literature, probably because of the larger number of patients. In this specific case, the treatment did not have an influence on the survival.

scholarly journals Assessment of the immunoexpression profile of breast ductal carcinoma with Cyclin D1, Her-2/Neu and p53 at Yangon General Hospital, Myanmar

2021 ◽  
Vol 5 (1) ◽  
pp. 44-49
Author(s):  
Khin Darli Tun ◽  
Min Ko Ko ◽  
Sudha Arumugam ◽  
Srikumar Chakravarthi ◽  
Jaya Vejayan
Keyword(s):  
Monoclonal Antibodies ◽  
Cyclin D1 ◽  
Invasive Ductal Carcinoma ◽  
Ductal Carcinoma ◽  
Histological Grade ◽  
Low Grade ◽  
High Grade ◽  
Carcinoma Of The Breast ◽  
Intermediate Grade ◽  
Ductal Carcinomas

One hundred cases of histologically proven invasive ductal carcinomas were histologically graded based on modified Bloom and Richardson Grading. Out of these 17 cases each of low grade, intermediate grade, and high grade invasive ductal carcinomas were selected for Immunostaining using the monoclonal antibodies Cyclin D1,pP53 and Her2/neu. It was found that for all three monoclonal antibodies the lowest histological grade of Invasive Ductal Carcinoma of the Breast showed the lowest positivity with Cyclin D1 ( 11.76%) and p53 ( 17.64%) and Her2/neu ( 47.05%). The intermediate grade tumour showed ( 70.58% ) positivity with Cyclin D1 and 58.58 % in p53 and Her2/neu. The high grade invasive ductal carcinoma of the breast showed the highest positivity of Cyclin D1 (76.47%) , p53 (88.24% ) ,Her2/neu ( 94.12% ); These suggest that Cyclin D1 , P53 and Her2/neuimmunoexpression positivity increases with rising histological grades of invasive ductal carcinoma of breast. 

scholarly journals Configuration of soft-tissue sarcoma on MRI correlates with grade of malignancy

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sam Sedaghat ◽  
Mona Salehi Ravesh ◽  
Maya Sedaghat ◽  
Marcus Both ◽  
Olav Jansen
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Grading System ◽  
Low Grade ◽  
High Grade ◽  
Intermediate Grade ◽  
Cancer Centers ◽  
Grade Of Malignancy

Abstract Background The aim of the study was to assess whether the configuration of primary soft-tissue sarcoma (STS) on MRI correlates with the grade of malignancy. Patients and methods 71 patients with histologically proven STS were included. Primary STS were examined for configuration, borders, and volume on MRI. The tumors were divided into high-grade (G3), intermediate-grade (G2) and low-grade (G1) STS according to the grading system of the French Federation of Cancer Centers Sarcoma Group (FNCLCC). Results 30 high-grade, 22 intermediate-grade and 19 low-grade primary STS lesions were identified. High- and intermediate-grade (G3/2) STS significantly most often appeared as polycyclic/multilobulated tumors (p < 0.001 and p = 0.002, respectively). Low-grade (G1) STS mainly showed an ovoid/nodular or streaky configuration (p = 0.008), and well-defined borders. The appearance of high-, intermediate- and low-grade STS with an ovoid/nodular configuration were mainly the same on MRI. All streaky G3/2 sarcoma and 17 of 20 patients with polycyclic/multilobulated G3 sarcoma showed infiltrative borders. High-grade streaky and polycyclic/multilobulated STS are larger in volume, compared to intermediate- and low-grade STS. Conclusions Configuration of STS on MRI can indicate the grade of malignancy. Higher-grade (G2/3) STS most often show a polycyclic/multilobulated configuration, while low-grade STS are mainly ovoid/nodular or streaky. Infiltrative behavior might suggest higher-grade STS in streaky and polycyclic/multilobulated STS.

scholarly journals Radiomics signature on CECT as a predictive factor for invasiveness of lung adenocarcinoma manifesting as subcentimeter ground glass nodules

