Can peritumoral regions increase the efficiency of machine-learning prediction of pathological invasiveness in lung adenocarcinoma manifesting as ground-glass nodules?
Xiang WangKaili ChenWei WangQingchu LiKai LiuQianyun LiXing CuiWenting TuHongbiao SunShaochun XuRongguo ZhangYi XiaoLi FanShiyuan Liu
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Abstract:
The peri-tumor microenvironment plays an important role in the occurrence, growth and metastasis of cancer. The aim of this study is to explore the value and application of a CT image-based deep learning model of tumors and peri-tumors in predicting the invasiveness of ground-glass nodules (GGNs).Keywords:
Pulmonary adenocarcinoma
To investigate the correlation between epidermal growth factor receptor (EGFR) mutation and the histologic subtypes features or computed tomography (CT) findings in patients with resected pulmonary adenocarcinoma.We retrospectively reviewed 153 patients underwent surgical resected pulmonary adenocarcinoma. EGFR mutations were detected using the amplification refractory mutation system. Histologic subtype was classified according to the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society pulmonary adenocarcinoma classification. Characteristics of CT in the tumor were retrospectively analyzed, and compared to mutation-negative cohort.EGFR mutations were found in 67 (43.79%) cases. The prevalent histologic subtypes of invasive adenocarcinoma were acinar predominant adenocarcinoma (33.99%), papillary predominant adenocarcinoma (24.18%), micropapillary predominant adenocarcinoma (MPA; 18.95%), solid predominant adenocarcinoma (11.76%), and lepidic predominant adenocarcinoma (LPA; 11.11%). EGFR mutations were correlated with the MPA and LPA subtypes (P = 0.009 and P = 0.018) and was correlated with the air bronchograms (P = 0.008). EGFR mutations were independently associated with other CT characteristics including ground-glass opacity/tumor ratio (P = 0.054).Correlation exists between EGFR mutations and histologic subtypes of invasive adenocarcinoma or air bronchograms on CT images, which could use to predict EGFR mutation status in patients with pulmonary adenocarcinoma.
Pulmonary adenocarcinoma
Ground-glass opacity
Papillary adenocarcinoma
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The gross and microscopic appearances of 106 resected pulmonary adenocarcinomas were reviewed and correlated with postoperative survival. Instead of using an established classification based on histological pattern, the tumours were categorised by cellular morphology and site as either parenchymal adenocarcinoma (67%), bronchial adenocarcinoma (13%), or adenocarcinoma of uncertain origin (20%). Despite their pleomorphic appearance parenchymal adenocarcinomas should be regarded as a single entity, derived from multipotential cells of the distal airway; bronchial adenocarcinomas were generally, but not invariably, associated with short postoperative survival; those tumours that could not be reclassified on histological grounds were large adenocarcinomas consisting mainly of mucus cells. Tumours of this type carry a poor prognosis.
Pulmonary adenocarcinoma
Parenchyma
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Objective To establish a model of pulmonary adenocarcinoma in mice,and to supply an experiment platform for screen of important miRNAs in the process of pulmonary adenocarcinoma. Methods The pulmonary adenocarcinoma model was established by intranasal administration of adenovirus Cre to Lox-stop-lox K-ras G12D mice.The lung tissues of model mice were digested with dispase and collagenase Ⅳ in combination,and then the expression of Sca-1 and CD34 was detected by the dual-color immunofluorescence. Results The model of pulmonary adenocarcinoma was established successfully,and Sca-1 and CD34 were expressed in the lung of model mice. Conclusion The model of pulmonary adenocarcinoma can be established successfully for further study on screen of important miRNAs in the process of pulmonary adenocarcinoma.
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To explore the histological subtypes of solitary pulmonary nodules (SPNs) of invasive adenocarcinoma and their clinical relevance.A total of 188 patients with pathologically confirmed invasive adenocarcinoma in our hospital from January 2007 to December 2011 were enrolled in this study. In accordance with the new classification of lung adenocarcinoma, all the histological sections were reviewed and classified, and the clinical data were collected and analyzed.Of these 188 patients who had been initially diagnosed as SPNs of adenocarcinoma, there were 6 cases of lepidic predominant adenocarcinoma (LPA), 71 cases of acinar predominant adenocarcinoma (APA), 74 cases of papillary predominant adenocarcinoma (PPA), 15 cases of micorpapillary predominant adenocarcinoma (MPA), and 22 cases of solid predominant adenocarcinoma (SPA) with mucin production. The incidence of lymph node metastasis was 80.0% and 81.8% in MPA and SPA, respectively, which was significantly higher than those in LPA, APA, and PPA (all P<0.01). The incidence of LPA was 83.3% (5/6) in women, which was significantly higher than that in men (P=0.037).According to the new classification, MPA and SPA have high incidence of lymph node metastasis. LPA is more likely to occur in women. Sub-typing of the lung adenocarcinoma based on the newest international classification criteria is helpful to identify the clinical features of this disease.
Pulmonary adenocarcinoma
Clinical Significance
Solitary pulmonary nodule
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Objective To analyze the pathological and clinical features of cervical adenocarcinoma to improve people's awareness and avoid misdiagnosis of the disease. Methods We collected 22 cases from 2001 to 2010,and analyzed the clinical data of them.All the biopsy specimens and pathological sections were reviewed. Results The age of cervical adenocarcinoma patients tends to be younger.Cervical neoplasm or mass of different sizes are found in most patients.Assist examination was not able to diagnose completely.Cervical mucinous adenocarcinoma was the most frequently seen pathological type. Conclusions The prognosis of cervical adenocarcinoma is poor.Due to the pathological position,morphological features and limitations of existing inspection tools,it is hard to early detect cervical adenocarcinoma.Doctors and patients need to work together to achieve early detection and treatment.
