Skip to main content

Advertisement

SpringerLink
Log in

Differentiation of adenocarcinoma in situ with alveolar collapse from minimally invasive adenocarcinoma or invasive adenocarcinoma appearing as part-solid ground-glass nodules (≤ 2 cm) using computed tomography

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the differentiating computed tomographic (CT) features between adenocarcinoma in situ (AIS) with alveolar collapse and minimally invasive adenocarcinoma (MIA) or invasive adenocarcinoma (IA) appearing as part-solid nodules.

Methods

A total of 147 consecutive patients with 157 pathology-confirmed part-solid ground-glass nodules (GGNs) ≤ 20 mm without other pathological condition such as inflammation and fibrosis who underwent chest CT were included.

Results

The 157 part-solid GGNs included 33 (21.02%) pathologically confirmed AISs with alveolar collapse. Multivariate analysis revealed that smaller lesion size (odds ratio [OR] 0.671), and well-defined border (OR 5.544), concentrated distribution (OR 7.994), and homogeneity of the solid portion (OR 4.365) were significant independent predictors for differentiating AIS with alveolar collapse from MIA (P < 0.05) with excellent accuracy (area under receiver operating characteristic [ROC] curve, 0.902). Multivariate analysis revealed that smaller lesion size (OR 0.782), and size (OR 0.821), well-defined border (OR 5.752), and homogeneity of solid portion (OR 6.182) were significant independent predictors differentiating AIS with alveolar collapse from IA (P < 0.05) with excellent accuracy (area under ROC curve 0.910).

Conclusion

Among part-solid GGNs, AIS with alveolar collapse can be accurately differentiated from MIA on the basis of smaller lesion size, well-defined border, concentrated distribution, and homogeneity of solid portion, and from IA according to smaller lesion size, and smaller size, well-defined border, and homogeneity of solid portion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AIS:

Adenocarcinoma in situ

ATS:

American Thoracic Society

AUC:

Area under the curve

CT:

Computed tomography

ERS:

European Respiratory Society

GGN:

Ground-glass nodule

GGN:

Ground-glass nodules

HU:

Hounsfield Units

IA:

Invasive adenocarcinoma

IASLC:

International Association for the Study of Lung Cancer

ICC:

Intra-class correlation coefficient

IPA:

Invasive pulmonary adenocarcinoma

MIA:

Minimally invasive adenocarcinoma

OR:

Odds ratio

ROC:

Receiver operating characteristic

References

  1. 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: executive summary. Proc Am Thorac Soc. 2011;8:381–5.

    Article  Google Scholar 

  2. Van Schil PE, Asamura H, Rusch VW, et al. Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification. Eur Respir J. 2012;39:478–86.

    Article  Google Scholar 

  3. Watanable S, Watanable T, Arai K, Kasai T, Haratake J, Urayama H. Results of wedege resection for focal bronchioloalveolar carcinoma showing pure ground-glass attenuation on computed tomography. Ann Thorac Surg. 2002;73:1071–5.

    Article  Google Scholar 

  4. Koike T, Togashi K, Shirato T, et al. Limited resection for noninvasive bronchioloalveolar carcinoma diagnosed by intraoperative pathologic examination. Ann Thorac Surg. 2009;88:1106–11.

    Article  Google Scholar 

  5. Austin JH, Garg K, Aberle D, et al. Radiologic implications of the 2011 classification of adenocarcinoma of the lung. Radiology. 2013;266:62–71.

    Article  Google Scholar 

  6. Naidich DP, Bankier AA, Macmahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology. 2013;266:304–17.

    Article  Google Scholar 

  7. Lee HJ, Goo JM, Lee CH, Yoo CG, Kim YT, Im JG. Nodular ground-glass opacities on thin-section CT: size change during follow-up and pathological results. Korean J Radiol. 2007;8:22–31.

    Article  Google Scholar 

  8. Lee SM, Park CM, Goo JM, Lee HJ, Wi JY, Kang CH. Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features. Radiology. 2013;268:265–73.

    Article  Google Scholar 

  9. Park CM, Goo JM, Lee HJ, Lee CH, Chun EJ, Im JG. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics. 2007;27:391–408.

    Article  Google Scholar 

  10. Noguchi M, Morikawa A, Kawasaki M, et al. Small adenocarcinoma of the lung. Histologic characteristics and prognosis. Cancer. 1995;75:2844–52.

    Article  CAS  Google Scholar 

  11. Hwanq EJ, Park CM, Ryu Y, et al. Pulmonary adenocarcinomas appearing as part-solid ground-glass nodules: is measuring solid component size a better prognostic indicator? Eur Radiol. 2015;25:558–67.

    Article  Google Scholar 

  12. Chae HD, Park CM, Park SJ, Lee SM, Kim KG, Goo JM. Computerized texture analysis of persistent part-solid ground-glass nodules: differentiation of preinvasive lesions from invasive pulmonary adenocarcinomas. Radiology. 2014;273:285–93.

    Article  Google Scholar 

  13. Henschke CI, Yankelevitz DF, Mirtcheva R, et al. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol. 2002;178:1053–7.

