Factors that discriminate invasive adenocarcinoma from minimally invasive adenocarcinoma and adenocarcinoma in situ in patients with pure ground-glass pulmonary nodules

Purpose The aim of the present study was to investigate predictors of pathological invasiveness and prognosis of lung adenocarcinoma in patients with pure ground-glass nodules (pGGNs). Methods Clinical and computed tomography (CT) features of invasive adenocarcinomas (IACs) and pre-IACs were retrospectively compared in 641 consecutive patients with pGGNs and confirmed lung adenocarcinomas who had been followed up by CT postoperatively, and potential predictors of prognosis were investigated. Results Of 659 pGGNs in 641 patients, 258 (39.1%) were adenocarcinomas in situ, 265 (40.2%) were minimally invasive adenocarcinomas, and 136 (20.6%) were IACs. Respective optimal cutoffs for age, serum carcinoembryonic antigen, maximal diameter, mean diameter, and CT density for distinguishing preIACs from IACs were 53 years, 2.19 ng/mL, 10.78 mm, 10.09 mm, and − 582.28 Hounsfield units (HU). In univariable analysis sex, age, maximal diameter, mean diameter, CT density, and spiculation were significant predictors of lung IAC. In multivariable analysis age, maximal diameter, and CT density were significant predictors of lung IAC. During a median follow-up of 41 months no pGGN IACs recurred. Conclusions pGGNs may be lung IACs, especially in patients aged > 55 years with lesions that are > 1 cm in diameter and exhibit CT density > − 600 HU. pGGN IACs of < 3 cm in diameter have good post-resection prognoses. These data may assist the selection of surgical procedures in patients with pGGNs at high risk of malignancy.