Yonsei Med J.  2016 Sep;57(5):1131-1138. 10.3349/ymj.2016.57.5.1131.

Three-Dimensional Ground Glass Opacity Ratio in CT Images Can Predict Tumor Invasiveness of Stage IA Lung Cancer

• Yu WS
• Hong SR
• Lee JG
• Lee JS
• Jung HS
• Kim DJ
• Chung KY
• Lee CY

• KMID: 2374157
• DOI: http://doi.org/10.3349/ymj.2016.57.5.1131

Abstract

PURPOSE
We investigated the relationship between various parameters, including volumetric parameters, and tumor invasiveness according to the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification.
MATERIALS AND METHODS
We retrospectively reviewed 99 patients with completely resected stage IA lung adenocarcinoma. The correlation between several parameters [one-dimensional ground glass opacity (1D GGO) ratio, two-dimensional (2D) GGO ratio, three-dimensional (3D) GGO ratio, 1D solid size, 2D solid size, and 3D solid size] and tumor invasiveness according to IASLC/ATS/ERS classification was investigated using receiver operating characteristic (ROC) analysis. Adenocarcinoma in situ and minimally invasive adenocarcinoma were referred to as noninvasive adenocarcinoma.
RESULTS
The areas under the curve (AUC) to predict invasive adenocarcinoma for the 1D, 2D, and 3D GGO ratios were 0.962, 0.967, and 0.971, respectively. The optimal cut-off values for the 1D, 2D, and 3D GGO ratios were 38%, 62%, and 74%, respectively. The AUC values for 1D, 2D, and 3D solid sizes to predict invasive adenocarcinoma were 0.933, 0.944, and 0.903, respectively. The optimal cut-off values for 1D, 2D, and 3D solid sizes were 1.2 cm, 1.5 cm2, and 0.7 cm3, respectively. The difference in the ROC curves for 3D GGO ratio and 3D solid size was significant (p=0.01).
CONCLUSION
Computed tomography image-related parameters based on GGO were well correlated with and predictive of invasiveness according to IASLC/ATS/ERS classification. 3D GGO ratio was more strongly correlated with pathologic invasiveness than 3D solid size.

Keyword

Adenocarcinoma of lung; neoplasm invasiveness; volumetric computed tomography; receiver operating characteristic

MeSH Terms

Adenocarcinoma/*diagnostic imaging/*pathology
Adult
Aged
Aged, 80 and over
Area Under Curve
Female
Humans
*Imaging, Three-Dimensional
Lung Neoplasms/*diagnostic imaging/*pathology
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Predictive Value of Tests
ROC Curve
Retrospective Studies
*Tomography, X-Ray Computed
Tumor Burden

Figure

• 

  Fig. 1 Representative examples of 3D segmentation and measurement of parameters. 3D segmentation performed using the lung window setting (window width=1465 HU; level=−498 HU). The threshold value for ground glass opacity (GGO) was determined after plotting line histograms on multiplanar axial (A), coronal (B), and sagittal (C) images. Using the threshold values obtained from the line histogram, segmentation was performed by including the entire nodule and adjacent parenchyma within the volume of interest and then extracting the pixel over the threshold values. Of the 3 threshold values, the most suitable one was selected by visual assessment on comparing the nodule on the source image and that on the extracted image. The threshold value for the solid portion was considered either −290 HU or −90 HU based on the comparison of the border between the GGO and the solid portion on the source image with that on the color-coded segmentation image (D). After segmentation, the volume of the total nodule, the volume of the GGO portion, the volume of the solid portion, and the volume percentage of the GGO and solid portion were calculated (E). On the axial plane of the greatest area of the nodule, the longest diameter of the nodule and the maximum perpendicular diameter were measured using electronic calipers on the color-coded image (F). On the axial plane with the greatest area of solid portion, the longest diameter and maximum perpendicular diameter of the solid portion were measured (G). 3D, three-dimensional; HU, Hounsfield unit.

• 

  Fig. 2 Box plots showing the distributions of parameters for noninvasive and invasive adenocarcinoma. (A) One-dimensional (1D) ground glass opacity (GGO) ratio, (B) two-dimensional (2D) GGO ratio, (C) three-dimensional (3D) GGO ratio, (D) 1D solid size, (E) 2D solid size, (F) 3D solid size.

• 

  Fig. 3 Receiver operating characteristic curves for the (A) one-dimensional (1D) ground glass opacity (GGO) ratio, (B) two-dimensional (2D) GGO ratio, (C) three-dimensional (3D) GGO ratio, (D) 1D solid size, (E) 2D solid size, and (F) 3D solid size showing the optimal cut-off values for the parameters. AUC, area under the curve.

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