Oncological Characteristics of Radiological Invasive Adenocarcinoma with Additional Ground-Glass Nodules on Initial Thin-Section Computed Tomography: Comparison with Solitary Invasive Adenocarcinoma

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Abstract

Introduction:

We aimed to evaluate the oncological outcomes of radiological invasive adenocarcinoma with additional ground-glass nodules (AGGNs) on initial thin-section computed tomography (CT).

Methods:

We examined 473 patients with surgically resected clinical stage IA lung adenocarcinoma showing a radiological invasive appearance on thin-section CT. Radiological invasiveness was defined as a solid tumor with a consolidation tumor ratio of at least 0.5 but no greater than 1.0 on thin-section CT.

Results:

Ninety patients (19%) had dominant invasive adenocarcinoma (DA) with AGGNs, whereas 383 (81%) had solitary invasive adenocarcinoma (SA). DA showed a significantly lower maximum standardized uptake value of 18F-fluorodeoxyglucose on positron emission tomography (p = 0.0086), higher frequency of radiological part solid tumor (p = 0.0232) and histological lepidic predominant tumor (p = 0.0015), and lesser presence of nodal involvement (p = 0.0350) and lymphovascular invasion (p = 0.0001) than with SA. Surgically resected AGGNs were shown to be pathologically atypical adenomatous hyperplasia in 17% of patients, adenocarcinoma in situ in 53%, and minimally invasive adenocarcinoma in 21%. Furthermore, the 5-year overall survival of DA with AGGNs was better than that of SA, and the difference was significant (92.2% versus 79.9%, p = 0.0323). On the basis of a multivariate analysis, tumor size, maximum standardized uptake value, and consolidation status of DA/SA were significant prognostic factors of survival for all patients (p = 0.0039, 0.0236, and 0.0385, respectively), whereas the presence of AGGNs was not associated with poor overall survival (p = 0.4809).

Conclusion:

DA accompanied by AGGNs showed an oncologically less invasive nature compared with SA. Presence of AGGNs is not related to poor prognosis, and is neither indicative of an advanced stage nor a contraindication to surgical resection in patients with clinical stage IA radiological invasive adenocarcinoma.

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