CT quantitative parameters to predict the invasiveness of lung pure ground-glass nodules (pGGNs)

AIM: To investigate the value of computed tomography (CT) quantitative parameters in predicting the invasiveness of lung pure ground-glass nodules (pGGNs). MATERIALS AND METHODS: Chest CT images and pathological findings of 163 pGGNs in 154 consecutive patients were reviewed. According to the clinical management strategies, cases were divided into pre-invasive and MIA groups (atypical adenomatous hyperplasia [AAH], adenocarcinoma in situ [AIS], and minimally invasive adenocarcinoma [MIA]) and invasive group (invasive adenocarcinoma [IAC]). CT quantitative parameters including maximum diameter, largest diameter perpendicular to the maximum diameter, maximum cross-sectional area, volume, mass, and mean attenuation value were measured and compared between two groups. Their diagnostic performances were evaluated using receiver operating characteristic (ROC) and logistic regression analysis. RESULTS: Significant differences existed for all the CT quantitative parameters in both groups (p<0.01). The values of area under the curve (AUC) were 0.783 of maximum diameter (95% CI: 0.711-0.843), 0.779 of longest diameter perpendicular to maximum diameter (95% CI: 0.707-0.840), 0.796 of largest cross-sectional area (95% CI: 0.726-0.855), 0.781 of volume (95% CI: 0.710-0.842), 0.794 of mass (95% CI: 0.722-0.865) and 0.625 of mean attenuation value (95% CI: 0.546-0.700), respectively. A pairwise-manner comparison showed the AUC of mean attenuation value was the smallest (p<0.01). Logistic regression analysis showed the largest cross-sectional area (OR = 2.307, 95% CI: 1.689-3.150) was the independent predictor for IAC with a cut-off value of 2.22 cm(2). CONCLUSIONS: CT quantitative parameters could predict the invasiveness of lung pGGNs. The largest cross-sectional area is the most valuable independent predictor and the mean attenuation value is less valuable. (C) 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.