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wufei Chen ◽  
Ming Li ◽  
Dingbiao Mao ◽  
Xiaojun Ge ◽  
Jiaofeng Wang ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Predictive Performance ◽  
Ground Glass ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Validation Set ◽  
Lung Adenocarcinomas ◽  
Radiomics Signature ◽  
Ground Glass Nodules

AbstractControversy and challenges remain regarding the cognition of lung adenocarcinomas presented as subcentimeter ground glass nodules (GGNs). Postoperative lymphatic involvement or intrapulmonary metastasis is found in approximately 15% to 20% of these cases. This study aimed to develop and validate a radiomics signature to identify the invasiveness of lung adenocarcinoma appearing as subcentimeter ground glass nodules. We retrospectively enrolled 318 subcentimeter GGNs with histopathology-confirmed adenocarcinomas in situ (AIS), minimally invasive adenocarcinomas (MIA) and invasive adenocarcinomas (IAC). The radiomics features were extracted from manual segmentation based on contrast-enhanced CT (CECT) and non-contrast enhanced CT (NCECT) images after imaging preprocessing. The Lasso algorithm was applied to construct radiomics signatures. The predictive performance of radiomics models was evaluated by receiver operating characteristic (ROC) analysis. A radiographic-radiomics combined nomogram was developed to evaluate its clinical utility. The radiomics signature on CECT (AUC: 0.896 [95% CI 0.815–0.977]) performed better than the radiomics signature on NCECT data (AUC: 0.851[95% CI 0.712–0.989]) in the validation set. An individualized prediction nomogram was developed using radiomics model on CECT and radiographic model including type, shape and vascular change. The C index of the nomogram was 0.915 in the training set and 0.881 in the validation set, demonstrating good discrimination. Decision curve analysis (DCA) revealed that the proposed model was clinically useful. The radiomics signature built on CECT could provide additional benefit to promote the preoperative prediction of invasiveness in patients with subcentimeter lung adenocarcinomas.

Survival Among Lymphoma Patients Over the Past Three Decades: A Single Institution Based Retrospective Review From 1976 to 2006.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4527-4527
Author(s):  
Monika Joshi ◽  
Hassan S Sheikh ◽  
Fabian Camacho ◽  
Lisa A Hand ◽  
Michael G. Bayerl ◽  
...  
Keyword(s):  
T Cell ◽  
Malignant Lymphoma ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Low Grade ◽  
High Grade ◽  
Cutaneous T Cell Lymphoma ◽  
Intermediate Grade ◽  
The Past ◽  
Improvement In Survival

