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Morphological classification of pre-invasive lesions and early-stage lung adenocarcinoma based on CT images

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To retrospectively analyze the computed tomography (CT) features in patients with pre-invasive lesions and early-stage lung adenocarcinoma and to explore the correlation between tumor morphological changes and pathological diagnoses.

Materials and methods

CT morphological characteristics in 2106 patients with pre-invasive (stage 0) and early-stage (stage I) lung adenocarcinoma were analyzed; lesions were confirmed by surgical pathology. Based on the morphological characteristics, the lesions were divided into eight types: I (cotton ball, ground-glass nodules), II (solid fill), III (granular), IV (dendriform), V (bubble-like lucencies), VI (alveolate or honeycomb), VII (scar-like), and VIII (notched or umbilication). The different distributions of eight morphological types in pathological types of the lesions and subtypes of invasive adenocarcinoma were analyzed by chi-squared or Fisher’s exact test. Correlation between the percentage of ground-glass opacity in the lesions and pathology types were analyzed by two-tailed Pearson’s test.

Results

A negative correlation was observed between the pathological types and proportion of ground-glass component in the lesions (p < 0.001 and r = − 0.583). Significant differences in morphological characteristics among various pathological types of pre-invasive lesions and early lung adenocarcinomas were observed (p < 0.05). Furthermore, among the different pathological subtypes of stage I invasive adenocarcinoma, the differences in their manifestation as morphological types I, II, III, and VI were statistically significant (p < 0.05).

Conclusion

The eight types of morphological classification of pre-invasive lesions and early-stage (stage 0 or stage I) lung adenocarcinoma has different pathological bases, and morphological classification may be useful for the diagnosis and differential diagnosis of lung adenocarcinoma.

Key Points

• CT morphological classification of pre-invasive lesions and lung adenocarcinoma is intuitive.

• CT morphological classification characterizes morphological changes of the entire lesion.

• Different pathological types of lung adenocarcinoma have different morphological features.

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Abbreviations

AAH:

Atypical adenomatous hyperplasia

AIS:

Adenocarcinoma in situ

CPR:

Curved planar reformation

GGN:

Ground-glass nodule

GGO:

Ground-glass opacity

IAC:

Invasive adenocarcinoma

LLL:

Left lower lobe

LUL:

Left upper lobe

mGGN:

Mixed ground-glass nodule

MIA:

Minimal invasive adenocarcinoma

MIP:

Maximum intensity projection

MPR:

Multi-planar reformation

pGGN:

Pure ground-glass nodule

RLL:

Right lower lobe

RML:

Right middle lobe

RUL:

Right upper lobe

VR:

Volume rendering

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Acknowledgements

I would like to express my gratitude to all those who helped me during the writing of this paper.

Funding

This study has received funding by the Research Program of Shanghai Hospital Development Center (SHDC22015025) and the Medical Imaging Key Program of Wise Healthcare Technology 120, Health Commission of Shanghai (2018ZHYL0103).

Author information

Authors and Affiliations

  1. Department of Radiology, Huadong Hospital Fudan University, Shanghai, 200040, China

    Feng Gao, Ming Li, Guozhen Zhang & Yanqing Hua

  2. Diagnostic and Treatment Center of Small Lung Nodules, Huadong Hospital Fudan University, 221#, West Yanan Road, Shanghai, 200040, China

    Ming Li & Xiangpeng Zheng

  3. Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, 200040, China

    Ming Li

  4. Department of Radiology, Duke University Medical Center, Durham, NC, USA

    Ziwei Zhang

  5. Department of Pathology, Huadong Hospital Fudan University, Shanghai, 200040, China

    Li Xiao

  6. CT Research Center, GE Healthcare China, Shanghai, 200040, China

    Jianying Li

Authors
  1. Feng Gao
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  2. Ming Li
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  3. Ziwei Zhang
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  4. Li Xiao
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  7. Yanqing Hua
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Corresponding author

Correspondence to Ming Li.

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Guarantor

The scientific guarantor of this publication is Ming Li.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in “CT features of lung scar cancer”. J Thorac Dis 2015;7(3):273–80.

Methodology

• retrospective

• diagnostic/observational

• performed at one institution

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Gao, F., Li, M., Zhang, Z. et al. Morphological classification of pre-invasive lesions and early-stage lung adenocarcinoma based on CT images. Eur Radiol 29, 5423–5430 (2019). https://doi.org/10.1007/s00330-019-06149-0

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  • DOI: https://doi.org/10.1007/s00330-019-06149-0

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