A study on the clinical application of"four taxonomies classification method"of pulmonary ground-glass opacity lesions based on thin-section CT scanning of the chest

SU Lei; ZHANG Yi; GAO Yan; WANG Tengteng; LI Yuanbo; ZHANG Peilong; WANG Leiming; WEI Xiuqin

doi:10.3969/j.issn.1674-3806.2024.10.08

Abstract：Objective To explore the clinical application value of"four taxonomies classification method"of pulmonary ground-glass opacity(GGO)lesions based on thin-section computed tomography(TSCT)scanning of the chest.Methods The clinical data of 1 541 patients who underwent thoracoscopic surgery in Xuanwu Hospital Capital Medical University from January 2020 to December 2022 were retrospectively analyzed,including 2 005 pulmonary GGO lesions.The pulmonary GGO lesions were classified by using"four taxonomies classification method":type Ⅰ,pure GGO(p-GGO)without vacuolar sign and(or)bronchiole sign;type Ⅱ,p-GGO with vacuolar sign and(or)bronchiole sign;type Ⅲ,heterogeneous GGO(h-GGO)of solid components visible only in the lung window;type Ⅳ,part-solid GGO(ps-GGO)of solid components visible in both the lung window and the mediastinal window.The relationship between the imaging characteristics of pulmonary GGO lesions[maximum diameter,type of lesions,occurrence site,classification and consolidation-to-tumor ratio(CTR)]and the results of postoperative pathological examination was analyzed.Results In the 1 541 patients,the time from the discovery of pulmonary GGO to receiving surgical treatment was 0.10-156.00 months,with an average of 11.23 months.During this period,there were no significant changes in 1 255 pulmonary GGO lesions(62.59％),and the maximum diameter increased in 536 pulmonary GGO lesions(26.73％),and the density increased in 45 pulmonary GGO lesions(2.24％),and the maximum diameter increased with increases in density in 169 pulmonary GGO lesions(&43％).The maximum diameter of preoperative pulmonary GGO was(13.21±7.90)mm.The characteristics of the lesions were mainly single lesion,with a total of 1 098 lesions(54.76％),and the lesions were mostly distributed in the upper lobe of the right lung(757 lesions,37.76％).Types of pulmonary GGO:248 GGOs of type 1(12.37％),682 GGOs of type Ⅱ(34.01％),862 GGOs of type Ⅲ(42.99％)and 213 GGOs of type Ⅳ(10.62％),950 GGOs with CTR≤25％(47.38％),616 GGOs with 25％＜CTR ≤ 50％(30.72％),314 GGOs with 50％＜CTR≤75％(15.66％)and 125 GGOs with CTR＞75％(6.23％).Among the pulmonary GGO lesions,there were 186 benign lesions(9.28％)and 1 819 malignant lesions(90.72％),including 744 glandular prodromal lesions and 1 075 infiltrative lesions.The analysis results showed that the results of postoperative pathological examination of the pulmonary GGO lesions were correlated with the maximum diameter of GGO,type of lesions,occurrence site,classification,CTR and the changes in GGO lesions during follow-up(P＜0.05).The results of correspondence analysis showed that compared with the CTR of pulmonary GGO lesions,the scattered spots of pulmonary GGO lesions were more similar to the scattered spots of postoperative pathological malignant changes[atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),microinvasive adenocarcinoma(MIA)and invasive adenocarcinoma(IA)]in the two-dimensional distribution map,suggesting that the imaging characteristics of pulmonary GGO lesions based on the"four taxonomies classification method"had good corresponding relations with postoperative pathological malignant changes.Conclusion The"four taxonomies classification method"based on TSCT is helpful for clinicians to better evaluate the risk degree of early-stage lung cancer with GGO as the main imaging manifestation.