Association of CT findings with invasive subtypes and the new grading system of lung adenocarcinoma

Kirsi K Volmonen, Anastasia Sederholm, Mikko Rönty, Juuso Paajanen, Aija Knuuttila, Airi Jartti

Forskningsoutput: TidskriftsbidragArtikelVetenskapligPeer review


AIM: To predict the differentiation between invasive growth patterns and new grades of lung adenocarcinoma (LAC) using computed tomography (CT). MATERIALS AND METHODS: The CT features of 180 surgically treated LAC patients were compared retrospectively to pathological invasive subtypes and tumour grades as defined by the new grading system published in 2021 by the World Health Organization. Two radiologists reviewed the images semi-quantitatively and independently. Univariable and multivariable regression models were built from the statistical means of their assessments to predict invasive subtypes and grades. The area under the curve (AUC) calculation was used to select the best models. The Youden index was applied to determine the cut-off values for radiological parameters. RESULTS: The acinar/papillary patterns were associated with ill-defined margins, lower consolidation/tumour ratio and air bronchogram. The solid growth pattern was associated with a well-defined margin and hypodensity, and the micropapillary (MP) subtype with spiculation. From Grades 1 to 3, the amount of air bronchogram decreased and the consolidation/tumour ratio increased. In the sub-analyses, the best model for differentiating Grade 2 from Grade 1 had the following CT features: solid/subsolid type, consolidation/tumour ratio, well-defined margin, and air bronchogram (AUC = 0.783) and Grade 3 from Grade 2: size of the consolidation part/whole tumour ratio, size of the consolidation part, and well-defined margin (AUC = 0.759). The interobserver agreements between the two radiologists varied between 0.67 and 0.98. CONCLUSIONS: Air bronchogram, consolidation/tumour ratio , well-defined margin are among the best imaging findings to discriminate between both invasive subtypes , the new grades in LAC. (c) 2023 The Authors. Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY license ( 4.0/).
TidskriftClinical Radiology
Sidor (från-till)251-259
Antal sidor9
StatusPublicerad - mars 2023
MoE-publikationstypA1 Tidskriftsartikel-refererad


  • 3126 Kirurgi, anestesiologi, intensivvård, radiologi

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