Morphological factors differentiating between early lung adenocarcinomas appearing as pure ground-glass nodules measuring ≤10 mm on thin-section computed tomography

BACKGROUND: We aimed to compare the morphological features of pure ground-glass nodules (GGNs; diameter, ≤10 mm) on thin-section computed tomography (TSCT) with their histopathological results in order to identify TSCT features differentiating between atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA). METHODS: Between January and December 2013, 205 pure GGNs with a diameter ≤10 mm on TSCT were pathologically confirmed as AAH (40), AIS (95) or MIA (70) lesions. The patients’ age and sex were recorded. The morphological features were evaluated, and maximum diameter and mean CT value were measured for each nodule. F test, Pearson χ(2) test, Fisher exact test and multinomial logistic regression analysis were used to identify factors differentiating between AAH, AIS and MIA. Receiver operating characteristic (ROC) curve analysis was performed for maximum diameter and mean CT value. RESULTS: F test, Pearson χ(2) test and Fisher exact test revealed that maximum diameter (P <0.00001), mean CT value (P =0.005), type of interface (P =0.005) and presence of air bronchograms (P =0.02, n =44) significantly differed among the AAH, AIS and MIA groups. Multinomial logistic regression analysis showed that maximum diameter ≥6.5 mm, a well-defined and coarse interface indicated AIS or MIA rather than AAH; air bronchograms differentiated MIA from AAH; but these parameters did not differentiate between AIS and MIA. A mean CT value less than −520 HU indicated AAH or AIS rather than MIA, but did not differentiate between AAH and AIS. CONCLUSIONS: In the case of pure GGNs measuring ≤10 mm, a maximum diameter ≥6.5 mm, a well-defined and coarse interface indicate AIS or MIA rather than AAH; an air bronchogram can differentiate MIA from AAH. A mean CT value less than −520 HU indicates AAH or AIS rather than MIA.