Abstract
Our purpose was to identify thin-section chest computed tomography (CT) findings of malignancy other than the presence of a solid portion within ground-glass nodules (GGNs) and to evaluate whether the radiologists’ performance in determining malignancy can be enhanced with this information. The predictive CT findings of malignancy extracted from the CT findings of 80 GGNs (47 malignant, 33 benign) were a size of >8 mm [odds ratio (OR), 10.930; P = 0.045] and a lobulated border (OR, 13.769; P = 0.016) for pure GGNs and a lobulated border (OR, 10.200; P = 0.024) for mixed GGNs. Four chest radiologists and five radiology residents participated in the observer performance study with CT of 130 GGNs (67 malignant, 63 benign). Receiver-operating characteristic (ROC) analysis was used to compare radiologists’ performances before and after providing these predictive findings. For pure GGNs, mean areas under the curve (Az) of all readers without and with CT predictive information were significantly different (0.621 ± 0.052 and 0.766 ± 0.055, P < 0.05). For mixed GGNs, the Az values achieved without and with predictive information were not significantly different (0.727 ± 0.064 and 0.764 ± 0.056, P > 0.05). Information about lesion size and morphological characteristics can enhance radiologists’ performance in determining malignancy of pure GGNs.
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References
Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS (2002) CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 178:1053–1057
Lee HJ, Goo JM, Lee CH, Yoo CG, Kim YT, Im JG (2007) Nodular ground-glass opacities on thin–section CT: size change during follow-up and pathological results. Korean J Radiol 8:22–31
Park CM, Goo JM, Lee HJ, Lee CH, Chun EJ, Im JG (2007) Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics 27:391–408
Park CM, Goo JM, Lee HJ et al (2006) CT findings of atypical adenomatous hyperplasia in the lung. Korean J Radiol 7:80–86
Kitamura H, Kameda Y, Nakamura N et al (1996) Atypical adenomatous hyperplasia and bronchoalveolar lung carcinoma. Analysis by morphometry and the expressions of p53 and carcinoembryonic antigen. Am J Surg Pathol 20:553–562
Nomori H, Ohtsuka T, Naruke T, Suemasu K (2003) Differentiating between atypical adenomatous hyperplasia and bronchioloalveolar carcinoma using the computed tomography number histogram. Ann Thorac Surg 76:867–871
Kawakami S, Sone S, Takashima S et al (2001) Atypical adenomatous hyperplasia of the lung: correlation between high-resolution CT findings and histopathologic features. Eur Radiol 11:811–814
Kim HY, Shim YM, Lee KS, Han J, Yi CA, Kim YK (2007) Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology 245:267–275
Park CM, Goo JM, Lee HJ et al (2007) Focal interstitial fibrosis manifesting as nodular ground-glass opacity: thin-section CT findings. Eur Radiol 17:2325–2331
Nakata M, Saeki H, Takata I et al (2002) Focal ground-glass opacity detected by low-dose helical CT. Chest 121:1464–1467
Shimizu K, Ikeda N, Tsuboi M, Hirano T, Kato H (2006) Percutaneous CT-guided fine needle aspiration for lung cancer smaller than 2 cm and revealed by ground-glass opacity at CT. Lung Cancer 51:173–179
Metz CE, Herman BA, Shen JH (1998) Maximum likelihood estimation of receiver operating characteristic (ROC) curves from continuously-distributed data. Stat Med 17:1033–1053
Ost D, Fein AM, Feinsilver SH (2003) Clinical practice. The solitary pulmonary nodule. N Engl J Med 348:2535–2542
Colby TV, Noguchi M, Henschke H et al (2004) Adenocarcinoma. In: Travis WD, Brambilla HK, Muller-Hermelink K, Harris CC (eds) World Health Organization classification of tumours. Tumors of the lung, pleura, thymus and heart, 1st edn. IARC Press, Lyon, pp 35–44
MacMahon H, Austin JH, Gamsu G et al (2005) Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 237:395–400
idthun DE, Swensen SJ, Jett JR, Hartman TE (2003) Evaluation of nodules detected by screening for lung cancer with low dose spiral computed tomography. Lung Cancer 41:S40
Ikeda K, Awai K, Mori T, Kawanaka K, Yamashita Y, Nomori H (2007) Differential diagnosis of ground-glass opacity nodules: CT number analysis by three-dimensional computerized quantification. Chest 132:984–990
Nomori H, Horio H, Naruke T, Suemasu K, Morinaga S, Noguchi M (2001) A case of multiple atypical adenomatous hyperplasia of the lung detected by computed tomography. Jpn J Clin Oncol 31:514–516
Barsky SH, Grossman DA, Ho J, Holmes EC (1994) The multifocality of bronchioloalveolar lung carcinoma: evidence and implications of a multiclonal origin. Mod Pathol 7:633–640
Nanki N, Fujita J, Hojo S et al (2002) Evaluation of the clonality of multilobar bronchioloalveolar carcinoma of the lung: case report. Am J Clin Oncol 25:291–295
Acknowledgements
The authors thank Dae Sik Kim, MD, Ji Won Choi, MD, Ji Hyun Baek, MD, Su Ryoung Jeon, MD, and Su Jin Kim, MD for their participation in the observer performance study. This work was supported by a Korean Research Foundation Grant funded by the Korean Government (MOEHRD) (#KRF-2005-E00294).
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Lee, H.J., Goo, J.M., Lee, C.H. et al. Predictive CT findings of malignancy in ground-glass nodules on thin-section chest CT: the effects on radiologist performance. Eur Radiol 19, 552–560 (2009). https://doi.org/10.1007/s00330-008-1188-2
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DOI: https://doi.org/10.1007/s00330-008-1188-2