Correlative Study Of Cavity Lung Adenocarcinoma In Clinical,Imaging,Pathology And EGFR Gene Mutations

BackgroundLung cancer is currently one of the types with the highest morbidity and mortality among various malignant tumors.In recent years,the incidence of lung cancer has been increasing year by year,seriously endangering human health.Lung cancer is divided into two major categories according to histological types,non-small cell lung cancer and small cell lung cancer,of which non-small cell lung cancer accounts for the highest proportion,and lung adenocarcinoma is the most common type.Cavity is one of the basic types of lung lesions.A variety of benign and malignant lesions can form cavitary lesions in the lung.In the past,cavitary lung cancer was more common in lung squamous cell carcinoma,mostly thick-walled cavities.Now the incidence of lung adenocarcinoma with cavities as the first manifestation is increasing year by year.Lung adenocarcinoma cavities can be manifested as thick-walled cavities,thin-walled cavities,and multiple cavities,which are easily misdiagnosed as pulmonary inflammatory diseases.Correlation analysis of the clinical and imaging characteristics of cavitary lung adenocarcinoma is helpful to improve the understanding of its clinical imaging characteristics,improve the clinical diagnosis rate,and reduce the rate of misdiagnosis.In the past histological classification of lung adenocarcinoma,the histological classification of lung cancer from 1999 to 2004 was mainly formulated by pathologists,and was not integrated with imaging and analytical biology.The classification was not accurate enough,greater than 90%Invasive lung adenocarcinoma is classified into mixed subtypes.In 2011,the new classification standard for lung cancer divided lung adenocarcinoma into atypical neoplasia,adenocarcinoma in situ,microinvasive adenocarcinoma,and invasive adenocarcinoma.Among them,invasive adenocarcinoma was further classified into histological subtypes,including adherence.Mainly,acinar-based,papillary-based,solid-based,micropapillary-based,and invasive adenocarcinoma variants(mucinous adenocarcinoma,colloid adenocarcinoma,fetal adenocarcinoma,and intestinal adenocarcinoma).Different histological types of lung adenocarcinoma have different imaging features and prognosis.Through the correlation analysis of the pathological classification and imaging characteristics of lung adenocarcinoma,we can make a preliminary judgment of the corresponding histological classification through the analy sis of the chest CT imaging characteristics,and have a preliminary prediction of the prognosis of the patient,which has certain guiding significance for clinical treatment..Traditional lung cancer treatment is mainly chemotherapy and radiotherapy.With the continuous deepening of research on the heterogeneity of lung cancer,the detection technology of non-small cell lung cancer driver genes has become more mature and perfect.The application of targeted drugs for mutant genes has improved the quality of life of lung cancer patients.And the prognosis has been significantly improved.Among them,epidermal growth factor receptor(EGFR)is the most common type of gene mutation in patients with lung adenocarcinoma.The detection of gene mutations and the application of corresponding targeted drugs are gradually becoming a routine method for evaluating and improving the prognosis of lung adenocarcinoma.Transform from a simple morphological diagnosis to a multidisciplinary assisted diagnosis.At present,there are few reports on the analysis of the related pathological characteristics of cavitary lung adenocarcinoma and the analysis of EGFR gene mutation related factors.This study focuses on the clinical characteristics of cavitary lung adenocarcinoma and the characteristics of high-resolution CT(HRCT),solitary cavity type The pathological classification of lung adenocarcinoma and the analysis of related factors of EGFR gene mutation in solitary cavity lung adenocarcinoma were discussed in three aspects.Part Ⅰ Analysis of clinical features and HRCT image features of cavitary lung adenocarcinomaObjectiveDiscuss the clinical and imaging features of cavitary lung