Analysis Of Solitary Ground-glass Opacity Pulmonary Nodules

Objective:The purpose of this study was to investigate: the clinical factors of patients with solitary ground-glass opacity pulmonary(GGO)nodules on computed tomography(CT)associated with lung cancer.Methods:A total of 320 resected solitary GGO nodules were restrospectively evaluated.We analyzed the clinical,imaging and pathological data and investigated the clinical differences in patients with benign nodules,adenocarcinoma in situ(AIS)or minimally invasive adenocarcinoma(MIA)and those with invasive adenocarcinoma(IA).Statistical analysis performed by using SPSS24.0 software.The t test,Mann-Whitney U test,?~2 test or Fisher's exact test were used to test for difference in clinical factors and imaging characters between different pathology groups,as appropriate.T test was used for categorical variables fitted normal distribution and expressed by (x|-)±s.Mann-Whitney U test was used for categorical variables fitted non-normal distribution and expressed by M(P25,P75).?~2 test or Fisher's exact test was used for categorical variables.Results:Two hundred and ninety-seven adenocarcinomas(92.8%)and 23 benign nodules were diagnosed,including 207(64.4%)IA,81(25.6%)MIA,and 9(2.8%)AIS.In benign group and malignant group,univariate analysis showed that age,serum CEA,TPSA,CYFRA21-1 levels,tumor size,GGO type,air bronchogram,bubble-like sign,spicule sign and pleural tag were significantly different between the two groups(p:0.000,0.012,0.024,0.026,0.000,0.016,0.006,0.003,0.002,0.010).In AIS/MIA group and IA group,univariate analysis showed that Family history of cancer,serum CEA,ProGRP,CYFRA21-1 levels,tumor size,GGO type,air bronchogram,bubble-like sign,spicule sign and pleural tag were significantly different between the two groups(p:0.000,0.011,0.001,0.001,0.027,0.000,0.000,0.011,0.004,0.009,0.000,0.002).Multivatiate analysis confirmed that tumor size(OR = 11.075;95%CI 15.173,23.71)and GGO type(OR =6.451;95%CI 3.049,13.648)were independent factors that were significantly associated with IA.Increased age,GGO size,serum TPSA level and carcinoembryonic antigen(CEA)level indicated a high possibility of tumor progression from atypical adenomatous hyperplasia(AAH)to adenocarcinoma(p:0.000,0.000,0.026,0.000,respectly.).The EGFR mutation in isolated GGO nodules was not associated with gender,age,smoking history,family history of cancer,serum CEA,CA19-9,and tumor size(p>0.05).EGFR mutation rate was higher in IA group than in AIS/MIA group(68.9% vs 38.2%)(p=0.003).In pGGO,the proportion of IA is 42.7%.Conclusion:Solitary GGO nodules in a higher proportion of invasive adenocarcinoma,patients with higher tumor diameter,mixed GGO are higher possibility of IA.Therefore,for the larger diameter mixed GGO,we should be regulated by lobectomy plus systemic lymph node dissection.