Abstract:

Objective To investigate the clinic diagnostic value of multi-slice CT (MSCT) imaging features in various subtypes of nodular lung adenocarcinoma. Methods The imaging information and general clinical data of 160 patients with nodular lung adenocarcinoma who were admitted to Yantai Affiliated Hospital of Binzhou Medical University and received surgical treatment from January 2017 to May 2019 were retrospectively analyzed. Univariate analysis was used to screen statistically significant imaging features of each pathological subtype, and binary logistic regression analysis was performed. The diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, the area under the curve (AUC) was calculated, and the diagnostic efficacy was compared. Results The age of patients with atypical adenomatous hyperplasia and adenocarcinoma in situ (AAH+AIS), minimally invasive ademocarcinoma (MIA), invasive adenocarcinoma cancer (IAC) and variant of invasive adenocarcinoma cancer (VIAC) were (57.07±7.92), (59.37±6.96), (60.68±8.83), (63.33±6.89) years old, with no statistically significant difference (F=1.221, P=0.304). The age of patients with VIAC, IAC, MIA and AAH+AIS decreased in turn. The imaging features of AAH+AIS, MIA, IAC and VIAC that exhibited statistically significant differences were as following in turn: the maximum diameter of lesion [6.85 (3.73) mm vs. 8.00 (5.00) mm vs. 16.00 (11.90) mm vs. 17.20 (9.08) mm, H=55.107, P<0.001], CT value [-563.50 (176.63) HU vs. -536.00 (293.50) HU vs. -235.50 (346.50) HU vs. -23.00 (30.50) HU, H=47.499, P<0.001], solid ratio [0 (0) vs. 0 (0) vs. 49.00% (100.00%) vs. 100.00% (0), H=44.242, P<0.001], vacuolar sign [14 (87.50%) vs. 35 (100.00%) vs. 84 (81.55%) vs. 3 (50.00%), χ ²=13.925, P=0.002], inflatable bronchus sign [1 (6.25%) vs. 2 (5.71%) vs. 36 (34.95%) vs. 2 (33.33%), χ ²=16.578, P=0.001], intratumoral vascular sign [13 (81.25%) vs. 28 (80.00%) vs. 64 (62.14%) vs. 1 (16.67%), χ ²=11.168, P=0.009], vessel convergence sign [1 (6.25%) vs. 3 (8.57%) vs. 66 (64.08%) vs. 6 (100.00%), χ ²=54.232, P<0.001], short burr sign [3 (18.75%) vs. 11 (31.43%) vs. 77 (74.76%) vs. 6 (100.00%), χ ²=36.218, P<0.001], lobulation sign [4 (25.00%) vs. 18 (51.43%) vs. 93 (90.29%) vs. 6 (100.00%), χ ²=43.302, P<0.001], pleural traction sign [0 (0) vs. 6 (17.14%) vs. 70 (67.96%) vs. 5 (83.33%), χ ²=50.794, P<0.001]. The maximum diameter of lesion (OR=0.858, 95%CI: 0.754-0.977, P=0.021) and pleural traction sign (OR=0.288, 95%CI: 0.084-0.993, P=0.049) were independent influencing factors of MIA. The maximum diameter of lesion (OR=1.131, 95%CI: 1.030-1.241, P=0.010) and pleural traction sign (OR=3.441, 95%CI: 1.279-9.254, P=0.014) were independent influencing factors of IAC. The optimum threshold of the maximum diameter of lesion in diagnosis of MIA was 11.05 mm, AUC was 0.798 (95%CI: 0.724-0.872) sensitivity was 68.00%, and specificity was 85.70%. The AUC of pleural traction sign in diagnosis of MIA was 0.714 (95%CI: 0.623-0.806). The diagnostic efficacy exhibited no statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of MIA (Z=1.838, P=0.066). The optimum threshold of the maximum diameter of lesion in diagnosis of IAC was 11.05 mm, AUC was 0.827 (95%CI: 0.759-0.895), sensitivity was 75.70%, and specificity was 78.90%. The AUC of pleural traction sign in diagnosis of IAC was 0.743 (95%CI: 0.663-0.823). The diagnostic efficacy exhibited statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of IAC (Z=2.114, P=0.035), and the maximum diameter of lesion > 11.05 mm was better for the diagnosis of IAC. Conclusion The maximum diameter of lesion and pleural traction sign are independent influence factors in diagnosis of MIA and IAC, and the maximum diameter of lesion > 11.05 mm is better for the diagnosis of IAC.

Key words: Lung neoplasms, Adenocarcinoma, Pathological subtype, Multi-slice CT, Imaging features