adenocarcinoma,and improve the clinical diagnosis rate.MethodsA retrospective analysis of the age,gender,clinical symptoms and laboratory test results of patients with cavitary lung adenocarcinoma admitted to our hospital from January 2013 to December 2018,and analysis of chest imaging features.The analysis content includes:the location of the lesion,Morphological classification,overall shape of the lesion,edge morphology,changes in adjacent structures,relationship with bronchus,whether the cavity wall is smooth,whether the cavity can show separation,whether there are blood vessels in the cavity,serum CEA level,etc.are measured and analyzed.All datas are analyzed by SPSS 19.0 software,measurement indicators are expressed as x ± s,counting data are expressed as frequency and percentage,and the comparison of image features between the thick-walled cavity group and the thin-walled cavity group uses chi-square test or Fisher’s exact probability method For analysis;the relationship between the imaging characteristics of cavitary lung adenocarcinoma and the level of serum tumor marker CEA was performed by t test,and all results were statistically significant with P<0.05.Results1.432 patients with cavitary lung adenocarcinoma,208 males(48.1%),224 females(51.9%),aged 26 to 83 years,an average of 58±6.7 years.There were 306 cases(70.8%)with cough,234 cases(54.2%)with sputum,103 cases(23.8%)with chest tightness,67 cases(15.5%)with chest pain,52 cases(12.0%)with fever,46 cases(10.6%)with blood in sputum),the course of the disease was 5 days to 8 months,63 cases(14.6%)had no clinical symptoms,which were found during routine physical examination.2.Among the 432 patients with cavitary lung adenocarcinoma,346(80.1%)had a single cavity,of which 226(52.3%)were surgically removed;86(19.9%)had multiple cavities.The maximum axial diameter of the lesion was 12.62-64.62mm,with an average of 32.66±17.75mm;the maximum axial diameter of the cavity was 7.37～51.48mm,with an average of 18.06±10.47mm.3.In the thin-walled cavity group,there were 124 cases(67.4%)of the hollow space within the cavity,69 cases(37.5%)of the ground glass shadow around the lesion,which were significantly higher than those of the thick-walled cavity group(P<0.05),and the thick-walled cavity group had pleural depression.114 cases(70.4%),134 cases(82.7%)with lobular sign,102 cases(63.0%)with intra-lesional vascular penetrating sign,which were significantly higher than those in the thin-walled cavity group(P<0.05).4.Among multiple cavitary lung adenocarcinomas,42 cases(48.8%)had multiple small annular cavities in both lungs,of which 16 cases(18.6%)had thick-walled cavities with multiple small annular cavities,and 8 cases had thin-walled cavities with multiple small annular cavities(9.3%),4 cases(4.7%)of lung masses with multiple small circular cavities,14 cases(16.3%)with diffuse circular cavities in both lungs;28 cases(32.6%)with multiple cavities in both lungs,of which 14 cases were multiple thick-walled cavities Among the cases(16.3%),there were 9 cases(10.5%)of multiple thin-walled cavities,5 cases(5.8%)of thick-walled cavities and thin-walled cavities;16 cases(18.6%)of cavities with surrounding ground glass shadows or large-scale consolidation shadows.5.Among 432 patients,312 cases underwent CEA testing.CEA increased in 156 cases(50.0%),solitary cavitary lung adenocarcinoma increased in 98 cases(31.4%),and multiple cavitary lung adenocarcinoma increased in 58 cases(18.6%).There were 62 cases(63.3%)of thick-walled cavities in isolated cavitary lesions,36 cases(36.7%)of thin-walled cavities,and the difference was statistically significant(P<0.05);among them,there was deep lobular sign or cancer For lung cancer with a body diameter of≥3 cm,the serum CEA level is higher than that without deep lobular signs or a cancer body with a diameter of<3 cm.There was no statistically significant difference between lung cancer with or without pleural depression sign,burr sign,ground glass sign around the lesion and serum CEA level.6.92 cases were misdiagnosed as benign lung lesions upon admission.32 cases(34.8%)were misdiagnosed as fungus,28 cases(30.4%)were misdiagnosed as tuberculosis,19 cases(20.7%)were misdiagnosed