    Article  Google Scholar 

  14. Kim H, Park CM, Koh JM, Lee SM, Goo JM. Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy. Diagn Interv Radiol. 2014;20:47–57.

    Article  Google Scholar 

  15. Matsuguma H, Mori K, Nakahara R, et al. Characteristics of subsolid pulmonary nodules showing growth during follow-up with CT scanning. Chest. 2013;143:436–43.

    Article  Google Scholar 

  16. Sim HJ, Choi SH, Chae EJ, et al. Surgical management of pulmonary adenocarcinoma presenting as a pure ground-glass nodule. Eur J Cardiothorac Surg. 2014;46:632–6.

    Article  Google Scholar 

  17. Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e93S-e120S.

    Article  Google Scholar 

  18. Krochmal R, Arias S, Yarmus L, Feller-Kopman D, Lee H. Diagnosis and management of pulmonary nodules. Expert Rev Respir Med. 2014;8:677–91.

    Article  CAS  Google Scholar 

  19. Honda T, Kondo T, Murakami S, et al. Radiographic and pathological analysis of small lung adenocarcinoma using the new IASLC classification. Clin Radiol. 2013;68:e21–6.

    Article  CAS  Google Scholar 

  20. Yamato Y, Tsuchida M, Wantanbe T, et al. Early results of a prospective study of limited resection for bronchioloalveolar adenocarcinoma of the lung. Ann Thorac Surg. 2001;71:971–4.

    Article  CAS  Google Scholar 

  21. Yoshida J, Naga K, Yokose T, et al. Limited resection trial for pulmonary ground-glass opacity nodules: fifty-case experience. J Thorac Cardiovasc Surg. 2005;129:991–6.

    Article  Google Scholar 

  22. Tsutani Y, Miyata Y, Mimae T, et al. The prognostic role of pathologic invasive component size, excluding lepidic growth, in stage I lung adenocarcinoma. J Thorac Cardiovasc Surg. 2013;146:580–5.

    Article  Google Scholar 

  23. Son JY, Lee KS, Kim JH, et al. Quantitative analysis of pulmonary ground-glass opacity nodules for the distinction of invasive adenocarcinoma from pre-invasive or minimally invasive adenocarcinoma. PLoS ONE. 2014;9:e104066.

    Article  Google Scholar 

  24. 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:e97867.

    Article  Google Scholar 

  25. Lindell RM, Hartman TE, Swensen SJ, Jett JR, Midthun DE, Mandrekar JN. 5-year lung cancer screening experience: growth curves of 18 lung cancers compared to histologic type, CT attenuation, stage, survival, and size. Chest. 2009;136:1586–95.

    Article  Google Scholar 

  26. Lee SW, Leem CS, Kim TJ, et al. The long-term course of ground-glass opacities detected on thin-section computed tomography. Respir Med. 2013;107:904–10.

    Article  Google Scholar 

  27. Ohde Y, Nagai K, Yoshida J, et al. The pro-portion of consolidation to ground-glass opacity on high resolution CT is a good predictor for distinguishing the population of non-invasive peripheral adenocarcinoma. Lung Cancer. 2003;42:303–10.

    Article  Google Scholar 

  28. Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol. 2011;6:751–6.

    Article  Google Scholar 

  29. Tsutani Y, Miyata Y, Nakayama H, et al. Prognostic significance of using solid versus whole tumor size on high-resolution computed tomography for predicting pathologic malignant grade of tumors in clinical stage IA lung adenocarcinoma: a multicenter study. J Thorac Cardiovasc Surg. 2012;143:607–12.

    Article  Google Scholar 

  30. Lee KH, Goo JH, 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 Thorac Oncol. 2014;9:74–82.

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by grants from the Scientific Research Foundation of Ministry of Public Health of China/Major Science and Technology Program of Medicine and Health of Zhejiang Province of China (grant no. WKJ2014-2-021), Heath and Family Planning Commission of Zhejiang Province (grant no. 2015ZDA032) and Public Project of Science Technology Department of Zhejiang Province of China (grant no. 2015C33254).

Author information

Authors and Affiliations

  1. Department of Cardio-Thoracic Surgery, Lung Cancer Research Center, Zhoushan Hospital, Zhejiang University School of Medicine, No. 739, Dingshen Road, Lincheng Street, Dinghai District, Zhoushan, 316000, Zhejiang, China

    Liyun Xu, Shuaidong Lin & Yongkui Zhang

Authors
  1. Liyun Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuaidong Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yongkui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by LX, SL and YZ. The first draft of the manuscript was written by LX and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yongkui Zhang.

Ethics declarations

Conflict of interest

LX, SL and YZ declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, L., Lin, S. & Zhang, Y. Differentiation of adenocarcinoma in situ with alveolar collapse from minimally invasive adenocarcinoma or invasive adenocarcinoma appearing as part-solid ground-glass nodules (≤ 2 cm) using computed tomography. Jpn J Radiol 40, 29–37 (2022). https://doi.org/10.1007/s11604-021-01183-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-021-01183-9

Keywords

Search

Navigation