Quantitative Prediction Of Infiltration And Expression Of MVD And Ki-67 In Pure Ground Glass Lung Adenocarcinoma With Dual-energy CT Iodine Graph

Objective: Based on imaging and immunohistochemical parameters,we explore the dual-source dual-energy-enhanced CT iodine images related parameters to predict the relationship between MVD and Ki-67 expression and the invasiveness of pulmonary adenocarcinomas appearing as pure ground-glass nodules,and we hope it can provide valuable information for formulating treatment plans and evaluating prognosis in clinical work.Methods: In a total of 43 patients with 65 pGGNs,we performed dual-energy CT and pathological confirmation,and divided them into two groups: one group was pre-invasive lesion group,and the other was invasive lung adenocarcinoma.Features investigated are as follow:(1)The CT plain scan image parameters of pGGNs were analyzed,including morphological characteristics and quantitative parameters(long diameter,CT value);The quantitative measurements of dual-energy CT iodine images were analyzed,including Mix CT,overlay value,iodine Concentration(IC),normalized iodine Concentration(NIC)in the arterial and venous phases.(2)Analyze the immunohistochemical parameters of the lesion,including MVD value and Ki-67 expression level.(3)Statistical methods: First,t or rank sum test was used for measurement data,chi-square or Fisher’s exact test was used for count data.Secondly,the imaging parameters with statistically significant differences between the two groups were included in the binary logistic regression model for analysis and the receiver operating characteristic(ROC)curve was drawn to obtain the area under the ROC curve(AUC)for each independent risk factor to identify the two groups.Finally,Spearman correlation test is used to analyze the correlation between imaging parameters and MVD and Ki-67 expression levels.Results: Of the 65 pGGNs,31 were pre-invasive lesions,34 were invasive pulmonary adenocarcinomas.(1)Among the parameters of conventional plain scan CT,long diameter,CT value and lobulation were statistically different between two groups;Among the parameters of the dual-energy CT iodine images,IC and NIC in venous phases of invasive lung adenocarcinomas were higher than those of pre-invasive lesion,and the differences were statistically significant.In the binary logistic regression analysis,long diameter and NIC were independent risk factors,and the AUC were 0.706,0.853,the sensitivity were 82.4%,82.4%,and the specificity were 58.1%,77.4%,respectively.(2)Analyzing the immunohistochemical parameters,the MVD and the expression levels of Ki-67 in the invasive pulmonary adenocarcinomas group were higher than those in the pre-invasive lesion group,and the differences were statistically significant.(3)The independent risk factors were correlated with MVD and Ki-67.The results showed that NIC has a strong correlation with MVD(r=0.689,P<0.001),and the correlation between and Ki-67 is weak(r=0.251,P=0.044);the correlation between long diameter and Ki-67 is moderate(r=0.548,P<0.001),and the correlation between long diameter and MVD is weak(r=0.270,P=0.030).Conclusion: NIC in venous phase and long diameter can well predict invasiveness of pGGNs,and realize to distinguish pre-invasive lesions from invasive lung adenocarcinoma before surgery;and NIC of the venous stage and long diameter were closely related to MVD value and Ki-67 expression level,respectively,which can realize noninvasive assessment of the angiogenesis and cell proliferation levels of lung adenocarcinoma.On this basis,it can provide more valuable information and basis for determining the follow-up time,treatment methods and intervention timing in clinical work.