as bacterial pneumonia,7 cases(7.6%)were misdiagnosed as pulmonary Wegener’s granulomatosis,and misdiagnosis was There were 6 cases(6.5%)of lung Langerhans cell macrophage hyperplasia.Conclusions1.Cavitating lung adenocarcinoma has no obvious difference between men and women,and the clinical features have no obvious specificity.2.Cavitating lung adenocarcinoma includes solitary cavity type and multiple cavity type,among which solitary cavity type lung adenocarcinoma is more common.3.In the thin-walled cavity group of solitary cavitary lung adenocarcinoma,the display of the intracavitary interval and the ground glass shadow around the lesion are more common.The interval within the cavity is mainly composed of fine mesh intervals;the thick-walled cavity group is more prone to pleural depression and The lobular sign,mural nodules,and vascular penetration signs within the lesion,the cave is dominated by thick intervals,usually coexisting with mural nodules.4.Multiple cavitation lung adenocarcinomas are more common in multiple small annular cavities.Thick-walled cavities,thin-walled cavities,ground glass shadows and consolidation shadows around the cavities can also be seen,and multiple lesions are usually present at the same time.5.The serum CEA of thick-walled cavities is significantly higher than that of thin-walled cavities,and the serum CEA of lesions with deep lobular sign and tumor diameter≥3 cm is significantly increased.6.Void lung adenocarcinoma is easy to be misdiagnosed as a benign lung lesion when admitted to the hospital.Part Ⅱ Correlative research on imaging characteristics and pathological classification of solitary cavitary lung adenocarcinomaObjectiveA retrospective analysis of the relationship between the imaging characteristics and pathological classification of solitary cavitary lung adenocarcinoma undergoing surgical treatment will provide a basis for the prognosis and further adjuvant treatment of solitary cavitary lung adenocarcinoma.MethodsA retrospective analysis of the CT and PET-CT data of 226 consecutively collected patients with lung adenocarcinoma confirmed by surgery or puncture pathology from January 2013 to December 2018 was retrospectively analyzed.The pathological section of the patient was analyzed for lung adenocarcinoma pathological classification and subtype analysis.All data were analyzed by SPSS 19.0 software.The measurement index was expressed by x ± s,and the count data was expressed by frequency and percentage.The comparison of pathological types in the wall cavity group and the comparison of imaging signs and pathological types were analyzed by chi-square test or Fisher exact probability method;the comparison of lesion size,cavity size,and cavity wall thickness among the three groups of pathological types uses t test;the correlation between lesion size,cavity size,cavity wall thickness and pathological type was correlated with Spearman grade Analysis,the correlation between the size of the lesion and the size of the cavity was analyzed by Pearson correlation;all results were statistically significant with P<0.05.Results1.There were 226 patients enrolled in this study,93 males(41.2%),133 females(58.8%),the age of onset was 31-78 years old,with an average of 57.6±9.8 years old;86 cases(38.1%)had a history of smoking.The lesions were located in 45 cases(19.9%)of the right upper lobe,21 cases(9.3%)in the right middle lobe,89 cases(39.4%)in the right lower lobe,33 cases(14.6%)in the left upper lobe,and 38 cases in the left lower lobe Patients(16.8%)were treated with wedge resection in 24 cases(10.6%),segmental resection in 11 cases(4.9%),lobectomy in 189 cases(83.6%).Among them,108 cases(47.8%)were thick-walled cavities and 118 cases(52.2%)were thin-walled cavities.2.Among the 226 postoperative solitary cavity lung adenocarcinoma patients,18 cases(8.0%)of carcinoma in situ(AIS)were non-mucinous;34 cases(15.0%)of microinvasive adenocarcinoma(MIA)were all It was non-mucinous type;174 cases(77.0%)of invasive adenocarcinoma(IAC),47 cases(20.8%)of mural-based type,66 cases(29.2%)of acinar-based type,and 18 cases of papillary-based type(8.0%),11 cases(4.9%)of micropapillary type,29 cases(12.8%)of solid