Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 9792-9803
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9792
High-resolution computed tomography findings independently predict epidermal growth factor receptor mutation status in ground-glass nodular lung adenocarcinoma
Ping Zhu, Xiao-Jun Xu, Min-Ming Zhang, Shu-Feng Fan
Ping Zhu, Xiao-Jun Xu, Min-Ming Zhang, Shu-Feng Fan, Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
Author contributions: Zhu P contributed to literature research, clinical studies, statistical analysis, manuscript preparation and editing; Xu XJ contributed to experimental studies/data analysis; Zhang MM was the guarantor of integrity of the entire study; Fan SF contributed to study concepts and design; all authors have read and approved the final manuscript.
Supported by the Zhejiang Province Traditional Chinese Medicine Science and Technology Plan - Zhejiang Province Traditional Chinese Medicine Project for Traditional Chinese Medicine Scientific Research (2020) (Class B), No. 2020ZB117.
Institutional review board statement: This study was approved by the Ethics Committee of the Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Province, China.
Informed consent statement: The individual consent was waived by the committee owing to the retrospective study design.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: The data set supporting the results of this article are included within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Feng Fan, PhD, Doctor, Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, Zhejiang Province, China. shufengfan16@126.com
Received: June 4, 2021
Peer-review started: June 4, 2021
First decision: June 25, 2021
Revised: July 30, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 16, 2021
Abstract
BACKGROUND

For lung adenocarcinoma with epidermal growth factor receptor (EGFR) gene mutation, small molecule tyrosine kinase inhibitors are more effective. Some patients could not obtain enough histological specimens for EGFR gene mutation detection. Specific imaging features can predict EGFR mutation status to a certain extent.

AIM

To assess the associations of EGFR mutations with high-resolution computerized tomography (HRCT) features in ground-glass nodular lung adenocarcinoma.

METHODS

This study retrospectively assessed patients with ground-glass nodular lung adenocarcinoma diagnosed between January 2011 and March 2017. EGFR gene mutations in exons 18-21 were detected. The patients were classified into mutant EGFR and wild-type groups, and general data and HRCT image characteristics were assessed.

RESULTS

Among 98 patients, 31 (31.6%) and 67 (68.4%) had mutated and wild-type EGFR in exons 18-21, respectively. Gender, age, smoking history, location of lesions, morphology, edges, borders, pleural indentations, and associations of nodules with bronchus and blood vessels were comparable in both groups (all P > 0.05). Patients with mutant EGFR had larger nodules than those with the wild-type (17.19 ± 6.79 and 14.37 ± 6.30 mm, respectively; P = 0.047). Meanwhile, the vacuole/honeycomb sign was more frequent in the mutant EGFR group (P = 0.011). The logistic regression prediction model included the combination of nodule size and vacuole/honeycomb sign (OR = 1.120, 95%CI: 1.023-1.227, P = 0.014) revealed a sensitivity of 83.9%, a specificity of 52.2% and an AUC of 0.698 (95%CI: 0.589-0.806; P = 0.002).

CONCLUSION

Nodule size and vacuole/honeycomb features could independently predict EGFR mutation status in ground-glass nodular lung adenocarcinoma.

Keywords: Lung adenocarcinoma, Tomography, Epidermal growth factor receptor, Logistic model, Receiver operating characteristic analysis

Core Tip: For patients who have been clinically diagnosed with lung adenocarcinoma but failed to undergo epidermal growth factor receptor (EGFR) gene testing: When the lesion is shown as a pure ground glass nodule, and the size of the nodule is ≥ 8.65 mm, it can be used as an independent indicator to predict EGFR gene mutation. The appearance of the vesicle sign or honeycomb sign may indicate a mutation in the EGFR gene.