Computerized Texture Analysis of Persistent Part-Solid Ground-Glass Nodules: Differentiation of Preinvasive Lesions from Invasive Pulmonary Adenocarcinomas

TLDR

To retrospectively evaluate whether computerized three‑dimensional texture analysis can differentiate preinvasive lesions from invasive pulmonary adenocarcinomas in part‑solid ground‑glass nodules. The study analyzed 86 retrospectively collected part‑solid GGNs, manually segmented on CT, extracted texture features with in‑house software, and employed multivariate logistic regression and a three‑layer artificial neural network to build a discriminating model. The ANN model achieved an AUC of 0.981, with smaller mass (adjusted OR 0.092) and higher kurtosis (adjusted OR 3.319) emerging as the strongest predictors distinguishing preinvasive lesions from IPAs. The study received IRB approval with a waiver of informed consent, and supplemental material is available online.

Abstract

To retrospectively investigate the value of computerized three-dimensional texture analysis for differentiation of preinvasive lesions from invasive pulmonary adenocarcinomas (IPAs) that manifest as part-solid ground-glass nodules (GGNs).The institutional review board approved this retrospective study with a waiver of patients' informed consent. The study consisted of 86 patients with 86 pathologic analysis-confirmed part-solid GGNs (mean size, 16 mm ± 5.4 [standard deviation]) who had undergone computed tomographic (CT) imaging between January 2005 and October 2011. Each part-solid GGN was manually segmented and its computerized texture features were quantitatively extracted by using an in-house software program. Multivariate logistic regression analysis was performed to investigate the differentiating factors of preinvasive lesions from IPAs. Three-layered artificial neural networks (ANNs) with a back-propagation algorithm and receiver operating characteristic curve analysis were used to build a discriminating model with texture features and to evaluate its discriminating performance.Pathologic analysis confirmed 58 IPAs (seven minimally invasive adenocarcinomas and 51 invasive adenocarcinomas) and 28 preinvasive lesions (four atypical adenomatous hyperplasias and 24 adenocarcinomas in situ). IPAs and preinvasive lesions exhibited significant differences in various histograms and volumetric parameters (P < .05). Multivariate analysis revealed that smaller mass (adjusted odds ratio, 0.092) and higher kurtosis (adjusted odds ratio, 3.319) are significant differentiators of preinvasive lesions from IPAs (P < .05). With mean attenuation, standard deviation of attenuation, mass, kurtosis, and entropy, the ANNs model showed excellent accuracy in differentiation of preinvasive lesions from IPAs (area under the curve, 0.981).In part-solid GGNs, higher kurtosis and smaller mass are significant differentiators of preinvasive lesions from IPAs, and preinvasive lesions can be accurately differentiated from IPAs by using computerized texture analysis. Online supplemental material is available for this article.