The Analysis Of CT Signs In The Pure Ground Glass Density Lung Adenocarcinoma With Invasive Lesions

ObjectiveTo analyze the characteristic of CT Signs in the Pure Ground Glass Density Lung Adenocarcinoma with Invasive Lesions.Materials and methods128 patients with pure ground glass density pulmonary nodules on CT from January 2017 to October 2018 were selected.All the above nodules were single nodules and had undergone pathological examination.TNM staging of all cases was T1N0M0.The above patients have complete imaging,pathological and clinical data.According to the pathological results,the Fifty-six cases patients were divided into invasive lesion group(including Thirty-five MIA cases,Twenty-one IAC cases)and the Seventy-two patients were divided into preinvasive lesion group(including Thirty-two AAH cases,Forty AIS cases).The CT images of the above patients were retrospectively analyzed.The size and CT value of the lesions were measured and recorded.The location,shape,tumor-lung interface,homogeneity,spiculation,lobulation,pleural indentation,vascular cluster,vacuole sign and air bronchogram were observed and recorded.The general clinical data of patients,including age,sex and smoking history,were also analyzed.By Pearson Chi-squaretest or Fisher's exact probability method,the difference of qualitative data between the two groups was compared.When P < 0.05,the difference between the two groups was considered to be statistically significant.The difference of quantitative data between the two groups was compared by independent sample t test or rank sum test,and the difference was significant when P < 0.05.The data with statistical differences between groups were taken as independent variables,and the infiltration of lesions was taken as dependent variable for binary multivariate logistic regression analysis.When P < 0.05,the statistical significance was considered.The predictive probability was taken as test variable,and the ROC curve was drawn with the infiltration of lesions as state variable.Quantitative data with statistical significance in binary multivariate logistic regression analysis were used as test variables.Whether the lesion had infiltration or not was used as state variables.ROC curves were drawn,and the area under the curve(AUC)and the cut-off point at the time of maximum diagnostic efficiency were calculated.ResultsThere were no significant differences in age(P=0.317),sex(P=0.759),smoking history(P=0.819),location(P=0.974),shape(P=0.147),vacuole sign(P=0.085)and air bronchogram(P=0.109)between two groups.The lesion size(P=0.000),density(P=0.000),tumor-lung interface(P=0.038),homogeneity(P=0.026),lobulation sign(P=0.000),vascular cluster sign(P=0.004),burr sign(P=0.012),pleural indentation sign(P=0.033)were significantly different among the groups.In binary multivariate logistic regression analysis,the size(P=0.005),density(P=0.000),lobulation sign(P=0.034),and vascular cluster sign(P=0.041)had statistical significance.Regarding the generated predictive probability as the test variable and the infiltration of the lesion as the state variable,ROC curve was drawn,its area was 0.915,sensitivity was 85.7%,specificity was86.1%,Yoden index was 71.8%.ROC curve with lesion size as diagnostic criterion was drawn,its area was 0.808,cut-off point was13.33 mm,sensitivity was 58.9%,specificity was 87.5%,Yoden index was46.4%.ROC curve with density as diagnostic criterion was drawn,its area was 0.818,cut-off point was-538.86 HU,sensitivity was 66.1%,specificity was 84.7%,Yoden index was 50.8%.ConclusionPure ground glass density lung adenocarcinoma with lobulated sign and vascular cluster sign and its size > 13.33 mm,density >-538.86 HU is more likely to be invasive.The incidences of burr sign,pleural indentation sign,clear lung-tumor interface and heterogeneous lesions in invasive lesions were higher than those in pre-invasive lesions and had statistical significance.It was valuable to judge the invasiveness of pure ground glass density lung adenocarcinoma,but it can not be used independently to judge invasion.Age,sex,smoking history,lesionlocation,shape,vacuole sign and pneumatic bronchial sign have little significance in judging the invasiveness of pure ground glass density lung adenocarcinoma.