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Pulmonary adenocarcinoma is a common disease,but it is rare for bilateral suffered and seldom seen combining with primary gastric adenocarcinoma.Especially for those patients who had a history of adenocarcinoma of lung,clinicians are often misled by the symptoms to regard the lesion of the stomach as a metastasis.The patient was preoperative diagnosed with gastric adenocarcinoma,and confirmed as primary adenocarcinoma by pathological immunohistochemistry after operation.A case report is presented.
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A limited number of pulmonary adenocarcinoma cases with morule-like components have been described to date, and the most frequent histological subtype is papillary-predominant adenocarcinoma. Occasionally, this type of adenocarcinoma is associated with solid-predominant adenocarcinoma. EGFR mutations are predominant in adenocarcinoma with morule-like components, followed by ALK rearrangements. Herein, we present 2 cases of solid-predominant adenocarcinoma with morule-like components harboring either an EGFR or KRAS mutation. This KRAS-mutant case is the first to be associated with morule-like components, to the best of our knowledge. Both cases showed transition between micropapillary and morule-like components. Transition between morule-like and solid components was also observed in both cases. Although a few cases of solid-predominant adenocarcinoma have been shown to harbor morule-like components, this type of transition has not been previously well described. We surmised that the solid components of some EGFR-mutant adenocarcinomas might be derived from morule-like components.
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In order to characterize the relationship between background anthracosis and pulmonary adenocarcinogenesis, surgically resected tissues of 66 cases of stage I pulmonary adenocarcinoma, 4 cm or less at their greatest dimension, were examined. These cases were diagnosed based on the classification of small‐sized adenocarcinoma of the lung (Noguchi et al., Cancer 75, 1995). Thirteen cases were diagnosed as types A (localized bronchioloalveolar adenocarcinoma, LBAC) and B (LBAC with alveolar collapse), 40 cases as type C (LBAC with a focus of fibroblastic proliferation), 8 as type D (poorly differentiated adenocarcinoma) and 5 as types E (bronchial gland type adenocarcinoma) and F (true papillary adenocarcinoma). The 5‐year survival rate of types A and B cases was 100%, while those of type C, type D and types E and F were 52%, 48% and 39%, respectively. Nuclear accumulation of abnormal p53 protein in non‐replacement type adenocarcinomas (types D, E and F) was detected more frequently than that in replacement type adenocarcinomas (types A, B and C) ( P <0.05). In each case, black dusty material was extracted from tumorous lesions and non‐tumorous regions and blotted onto a nitrocellulose membrane. The anthracotic index (AI) was calculated with a densitometer. AIs of non‐tumorous regions in early and replacement type adenocarcinomas (types A and B) were significantly less than in relatively advanced (type C) and poorly differentiated (type D) adenocarcinomas ( P <0.05). These results indicated that adenocarcinoma developing in heavily anthracotic lungs readily progresses to an advanced stage, or that adenocarcinoma with a less favorable prognosis tends to develop in severely anthracotic lungs.
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In the developing process of pulmonary adenocarcinoma in mice induced by N-methyl-N'-nitro-N-nitrosoguanidine, the observations of histological pathology, ultrastructure and the changes of enzyme activity of the lesions related to pulmonary adenocarcinoma were made by light microscopy, transmission electron microscopy and enzyme histochemistry, by sacrificing animals at intervals. The results indicated that there was a series of precancerous lesions before the initiation of adenocarcinoma; that adenoma was a kind of precancerous lesion which might develop into adenocarcinoma; and that adenoma with malignant change might be a focus of early adenocarcinoma. Based on the results of histological pathology, ultrastructure and enzyme histochemistry, a process of the morphological genesis of pulmonary adenocarcinoma in mice was proposed, and the metabolic changes related to various lesions were discussed.
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Pulmonary adenocarcinoma is largely peripheral in location but often does occur centrally. In the course of this study, clinicopathologic features of pulmonary adenocarcinoma, including the prognosis of early-stage disease, were assessed and compared by tumor location.A retrospective chart review was conducted, examining 308 patients treated for pulmonary adenocarcinoma by curative resection. Clinicopathologic findings were analyzed, comparing central and peripheral primary locations. Recurrence-free survival (RFS) rates were determined for tumor subsets (central vs. peripheral).At all disease stages (N=308), 41 patients (13.3%) with central adenocarcinoma were documented. In central (vs. peripheral) adenocarcinoma, mean tumor size was larger (3.1 vs. 2.3 cm, P=0.014), nodal metastasis was more frequent (P=0.012), and the likelihood of advanced disease (stages II and III) was greater (P=0.007). Microscopically, central adenocarcinoma displayed more acinar (53.3% vs. 38.9%; P=0.006) and less lepidic (20.9% vs. 37.5%; P=0.001) growth. At stage I disease [N=329; central, 25 (10.5%)], group similarities were sustained. As with disease overall, central adenocarcinoma contained more acinar (51.8% vs. 37.1%; P=0.025) and fewer lepidic (26.2% vs. 44.1%; P=0.006) areas. Three-year RFS rates for central and peripheral adenocarcinoma at all disease stages were 63.2% and 82.5% (P=0.024), respectively, compared with 70.4% and 91.0% (P=0.023), respectively at stage I. Lepidic growth was identified as a statistically significant risk factor for early recurrence by multivariate analysis.Central pulmonary adenocarcinoma is generally detected at an advanced stage. In early (stage I) disease, the prognosis is comparatively worse for central adenocarcinoma, owing to significant micromorphologic differences in central and peripheral tumors.
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Histopathology
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