Abstract Abstract 4527 Background The incidence of lymphoma has doubled in the past 3 decades in the US and most western countries. Since the advent of multi-drug chemotherapy, studies have shown improvement in survival in specific diagnostic groups such as diffuse large B-cell lymphomas. However, there have been few studies showing the impact of evolving therapies on survival for the total burden of lymphoma patients. We assessed survival for an aggregate population of all patients presenting with lymphoma to a regional tertiary university hospital over the past 3 decades. Goal To assess the magnitude of improvement in survival for patients with lymphoma over the past 3 decades. Methods We analyzed data from the Penn State Hershey Medical Center Cancer Registry, selecting all cases diagnosed with lymphoma by ICD-0-3 codes from Jan 1st 1976 to Dec 31st 2006. Five and ten year (yr) absolute survival rates during five time periods [group (gp) 1: 1976-1980, gp 2: 1981-1985, gp 3: 1986-1990, gp 4: 1996-2000, gp 5: 2001-2006] were obtained by using conventional period analysis (PA). In addition, a period Cox Proportional Model (CPH) was fit to the data, allowing for survival risk estimates of 5 yr survival, statistical testing of time periods, and adjustments for age at diagnosis. SAS v 9.1 was used to obtain estimates, with Brenner's PERIOD macro used for PA and PHREG used for CPH. Results Of 2843 patients, Hodgkin's lymphoma accounted for 17%, high grade lymphoma 4%, intermediate grade lymphoma 29%, low grade lymphoma 17%, cutaneous T-cell lymphoma 6%, chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) 13%, malignant lymphoma not otherwise specified (NOS) 14%. Median age was 56 yr and mean was 52 yr with a standard deviation (SD) of 20.9 yr. Median follow up was 4 yr and mean was 6 yr with SD 6.5 yr. Approximately 25% (N=700) survived beyond 10 yr. CPH adjusted for age demonstrated a 5 yr improvement among all lymphomas of 8%, Hazard Ratio (HR)=1.31, 95%, p=0.0192, between gp 5 and gp 1. Consistent improvements in 5 yr survival were detected for intermediate grade lymphoma (15%, HR=1.5, p=0.0219), high grade lymphoma (40%, HR=12.83, p<0.0001), and malignant lymphoma NOS (19%, HR=1.8, p=0.069) comparing gp 5 to gp 1. Changes in survival rates for Hodgkin's lymphoma, low grade lymphoma, CLL/SLL, and cutaneous T-cell lymphoma were not significant. Results for conventional PA were similar. There was a 7% improvement in 5 yr survival between gp 5 and gp 1 for all patients with lymphoma. However, improvement in 10 yr survival between available time intervals was minimal. For the PA, significant improvement in 5 yr survival was seen for intermediate grade lymphoma (24%), high grade lymphoma (28%), malignant lymphoma NOS (19%) comparing gp 5 to gp 1. Interestingly, cutaneous T-cell lymphoma showed a descriptive decline in both 5 yr and 10 yr survival of 29% and 14% respectively. Conclusion There has been a significant improvement of 8% in overall 5 yr survival in lymphoma patients over the past 3 decades after adjusting for age. There was an improvement in survival in both intermediate and high grade groups. There was a trend towards declining survival in cutaneous T cell lymphoma. This could be attributed to diagnostic drift with changing classification and to the fewer number of cases diagnosed in the earlier years as compared to later years. Disclosures: No relevant conflicts of interest to declare.

Correlation of pathologic tumor grade with survival in oral cavity squamous cell carcinoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18557-e18557
Author(s):  
Eric Anderson ◽  
Michael Luu ◽  
Diana J. Lu ◽  
Anthony Tuan Nguyen ◽  
Jon Mallen-St. Clair ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Multivariable Analysis ◽  
Tumor Grade ◽  
Low Grade ◽  
High Grade ◽  
Intermediate Grade

e18557 Background: Pathologic tumor grade is a well-established prognostic risk factor that impacts staging and standard-of-care treatment decisions across multiple cancer types. However, the significance of tumor grade in cancers of the head and neck is less certain. Even in oral cavity squamous cell carcinoma (OCSCC), the head and neck cancer subsite with largest body of literature regarding the predictive value of tumor grade is, the prognostic significance of tumor grade remains controversial. Thus, we sought to better elucidate the prognostic importance of tumor grade in OCSCC. Methods: Patients with OCSCC diagnosed from 2004-2015 and undergoing primary surgery with or without adjuvant treatment in the National Cancer Data Base (NCDB) were identified. Overall survival (OS) was estimated using the Kaplan-Meier method with and without propensity score matching (PSM). Univariate and multivariable survival analyses were performed using Cox regression. Analyses were adjusted for multiple clinicopathologic factors, including age, sex, comorbidity status, year of diagnosis, pathologic staging, margin status, number of lymph nodes (LN) examined/positive, extranodal extension (ENE), lymphovascular invasion (LVI), adjuvant radiation, and concomitant chemotherapy. Results: Median follow-up was 40.7 months. Of 13,941 patients with OCSCC, 2,883 had low-grade tumors, 8,716 had intermediate-grade tumors, and 2,342 had high-grade tumors. Higher tumor grade was strongly associated with decreased survival. Specifically, five year OS was 62.7%, 52.8%, and 42.5% in low-grade (LG), intermediate-grade (IG), and high-grade (HG) OCSCC, respectively (p-value < 0.001). In PSM cohorts, OCSCC patients with high-grade had significantly worse 5 year OS (47.7% vs. 57.7%, p < 0.001) in comparison to those with LG OCSCC. Similarly, patients with IG tumors has worse 5-year OS (55.6% vs. 60.3%, p = 0.001) than patients with LG tumors in PSM cohorts. In multivariable analysis, both HG (HR 1.38, 95% CI 1.25-1.52, p < 0.001) and IG (HR 1.17, 95% CI 1.08-1.26, p < 0.001) OCSCC was associated with worse survival than what was observed in LG tumors. The magnitude of the independent effect of tumor grade in multivariable analysis was greater than or equal to what was observed with other well-established prognostic factors like margin positivity (HR 1.34), ENE (HR 1.35), and LVI (HR 1.18). Conclusions: Pathologic tumor grade is a strong predictor of survival among patients with OCSCC. Tumor grade should be considered when making therapeutic recommendations for OCSCC.