type,and 3 cases of invasive adenocarcinoma(1.3%).3.In the histological classification,103 cases of invasive adenocarcinoma in the thick-walled cavity group,49 cases(45.4%)of the acinar-based type,26 cases(24.1%)of the solid-based type,significantly higher than the thin-walled cavity group(P<0.05);18 cases of in situ adenocarcinoma(15.3%)in the thin-walled cavity group,29 cases(24.6%)of micro-invasive adenocarcinoma,significantly higher than the thick-walled cavity group(P<0.05);thin-walled cavity in invasive adenocarcinoma There were 39 cases(33.1%)in the adherent group,which was significantly higher than that in the thick-walled cavity group(P<0.05).4.In the carcinoma in situ group,13 cases(72.2%)had no solid components,5 cases had solid components(27.8%),28 cases(16.1%)had no solid components in the invasive adenocarcinoma group,and 146 cases had solid components(83.9%),the difference was statistically significant(P<0.05).The ground-glass sign,lobular sign,burr sign,intracavitary partition and wall nodules were statistically different in different pathological types(P<0.05).Among them,16 cases(88.9%)in the carcinoma-in-situ group had ground-glass sign(88.9%),micro-infiltration There were 28 cases(82.4%)with ground glass sign in the adenocarcinoma group,the difference was not statistically significant,32 cases(18.4%)in the invasive adenocarcinoma group with ground glass sign,the difference was statistically significant(P<0.05);Separate 126 cases(72.4%),mural nodules 113 cases(65.0%),lobular signs 113 cases(64.9%),burr signs 98 cases(56.3%),which are statistically different from the carcinoma in situ and microinvasive adenocarcinoma groups Academic significance(P<0.05).There was no statistically significant difference in the shape of the lesion,the location of the cavity,the sign of vascular penetration,the sign of vascular clustering,and the sign of pleural depression in different pathological types.5.The size of the in situ adenocarcinoma lesion was 8.25±3.11mm,the size of the micro-invasive adenocarcinom0a lesion was 9.53±4.27mm,which was significantly different from the size of the invasive adenocarcinoma lesion at 28.78±19.35mm(P<0.05);the in situ adenocarcinoma was cavity The size is 7.12±2.05mm,and the size of the micro-invasive adenocarcinoma cavity is 7.69±3.42mm,which is significantly different from the invasive adenocarcinoma cavity size of 19.14±16.57mm(P<0.05);the thickness of the cavity wall of the in situ adenocarcinoma is 2.05±1.14mm,The thickness of the cavity wall of micro-invasive adenocarcinoma is 3.23±2.12mm,which is significantly different from that of invasive adenocarcinoma of 18.25±16.5716.54mm(P<0.05);the size of the lesion,the size of the cavity,and the thickness of the cavity wall are correlated with pathological classification In sexual analysis,the size of the lesion,the size of the cavity,and the thickness of the cavity wall were positively correlated with the pathological classification,and the size of the cavity was positively correlated with the size of the lesion.Conclusions1.In postoperative solitary cavity lung adenocarcinoma,the main pathological type is invasive lung adenocarcinoma.Among them,the proportion of invasive adenocarcinomas in the thick-walled cavity group was significantly higher than that of the thin-walled cavity group,and the proportion of adherent-based invasive adenocarcinoma in the thin-walled cavity group was significantly higher than that of the thick-walled cavity group.The proportion of in situ adenocarcinoma and micro-invasive adenocarcinoma in the thin-walled cavity group was significantlyhigher than that in the thick-walled cavity group.2.Among solitary cavity lung adenocarcinomas,carcinoma in situ is mostly with no solid components,and invasive adenocarcinomas are mostly with solid components;the proportion of ground glass signs in the carcinoma in situ group and the microinvasive adenocarcinoma group is high,and the invasive glands The proportions of cancer components were leaf sign,burr sign,intracavitary partition,and wall nodules.3.The thicker the wall of the cavity,the larger the diameter of the lesion,and the larger the cavity,the higher the malignant degree of the lesion.Part