Correlation Study Of CT Imaging With Pathology And Genotype Of Pulmonary Ground-Glass Opacity Nodules

Objective: To analyze the clinical features,imaging manifestation,pathological typing and genetic testing results of patients undergoing surgery for ground-glass opacity(GGO)nodules,and explore the reasonable diagnosis and treatment program for GGO patients as to provide the basis for the establishment of GGO treatment process.Method: From January 2013 to June 2015,569 cases with GGO confirmed by HRCT,undergoing surgery and approved by pathologic diagnosis in Shanghai pulmonary hospital were enrolled in this study.Of 569 patients with GGO,there were 465 cases with single lesion and 104 cases with multiple lesions.The relationship between the clinical,imaging,pathological and molecular biological data of single GGO and multiple GGO patients were statistically studied.Result: 1)Among 465 cases of single GGO,the median age was 58 years and females were 315(67.7%);there were 397(85.4%)non-smoking,and 354 cases(76.1%)had no clinical symptoms.There were 33 cases of benign and 432 cases of malignant GGO.Significant differences were observed on the size,vacuole sign,pleural indentation and blood vessel sign of GGO between two groups(P<0.05).Of 230 m GGO,there were no AAH,13 cases of AIS,25 cases of MIA and 173 cases of invasive adenocarcinoma.The probability of solid nodules in invasive adenocarcinoma was higher than that in micro invasive carcinoma,and the difference was statistically significant(P<0.05).360 cases of single GGO were followed up with the average follow-up time of 6.05 months,and GGO of 34 cases(9.4%)increased.Two multivariate Logistic regression analysis showed that the duration of follow-up,having the real component or not and the pathologic results were related to the increase of GGO(P<0.05).2)In 428 adenocarcinoma samples approved by pathologic diagnosis,there were 262(61.2%)lesions of EGFR mutation,14(3.3%)lesions of KRAS mutation,1(0.2%)lesion of Braf mutation,9(2.1%)lesions of EML4-ALK gene fusion,2(0.5%)lesions of ROS1 fusion.The detection rate of gene mutation in m GGO was higher than that of p GGO.During the follow-up period,genetic testing results of 32 GGO showed that EGFR mutation rate was 53.1%,ALK positive rate of 6.3%,KRAS mutation rate of 3.1% and no ros1 and BRAF gene mutation.No statistical significant difference was observed in comparison with unchanged GGO.3)EGFR mutation rate of invasive adenocarcinoma was the highest(168/228,73.7%),mainly in the 19 Del and L858R point mutations.No KRAS mutation was found in atypical adenoma hyperplasia.No significant difference was observed on the mutation rate of KRAS between different types of GGO(P=0.811).EML4-ALK fusion gene was mainly detected in invasive adenocarcinoma(7/9).4)In this study,there were 104 cases of multiple GGO ranging from 2-4 lesions.A total of 231 GGO,including 16(6.9%)of benign GGO and 215(93.1%)of malignant GGO underwent surgery.There were 17 cases(16.3%)with consistent multiple GGO pathology,and 87 cases(83.7%)were not,whose histopathological results were invasive adenocarcinoma.There was no statistical correlation between the distribution of multiple GGO and the pathologic results(p<0.05).94.1% mixed GGO(also containing p GGO and m GGO)was not consistent with the pathological results,significantly higher than that of p GGO group and m GGO group(P=0.017).EGFR mutation heterogeneity of 104 patients with multiple GGO accounted for 28.8%(30/104).The existence of EGFR mutation(L858R missense mutations)and ALK fusion gene was observed in 2 GGO lesions,and existence of EGFR mutation(L858R missense mutation)and KRAS mutation(codon 12)was found in 1 GGO lesion.Conclusion: Multiple GGO was prevalent in young,non smoking women.Malignant GGO is characterized by pleural indentation sign,vacuole sign,blood vessel cluster sign and so on.The p GGO and m GGO reflect the pathological development process of GGO,and it is found that the GGO lesions became larger in the follow-up.There was an increase in the real component or solid component,which was the indication of surgical resection.The detection of driven gene in lung adenocarcinoma will become an important part of the era of precision treatment.Multiple GGO possess heterogeneity of image,pathology and molecular biology.Heterogeneity study is helpful to make correct diagnosis and treatment plan.