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A Nomogram Incorporating Tumor-Related Vessels for Differentiating Adenocarcinoma In Situ from Minimally Invasive and Invasive Adenocarcinoma Appearing as Subsolid Nodules

  • Author Footnotes
    † Lin DENG and Han Zhou TANG contributed equally to the work.
    Lin Deng
    Correspondence
    Address correspondence to: Jin Wei QIANG, Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai 201508, China.
    Footnotes
    † Lin DENG and Han Zhou TANG contributed equally to the work.
    Affiliations
    Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, 201508, China
    Search for articles by this author
  • Author Footnotes
    † Lin DENG and Han Zhou TANG contributed equally to the work.
    Han Zhou Tang
    Correspondence
    Address correspondence to: Jin Wei QIANG, Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai 201508, China.
    Footnotes
    † Lin DENG and Han Zhou TANG contributed equally to the work.
    Affiliations
    Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, 201508, China
    Search for articles by this author
  • Jin Wei Qiang
    Correspondence
    Address correspondence to: Jin Wei QIANG, Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai 201508, China.
    Affiliations
    Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, 201508, China
    Search for articles by this author
  • Li Min Xue
    Correspondence
    Address correspondence to: Jin Wei QIANG, Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai 201508, China.
    Affiliations
    Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, 201508, China
    Search for articles by this author
  • Author Footnotes
    † Lin DENG and Han Zhou TANG contributed equally to the work.
Published:September 21, 2022DOI:https://doi.org/10.1016/j.acra.2022.08.024

      Highlights

      • Differentiation of adenocarcinoma in situ (AIS) from minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) is important but remains difficult.
      • Tumor-related vessels (TRVs) can be observed peri- and intra-tumor appearing as subsolid nodules without contrast-enhanced scanning.
      • A morphological analysis of TRVs would help optimize the differentiation of AIS and MIA-IAC.
      • The nomogram incorporated with the quantity of TRVs further facilitates differentiation of AIS from MIA-IAC.

      Objectives

      To develop a nomogram incorporating the quantity of tumor-related vessels (TRVs) and conventional CT features (CCTFs) for the preoperative differentiation of adenocarcinoma in situ (AIS) from minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) appearing as subsolid nodules.

      Methods

      High-resolution CT target scans of 274 subsolid nodules from 268 patients were included in this study and randomly assigned to the training and validation groups at a ratio of 7:3. A nomogram incorporating CCTFs with the category of TRVs (CTRVs, using TRVs as categorical variables) and a final nomogram combining the number of TRVs (QTRVs) and CCTFs were constructed using multivariable logistic regression analysis. The performance levels of the two nomograms were evaluated and validated on the training and validation datasets and then compared.

      Results

      The CCTF-QTRV nomogram incorporating abnormal air bronchogram, density, number of dilated and distorted vessels and number of adherent vessels showed more favorable predictive efficacy than the CCTF-CTRV nomogram (training cohort: area under the curve (AUC) = 0.893 vs. 0.844, validation cohort: AUC = 0.871 vs. 0.807). The net reclassification index (training cohort: 0.188, validation cohort: 0.326) and the integrated discrimination improvement values (training cohort: 0.091, validation cohort: 0.125) indicated that the CCTF-QTRV nomogram performed significantly better discriminative ability than the CCTF-CTRV nomogram (all p-value < 0.05).

      Conclusions

      The nomogram incorporating the QTRVs and CCTFs showed favorable predictive efficacy for differentiating AIS from MIA-IAC appearing as subsolid nodules and may serve as a potential tool to provide individual care for these patients.

      Key words

      Abbreviations:

      AAB (Abnormal air bronchogram), AIC (Akaike information criterion), AUC (Area under the curve), AVN (Number of adherent vessels), CCTF (Conventional CT feature), CTRV (category of tumor-related vessel), CVN (Number of convergent vessels), DV (Dilated and distorted vessel), FOV (Field of view), HRCT (High-resolution CT), IDI (Integrated discrimination improvement), ISV (Intrasolid-component vessel), IV (Number of intra-nodule vessels), MIA (Minimally invasive adenocarcinoma), NRI (Net reclassification index), PSN (Part solid nodule), ROC (Receiver operating characteristic), SD (Standard deviation), TNV (Total number of tumor-related vessels), TRV (tumor-related vessel), WHO (World Health Organization), AAH (Atypical adenomatous hyperplasia), AIS (Adenocarcinoma in situ), AV (Adherent vessel), CI (Confidence interval), CV (Convergent vessel), DCA (Decision curve analysis), DVN (Number of dilated and distorted vessels), pGGN (Pure ground glass nodule), IAC (Invasive adenocarcinoma), ISVN (Number of intrasolid-component vessels), OR (Odd ratio), QTRV (Quantity of tumor-related vessel), SSC (Size of solid component), VIF (Variance inflation factor)
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