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Pulmonary nodular ground-glass opacities in patients with extrapulmonary cancers: What is their clinical significance and how can we determine whether they are malignant or benign lesions?

¹Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea ²Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-Do, Korea ³Seoul National University Hospital, Healthcare Gangnam Center, Seoul, Korea ⁴Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea ⁵Department of Biomedical Engineering, Division of Basic & Applied Sciences, National Cancer Center, Gyeonggi-Do, Korea

jmgoo{at}plaza.snu.ac.kr

Abstract

Background: The clinical significance of pulmonary nodular ground-glass opacities (NGGOs) in patients with extrapulmonary cancers is not known, although there is an urgent need for study on this topic. The purpose of this study, therefore, was to investigate the clinical significance of pulmonary NGGOs in these patients, and to develop a computerized scheme to distinguish malignant from benign NGGOs.

Methods: Fifty-nine pathologically-proven pulmonary NGGOs in 34 patients with a history of extrapulmonary cancer were studied. We reviewed the CT characteristics of NGGOs and the clinical features of these patients. Artificial neural networks (ANNs) were constructed and tested as a classifier distinguishing malignant from benign NGGOs. The performance of ANNs was evaluated with receiver-operating characteristic analysis.

Results: On patient basis, 28 patients (82.4%) were determined to have malignancies. On nodule basis, 40 NGGOs (67.8%) were diagnosed as malignancies: 24 adenocarcinomas, and 16 bronchioloalveolar carcinomas. The rest were 14 atypical adenomatous hyperplasias, 4 focal fibrosis, and one inflammatory nodule. There were no cases of metastasis appearing as NGGOs. Between malignant and benign NGGOs, there were significant differences in lesion size, presence of internal solid portion, size and proportion of internal solid portion, lesion margin, and presence of bubble-lucency, air-bronchogram, or pleural retraction (P<0.05). Using these characteristics, ANNs showed excellent accuracy (Az value, 0.973) in discriminating malignant from benign NGGOs.

Conclusions: Pulmonary NGGOs in patients with extrapulmonary cancers tend to have high malignancy rates, and are very often primary lung cancers. ANNs might be a useful tool in distinguishing malignant from benign NGGOs.