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) of gastrointestinal (GI) tract: A single institution experience.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 633-633
Author(s):  
Manik A. Amin ◽  
Nikolaos Trikalinos
Keyword(s):  
Surgical Resection ◽  
Poor Prognosis ◽  
Braf V600e ◽  
Low Grade ◽  
Sequencing Analysis ◽  
High Grade ◽  
Gi Tract ◽  
Intermediate Grade ◽  
Disease Free

633 Background: MiNENs are heterogeneous group of rare tumors and represent less than 1% of all GI malignancies. These are pathologically classifiable according to neuroendocrine component into low grade, intermediate grade and high grade MiNENs but and managed based upon non-neuroendocrine component rather than true NENs. They have poor prognosis and less is known about treatment options. Methods: We identified 34 cases of MiNENs from 1/1/2000 to 1/1/2018 from Siteman Cancer Registry Database at Siteman Cancer Center, Washington University, St. Louis. Treatment and follow up information was obtained from medical charts of patients. Results: Of 34 identified cases of MiNENs, our database showed equal distribution of MiNENs in male and female patients (N = 17 each). Site of origin included appendix (N = 14), colon (N = 10), esophageal (N = 2), stomach (N = 3), rectum (N = 3), small intestine (N = 1) and ampulla of Vater (N = 1) locations. Histology was high grade (N = 22), intermediate grade (N = 8), low grade (N = 3) and unknown (1). Twenty nine (85%) underwent surgical resection with curative intent and 13 (40%) patients were disease free at five years of follow up. Disease was localized in 15 patients (44%) and distant metastasis were reported in 13 patients (40%). Ten out of 15 patient with localized disease were disease free with combined modality therapy of surgery and chemotherapy. Most common chemotherapy regimen used in the metastatic setting was FOLFOX (11), 5FU/capecitabine (3), and carboplatin plus etoposide (5). Next generation sequencing analysis was available on limited patients which showed MMR proficient (3), MMR deficiency (1), BRAF V600E mutation (1) and KRAS wild type (1). Conclusions: MiNENs of GI tract are rare and aggressive tumors and represent a distinct entity. Surgical resection whenever possible offers curative option. Our database of GI MiNENs showed efficacy with commonly used GI chemotherapy regimens. Patients with low grade tumor histology had better survival as compared to moderately and poorly differentiated tumors. Genomic testing through NGS would be recommended for personalized treatment decisions given poor prognosis in these patients.

Das Mukoepidermoidkarzinom – Bedeutung der Molekularpathologie

2020 ◽  
Vol 99 (03) ◽  
pp. 144-148 ◽  
Author(s):  
Lisa Nachtsheim ◽  
Christoph Arolt ◽  
Thomas Dreyer ◽  
Moritz F. Meyer ◽  
Alexander Brobeil ◽  
...  
Keyword(s):  
Low Grade ◽  
High Grade ◽  
Intermediate Grade

