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Diameter thresholds for pure ground-glass pulmonary nodules at low-dose CT screening: Chinese experience
Thorax ( IF 9.0 ) Pub Date : 2024-12-16 , DOI: 10.1136/thorax-2024-221642 Wenjun Ye, Wenhai Fu, Caichen Li, Jianfu Li, Shan Xiong, Bo Cheng, Bin Xu, Qixia Wang, Yi Feng, Peiling Chen, Jianxing He, Wenhua Liang
Thorax ( IF 9.0 ) Pub Date : 2024-12-16 , DOI: 10.1136/thorax-2024-221642 Wenjun Ye, Wenhai Fu, Caichen Li, Jianfu Li, Shan Xiong, Bo Cheng, Bin Xu, Qixia Wang, Yi Feng, Peiling Chen, Jianxing He, Wenhua Liang
Background Limited research exists on screening thresholds for low-dose CT in detecting malignant pure ground-glass lung nodules (pGGNs) in the Chinese population. Materials and methods A retrospective analysis of the Guangzhou Lung-Care programme was conducted, retrieving average transverse diameter, location, histopathology, frequency and follow-up intervals. Diagnostic performances for ‘lung cancers’ were evaluated using areas under the curve (AUCs), decision curve analysis (DCA), sensitivities and specificities, with thresholds ranging from 5 mm to 10 mm. We divide malignant pGGNs into three groups: (1) minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IA), (2) atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS) and MIA and IA and (3) IA-only. Results In ‘MIA+IA’, increasing the threshold from 5 mm to 8 mm improved specificity (60.97% to 88.85%, p<0.001) and positive predictive values (PPVs; 5.87% to 14.88%, p<0.001), but decreased sensitivity (94.44% to 75.56%, p<0.001). Further raising threshold from 8 mm reduced sensitivity (75.56% to 60.00%, p<0.001), while slightly increasing specificity (88.85% to 93.47%, p<0.001) and PPVs (14.88% to 19.15%, p<0.001). Increasing threshold from 5 mm to 7 mm enhanced the AUC for ‘MIA+IA’ (from 0.711 to 0.829), ‘AAH+AIS+MIA+IA’ (from 0.748 to 0.804) and ‘IA-only’ (from 0.783 to 0.833). At 8 mm, the AUCs for these categories were similar. However, increasing the threshold from 7 mm to 10 mm resulted in reduced AUCs for ‘MIA+IA’ (0.829 to 0.767), ‘AAH+AIS+MIA+IA’ (0.804 to 0.744) and ‘IA-only’ (0.833 to 0.800). DCA reveals that the 8 mm predictive model demonstrates greater clinical utility compared with models with other thresholds. Conclusions Increasing the diameter threshold for positive results for pGGNs, up to 8 mm could enhance diagnostic performance. Trial registration number [NCT04938804][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04938804&atom=%2Fthoraxjnl%2Fearly%2F2024%2F12%2F16%2Fthorax-2024-221642.atom
更新日期：2024-12-17
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