The Diagnostic Value of Quantitative CT Analysis of Ground-Glass Volume Percentage in Differentiating Epidermal Growth Factor Receptor Mutation and Subtypes in Lung Adenocarcinoma

OBJECTIVE: To retrospectively investigate computed tomographic (CT) quantitative analysis of ground-glass opacity (GGO) volume percentage and morphologic features of resected lung adenocarcinomas according to epidermal growth factor receptor (EGFR) mutation status and subtypes. METHODS: Amplification refractory mutation system was used to detect mutations in the EGFR gene. Distribution of demographics and GGO volume percentage were performed according to EGFR mutation status and subtypes. RESULTS: EGFR mutations were significantly more frequent in women (55.2% vs. 37.0%, p=0.001) and in never-smokers (59.5% vs. 38.4%, p < 0.001) than those without EGFR mutation. GGO volume percentage was significantly higher in tumors with EGFR mutation than in tumors without EGFR mutation (52.8±25.7% vs. 29.0±20.7%, p < 0.001). The GGO volume percentages in tumors with exon 21 mutation and EGFR mutation showed a significant difference compared with those without EGFR mutation (p < 0.001, area under the curve=0.871, sensitivity=94.6%, specificity=73.8%, and p < 0.001, area under the curve=0.783, sensitivity=69.9%, specificity=75.4%, resp.), with cut-off values of 37.7% and 34.3% in receiver operating characteristic curve analysis. CONCLUSION: GGO volume percentage in adenocarcinomas with EGFR mutation was significantly higher than that in tumors without EGFR mutation, and adenocarcinomas with exon 21 mutation showed significantly higher GGO volume percentage than in tumors with exon 19 mutation and those without EGFR mutation. Our results indicate that GGO volume percentage cut-off values of more than 37.7% and 34.3% were predictors of positive exon 21 mutation and EGFR mutation, respectively.