Radiological Characteristics And Pathological, Immunohistochemical Implications Of Early Stage Lung Adenocarcinoma With Pure Ground-Glass Opacity

Part Ⅰ:Pathological classification and radiological characteristics of early stage lungadenocarcinoma with pure ground-glass opacityPurpose: To discuss pathological classification and radiological characteristics of earlystage lung adenocarcinoma with pure ground-glass opacity (pGGO).Materials and Methods: Ninety-four lesions with pGGO on CT in eighty-eightpatients with T1N0M0lung adenocarcinoma were selected from January2010toDecember2012. There were33males and55females, the age ranged from26to78years with average age of57.139.80years. All lesions were resected and confirmedby pathology. CT appearances were analyzed including lesion location, size, density,uniformity, shape (round, oval, polygonal, irregular), margin (smooth, lobular,spiculated, lobular and spiculated), tumor-lung interface, internal and surroundingmalignant signs (bubble sign, air bronchogram, pleural tag, notch). Lesion size anddensity were compared with pathologic types using analysis of variance (AVOVA).Gender of patients, lesion location and CT appearances were compared withpathological types using2-test. The size of preinvasive and invasive lesions wereassessed using ROC curves.Results: There were no significant differences in gender, lesion location and densitywith pathological types, and no correlation between the lesion density and size(P>0.05). The size of preinvasive lesions was less than that of MIA and invasiveadenocarcinomas (P=0.03and0.002, respectively, P<0.05), the lesion size betweenMIA and invasive adenocarcinomas was no significant difference (P=0.28，P>0.05).The ROC curve showed that the possibility of invasive lesion was88.73%when thediameter of lesion was more than1.05cm. There was a significant difference between lesion uniformity and pathological types (P=0.01，P<0.05). The lesion uniformity ofpreinvasive lesions was better than that of invasive lesions. There were significantdifferences in margin, tumor-lung interface, air bronchogram with pathological types(P=0.02，P=0.00，P=0.048，P<0.05). The invasive lesions had more air bronchogram,lobulation with speculation, and well-demarcated tumor-lung interface.Conclusion: The lesion size and uniformity, tumor-lung interface and the airbronchogram can help predict the invasive lesion of early stage lung adenocarcinomawith pGGO. Part Ⅱ:Early stage lung adenocarcinoma with pure ground-glass opacity: a retrospectivepathological and Immunohistochemical analysisPurpose: To investigate the immunohistochemical expression differences in earlystage lung adenocarcinoma (T1N0M0) with pure ground-glass opacity (pGGO).Materials and Methods: Sixty-six cases of early stage lung adenocarcinomasurgically resected were analyzed retrospectively from January2010to December2012. The lesions with pGGO on CT were selected and immunohistochemical studywas performed in all cases. There were25male and41female patients (age range from36to78years, mean,55.6410.10years). Pathological types were divided into5groups: AAH, AIS, MIA, LPA and others. Common molecular markers inimmunohistochemical study included HER-1, HER-2, Top-Ⅱα, Ki-67, VEGF. Theexpression differences of molecular markers were analyzed on patient gender, lesionsize and pathological types using chi square test. The relationship between HER-2andTop-Ⅱα was evaluated using correlation analysis. A P-value less than0.05wasconsidered statistically significant.Results: There were no statistically significant differences of expression of HER-1,HER-2, Top-Ⅱα, Ki-67, VEGF on patient gender, lesion size and pathological types. There was a correlation between HER-2and Top-Ⅱα expression (P=0.02，P<0.05，r=0.30). In patients with weak positive expression of HER-2, the rate of Top-Ⅱαpositive expression was16.67%(5/30), with moderate positive expression of HER-2,the positive expression rate of Top-Ⅱα was50%(4/8), with negative expression ofHER-2, the rate of positive expression of Top-Ⅱα was9.09%(2/22).Conclusion: There are no statistically significant differences of expression of HER-1,HER-2, Top-Ⅱα, Ki-67, VEGF on patient gender, lesion size and pathological types inearly stage lung adenocarcinoma with pGGO. The expression of HER-2and Top-Ⅱαis positive correlated.