Potential Role of Intrapulmonary Concomitant Lesions in Differentiating Non-Neoplastic and Neoplastic Ground Glass Nodules

Abstract

Purpose

To determine the value of intrapulmonary concomitant lesions in differentiating non-neoplastic and neoplastic ground-glass nodules (GGNs).

Patients and Methods

From January 2014 to March 2022, 395 and 583 patients with confirmed non-neoplastic and neoplastic GGNs were retrospectively enrolled. Their clinical and chest CT data were evaluated. The CT features of target GGNs and intrapulmonary concomitant lesions in these two groups were analyzed and compared, and the role of intrapulmonary concomitant lesions in improving differentiation was evaluated.

Results

The intrapulmonary concomitant lesions were more common in patients with non-neoplastic GGNs than in those with neoplastic ones (87.88% vs 82.18%, P = 0.015). Specifically, patients with non-neoplastic GGNs had a higher incidence of multiple solid nodules (SNs), patchy ground-glass opacity/consolidation, and fibrosis/calcification in any lung fields (each P < 0.05). Logistic regression analysis indicated that patients < 44 years old, diameter < 7.35 mm, irregular shape, and coarse margin or ill-defined boundary for target GGN, pleural thickening, and concomitant SNs in the same lobe and fibrosis or calcification in any lung field were independent indicators for predicting non-neoplastic GGNs. The AUC of the model for predicting non-neoplastic GGNs increased from 0.894 to 0.926 (sensitivity, 83.10%; specificity, 87.10%) after including the concomitant lesions in the patients’ clinical characteristics and CT features of target GGNs (P < 0.0001).

Conclusion

Besides the patients’ clinical characteristics and CT features of target GGNs, the concomitant multiple SNs in the same lobe and fibrosis/calcification in any lung field should be considered in further differentiating non-neoplastic and neoplastic GGNs.

Keywords:

• ground-glass nodule
• intrapulmonary concomitant lesion
• differential diagnosis
• tomography
• X-rays

Abbreviations

GGNs, ground-glass nodules; SNs, solid nodules; LDCT, low‑dose computed tomography; AAH, atypical adenomatous hyperplasia; AIS, adenocarcinoma in situ; MIA, minimally invasive adenocarcinoma; IAC, invasive adenocarcinoma; GGO, ground-glass opacity; ROC, receiver operating characteristic; AUC, area under curve; PPV, positive predictive value; NPV, negative predictive value.

Data Sharing Statement

The datasets generated and/or analyzed during the current study are not publicly available because the cases are from the Picture Archiving and Communicating System of our Hospital but are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

This study conformed to the Declaration of Helsinki on Human Research Ethics standards and was approved by the institutional review board of the First Affiliated Hospital of Chongqing Medical University (number 2019–062). The need for written, informed consent was waived by the institutional review board of the First Affiliated Hospital of Chongqing Medical University because of the retrospective design.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This work was supported by the Joint Project of Chongqing Science and Technology Commission and Chongqing Public Health Commission (2022MSXM050), and the Senior Medical Talents Program of Chongqing for Young and Middle-aged from Chongqing Health Commission (Receptor: Zhigang Chu).