MSCT Quantitative Parameter Analysis And Histological Subtype Control Of Mixed Ground-glass Nodules Lung Adenocarcinoma

Objectives To investigate the value of multi-slice spiral computed tomography（MSCT）quantitative parameters of the whole and solid parts of mixed ground-glass nodules（m GGN）lung adenocarcinoma in the differential diagnosis of its histological subtypes,so as to provide a reference for predicting the prognosis of patients and formulating a more optimized clinical treatment plan.Methods The clinical data（including gender,age）,imaging and pathological data of patients with m GGN and lung adenocarcinoma confirmed by surgery and pathology in Tangshan workers’hospital from September 2019 to June 2021 were collected.According to the World Health Organization（WHO）histological classification standard of chest tumors in 2015,lung adenocarcinoma is divided into five main histological subtypes according to the growth mode:adherent growth dominated adenocarcinoma,acinar growth dominated adenocarcinoma,papillary growth dominated adenocarcinoma,micro papillary growth dominated adenocarcinoma and solid growth dominated adenocarcinoma.According to the recurrence risk level of main histological subtypes of lung adenocarcinoma newly classified by WHO in 2021,it is divided into three groups:mural growth dominated adenocarcinoma group（low risk）,acinar/papillary growth dominated adenocarcinoma group（medium risk）,micro papillary or solid growth dominated adenocarcinoma group（high risk）.The clinical data and MSCT signs of the three groups were compared and analyzed.The clinical data included the patient’s gender and age.MSCT signs include morphological indexes and quantitative measurement indexes.Morphological indexes include edge feature burr sign,lobulation sign and pleural depression sign;internal characteristics and adjacent structural changes,such as air bronchial sign,vacuole sign and abnormal vascular sign;quantitative measurement indexes include m GGN size（effective diameter）,average CT value and perfusion imaging parameter value;m GGN solid component size（effective diameter）,volume proportion of solid component and average CT value of solid component.SPSS25.0statistical software was used for data statistical analysis.The constituent ratio of counting data such as gender and MSCT morphological indexes was calculated.The constituent ratio between groups was compared by chi-square test,and the pairwise comparison was adjusted by Bonferroni methodαlevel,those that do not meet the conditions of chi-square test shall be tested by Fisher exact probability method.Test the normality of age,MSCT quantitative measurement indicators and other measurement data.The data conforming to normal distribution or approximate normal distribution shall be expressed as"mean±standard deviation"（x±s）.One-way ANOVA shall be used for the comparison of the mean among the three groups.If the data is skewed distribution,it is expressed as"median（interquartile interval）"[M(P₂₅,P₇₅)],and the median comparison between groups adopts Kruskal Wallis H test（nonparametric rank sum test）.Correlation analysis if the data is skewed,Spearman rank correlation analysis is used.In multivariate analysis,the variables with statistical significance in univariate analysis were included in the multivariate logistic regression model.Draw receiver operating characteristic curve（ROC）and determine the best cutoff value.Bilateral test,P<0.05,the difference was statistically significant.Results 1 102 patients with lung adenocarcinoma were enrolled in this study,and a total of 103 m GGN were detected（one patient had double foci,and both foci belonged to mural growth dominated adenocarcinoma）.There were 61 cases（59.2%）of adherent growth type adenocarcinoma,27 cases（26.2%）of acinar/papillary growth type adenocarcinoma and 15cases（14.6%）of micropapillary/solid growth type adenocarcinoma.2 Gender,hair prick sign,effective diameter of m GGN average CT value,effective diameter of solid component,volume proportion of solid component and average CT value of solid component had statistical differences among mural growth dominated group,acinar/papillary growth dominated group and micropapillary/solid growth dominated group（P<0.05）.3 There was significant difference in blood volume（BV）between the adherent growth dominated group and the acinar/papillary growth dominated group（P=0.017）.The blood supply of acinar/papillary growth dominated adenocarcinoma was richer than that of adherent growth dominated adenocarcinoma.4 The effective diameter of m GGN was significantly correlated with the pathological maximum diameter（r=0.842,P<0.001）.5 The volume proportion of solid components in m GGN and the average CT value of solid components are independent influencing factors for the identification of mural growth dominated adenocarcinoma（P=0.019,P=0.043）.ROC curve analysis showed that the volume proportion of solid components in m GGN area under curve（AUC）was 0.777,the best critical value was 53.54%,the sensitivity was 66.7%,and the specificity was 78.9%;The mean CT value AUC of solid components in m GGN was 0.773,the optimal critical value was-38.35HU,the sensitivity was 73.8%,and the specificity was 75.4%.6 Spearman rank correlation showed that the effective diameter of m GGN,the effective diameter of solid components in m GGN,the volume proportion of solid components and the average CT value of solid components were positively correlated with the recurrence risk level of histological subtypes,and the corresponding correlation coefficients were r=0.28,0.46,0.45 and 0.48 respectively.The P values of all parameters are less than 0.05.Conclusions 1 gender,hair prick sign,effective diameter of m GGN,average CT value,effective diameter of solid component,volume proportion of solid component and average CT value of solid component have certain value in the differential diagnosis of mural growth dominated adenocarcinoma,acinar/papillary growth dominated adenocarcinoma and micropapillary/solid growth dominated adenocarcinoma.2 The volume proportion of solid components of m GGN and the average CT value of solid components are independent predictors of mural growth dominated adenocarcinoma.When the volume proportion of solid components of m GGN is less than 53.54%and the average CT value of solid components is less than-38.35HU,it is more likely to consider mural growth dominated adenocarcinoma.3 The semi-automatic segmentation software of pulmonary nodules can evaluate the segmentation and measurement of three-dimensional structure and solid components of nodules,the effective diameter of m GGN is positively correlated with the maximum diameter obtained by pathology.Figure6;Table10;Reference 131...