J Korean Soc Radiol.  2015 Dec;73(6):357-366. 10.3348/jksr.2015.73.6.357.

Ground-Glass Nodule on Thin-Section CT: Differentiation among Adenocarcinoma In Situ, Minimally Invasive Adenocarcinoma and Lepidic Predominant Invasive Adenocarcinoma

• Lee MH
• Ryu DS
• Kim DY
• Ahn JH
• Choi SJ
• Gang GH
• Yoo DG
• Shin DR

• KMID: 2130940
• DOI: http://doi.org/10.3348/jksr.2015.73.6.357

Abstract

PURPOSE
To investigate different computed tomography (CT) features among adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and lepidic predominant invasive adenocarcinoma (LPA) that appeared as ground-glass nodules (GGN). We also analyzed different CT findings between Group A (AIS and MIA) and Group B (LPA).
MATERIALS AND METHODS
We evaluated 19 AIS, 4 MIA, and 9 LPA images that were histologically confirmed and manifested as GGN on thin-section CT scans. CT scans were assessed for lesion characteristics: size, shape, solid portion, internal air density, marginal irregularity and pleural tag. CT findings of Group A and Group B were analyzed using the Kruskal-Wallis test or Fisher's exact test.
RESULTS
A significant statistical difference was seen between AIS and LPA for lesion characteristics (p < 0.05). No significant difference was observed between AIS and MIA. Round or polygonal shape with smooth margin was significantly associated with Group A, and complex shape with marginal irregularity was associated with Group B.
CONCLUSION
Group A (AIS and MIA) could be distinguished from Group B (LPA) by smaller lesion size, round or polygonal shape, smaller solid portion and smooth margin.

MeSH Terms

Adenocarcinoma*
Lung Neoplasms
Tomography, X-Ray Computed

Figure

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  Fig. 1 The classification of ground-glass nodule (GGN): two GGN patterns, three GGN shapes and two GGN margins.

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  Fig. 2 Grade of part-solid ground-glass nodule. A. Grade 1 was a solid portion ≤ 5 mm. B. Grade 2 was a solid portion > 5 mm.

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  Fig. 3 A 70-year-old woman with adenocarcinoma in situ. A. Initial transverse 1.2 mm thin-section CT scan shows 6 mm pure ground-glass nodule (GGN) with round shape and smooth margin in the left upper lobe. B. Serial transverse 1.2 mm thin-section CT scan after 10 months shows slow-growing pure GGN measuring 7.3 mm with round shape and smooth margin in the left upper lobe. C. Photomicrograph (hematoxylin and eosin stain; magnification, × 1) shows round shaped tumor (arrows) of uniform cuboid cell proliferation involving alveolar walls.

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  Fig. 4 A 60-year-old woman with minimal invasive adenocarcinoma. A. Initial transverse 1.2 mm thin-section CT scan shows 9 mm pure ground-glass nodule (GGN) with round shape and smooth margin in the right upper lobe. B. Serial transverse 1.2 mm thin-section CT scan after 33 months shows slow-growing pure GGN 15 mm with round shape and smooth margin. C. Photomicrograph (hematoxylin and eosin stain; magnification, × 1) demonstrates minimally invasive adenocarcinoma non-mucinous type with a round homogeneous nodule (arrows).

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  Fig. 5 A 61-year-old man with lepidic predominant invasive adenocarcinoma (LPA). A. Initial transverse 1.2 mm thin-section CT scan shows 12 mm pure ground-glass nodule (GGN) with polygonal shape and smooth margin in the right middle lobe. B. Serial transverse 1.2 mm thin-section CT scan after 30 months shows GGN increased in size. The lesion shows complex shape with marginal irregularity, pleural tag, and increased attenuation, suggesting a part-solid nodule (colored area). The solid portion measured 8 mm, Grade 2. C. Photomicrograph (hematoxylin and eosin stain; magnification, × 1) of LPA non-mucinous type with complex shape and marginal irregularity (arrows).

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  Fig. 6 A 56-year-old man with lepidic predominant invasive adenocarcinoma (LPA). A. Initial transverse 2.5 mm thin-section CT scan shows 14 mm pure ground-glass nodule (GGN) with complex shape and marginal irregularity in the left lower lobe with no interval change after a 12-month follow-up CT. B. Photomicrograph (hematoxylin and eosin stain; magnification, × 1) demonstrates LPA non-mucinous type with complex shaped nodule (arrows) and 7 mm stromal invasion (arrows).

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  Fig. 7 Lesion size in Group A and Group B. Mean lesion size was significantly larger in Group B than in Group A (p= 0.003). Box = 1st-3rd quartiles, Bold line = median, Whiskers = minimum and maximum values

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  Fig. 8 A 62-year-old man with mucinous adenocarcinoma in situ. A. Initial transverse 2.5 mm thickness CT scan shows 7 mm pure ground-glass nodule (GGN) in right upper lobe. B. Serial transverse 2.5 mm thin-section CT scan after 27 months shows persistent GGN with 90% solid portion and increased lesion size. The solid portion measured 7 mm, Grade 2. C. Photomicrograph (hematoxylin and eosin stain; magnification, × 1) shows polygonal-shaped tumor (arrows) of uniform cuboid cell proliferation involving alveolar walls with much stromal fibrosis.

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