ZusammenfassungDas Mukoepidermoidkarzinom ist das häufigste primäre Speicheldrüsenmalignom im Kopf-Hals-Bereich. Das Tumorgrading hat eine erhebliche prognostische Bedeutung. Die 5-Jahres-Überlebensrate ist für Low-grade-Mukoepidermoidkarzinome deutlich höher als für Intermediate-grade- oder High-grade-Mukoepidermoidkarzinome. Für das Mukoepidermoidkarzinom scheint die Translokation von t(11;19)(q21;p13) mit der resultierenden CRTC1-MAML2-Transfusion ebenfalls von prognostischer Relevanz zu sein. Diese Translokation ist in 38–82 % aller Mukoepidermoidkarzinome nachweisbar. In Studien konnte für Patienten mit CRTC1-MAML2-positiven Mukoepidermoidkarzinomen eine deutlich bessere Prognose als für Patienten mit Translokations-negativen Mukoepidermoidkarzinomen nachgewiesen werden. Die t(11;19)(q21;p13) -Translokation wird deutlich häufiger bei Low- und Intermediate-grade-Mukoepidermoidkarzinomen detektiert als bei High-grade-Tumoren derselben Entität. Darüber hinaus wurden Translokations-positive Mukoepidermoidkarzinome häufiger bei jüngeren Patienten, kleineren Tumoren und niedrigeren Tumorstadien diagnostiziert sowie seltener Lymphknoten- und Fernmetastasierung gefunden. Bislang ist die Translokation nicht von therapeutischer Bedeutung. Jedoch sollte aufgrund der prognostischen Relevanz eine Diagnostik regelhaft erfolgen. Bei Grenzfällen kann der fehlende Nachweis der Translokation eine Entscheidungshilfe zu einer Therapieeskalation geben. Um den individuellen prognostischen und therapeutischen Wert des Fusionsgens genauer zu beurteilen, werden weitere Untersuchungen notwendig sein.

scholarly journals Rethinking a Non-Predominant Pattern in Invasive Lung Adenocarcinoma: Prognostic Dissection Focusing on a High-Grade Pattern

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2785
Author(s):  
Yeonu Choi ◽  
Jonghoon Kim ◽  
Hyunjin Park ◽  
Hong Kwan Kim ◽  
Jhingook Kim ◽  
...  
Keyword(s):  
Preoperative Imaging ◽  
Dual Energy Ct ◽  
Low Grade ◽  
Lower Grade ◽  
High Grade ◽  
Intermediate Grade ◽  
Imaging Parameters ◽  
Ct Value ◽  
Histologic Pattern ◽  
Contrast Ct

Background: Prognostic considerations for non-predominant patterns are necessary because most lung adenocarcinomas (ADCs) have a mixed histologic pattern, and the spectrum of actual prognosis varies widely even among lung ADCs with the same most predominant pattern. We aimed to identify prognostic stratification by second most predominant pattern of lung ADC and to more accurately assess prognostic factors with CT imaging analysis, particularly enhancing non-predominant but high-grade pattern. Methods: In this prospective study, patients with early-stage lung ADC undergoing curative surgery underwent preoperative dual-energy CT (DECT) and positron emission tomography (PET)/CT. Histopathology of ADC, the most predominant and second most predominant histologic patterns, and preoperative imaging parameters were assessed and correlated with patient survival. Results: Among the 290 lung ADCs included in the study, 231 (79.7%) were mixed-pathologic pattern. When the most predominant histologic pattern was intermediate-grade, survival curves were significantly different among the three second most predominant subgroups (p = 0.004; low, lepidic; intermediate, acinar and papillary; high, micropapillary and solid). When the second most predominant pattern was high-grade, recurrence risk increased by 4.2-fold compared with the low-grade group (p = 0.005). To predict a non-predominant but high-grade pattern, the non-contrast CT value of tumor was meaningful with a lower HU value associated with the histologic combination of lower grade (low-grade as most predominant and intermediate-grade as second most predominant pattern, OR = 6.15, p = 0.005; intermediate-grade as most predominant and high-grade as second most predominant pattern, OR = 0.10, p = 0.033). SUVmax of the tumor was associated with the non-predominant but high-grade pattern, especially in the histologic combination of intermediate-high grade (OR = 1.14, p = 0.012). Conclusions: The second most predominant histologic pattern can stratify lung ADC patients according to prognosis. Thus, predicting the malignant potential and establishing treatment policies should not rely only on the most predominant pattern. Moreover, imaging parameters of non-contrast CT value and SUVmax could be useful in predicting a non-predominant but high-grade histologic pattern.

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