Ⅲ Correlation study on mutation of EGFR gene in solitary cavitary lung adenocarcinomaObjectiveTo analyze the related factors of EGFR gene mutation in solitary cavitary lung adenocarcinoma undergoing surgical treatment,and guide the individualizedtreatment of cavitary lung adenocarcinoma after surgery.MethodsA retrospective analysis of the CT data of 135 patients with isolated cavitary lung adenocarcinoma who were finally surgically resected from January 2013 to December 2018,and their EGFR gene mutation detection status,was analyzed by a pathologist.Review the pathological sections to analyze the relationship between EGFR gene mutation and imaging and the relationship with pathological typing.All tests were performed using SPSS 19.0 statistical software.The count data was expressed in frequency and percentage,and the measurement index was expressed in x ± s.The relationship between pathological typing and EGFR gene mutation and the relationship between the influence characteristics and EGFR gene mutation were tested by chi-square Test,the result is statistically significant with P<0.05.Results1.135 cases met the enrollment criteria,including 65 males(48.1%)and 70 females(51.9%);aged 35-76 years,with an average age of 57.1±9.5 years;56 cases(41.5%)with a history of smoking;pTNM Stages:25 cases(18.5%)in stage IA,68 cases(50.4%)in stage ⅠB,22 cases(16.3%)in stage ⅡA,and 20 cases(14.8%)in stage ⅢA.2.Among the 135 samples,there was 1 case with exon 18 point mutation(0.7%),49 cases with exon 19 deletion mutation(36.3%),4 cases with exon 20 insertion mutation(3.0%),and exon 21 There were 29 cases(21.5%)of point mutations and 52 cases(38.5%)of wild-type;the EGFR mutation rate was 61.5%(83/135).3.Among the 135 pathological sections,there were 4 cases of AIS(3.0%),7 cases of MIA(5.2%),32 cases(23.7%)of mural component-based invasive adenocarcinoma,and 54 cases of acinar component-based invasive adenocarcinoma Cases(40.0%),15 cases(11.1%)of papillary component-based invasive adenocarcinoma,4 cases of micropapillary component-based invasive adenocarcinoma(3.0%),and solid component-based invasive adenocarcinoma 19(14.1%).Analysis of the degree of differentiation of tumor cells showed that of the 135 cases,39 cases were highly differentiated(28.9%),81 cases were moderately differentiated(60.0%),and 15 cases were poorly differentiated(11.1%).4.The diameter of the lesion was 0.6-4.5cm,with an average value of 3.12±0.57cm;of the 135 cases,64 cases(47.4%)were thick-walled cavities,71 cases were thin-walled cavities(52.6%),and 68 cases(50.4%)were lobular signs.There were 65 cases(48.1%)with burr sign,68 cases(50.4%)with pleural adhesions,64 cases(47.4%)with pleural depression,37 cases(27.4%)with ground glass density shadow around the lesion,and 81 cases(60.0)with unsmooth inner wall,69 cases(51.1%)were shown in the interval within the cavity.5.Among the patients of EGFR mutation,53 cases(75.7%)of women with mutations and 57 cases(72.2%)of non-smokers with mutations were statistically significant compared with men and smokers(P<0.05).41 cases(75.9%)with acinar-dominant invasive adenocarcinoma mutation were the histological type with the highest EGFR mutation rate.6.There was a statistically significant difference between 62 cases(76.5%)of EGFR mutation in the lesion diameter<3 cm group and the>3 cm group(P<0.05).There was no statistically significant difference in EGFR mutations in the thickness of the cavity wall,lesion lobulation sign,burr sign,pleural adhesion,pleural depression,ground glass shadow on the edge of the lesion,whether the inner wall of the hole is smooth,and the interval within the cavity.Conclusions1.Postoperative solitary cavity lung adenocarcinoma has a higher EGFR gene mutation rate,with exon 19 mutations being the main one,followed by 21 exon mutations.2.Female,no smoking history,lesion diameter<3cm,has a higher EGFR mutation rate in patients with early solitary cavity lung adenocarcinoma.3.There is no significant difference in EGFR mutation rate in the thickness of the cavity wall,the surrounding structure of the cavity,the edge shape and the internal structure.4.Acinar-based invasive adenocarcinoma is more prone to EGFR mutations.