Differentiation Between Heterogeneous GGN and Part-Solid Nodule Using 2 D Grayscale Histogram Analysis of Thin-Section CT Image

Heterogeneous ground-glass nodules (HGGNs) may have a less malignant potential than part-solid nodules (PSNs). We found some histogram parameters were useful for differentiating between the HGGNs and PSNs, respectively. These results provide useful information about treatment and follow-up of lung cancer for clinicians. Introduction/Background: To evaluate cases of surgically resected pulmonary adenocarcinoma (Ad) with heterogenous ground-glass nodules (HGGNs) or part-solid nodules (PSNs) and to clarify the differences between them, and between invasive adenocarcinoma (IVA) and minimally invasive adenocarcinoma (MIA) + adenocarcinoma in situ (AIS) using grayscale histogram analysis of thin-section computed tomography (TSCT). Materials and Methods: 241 patients with pulmonary Ad were retrospectively classified into HGGNs and PSNs on TSCT by three thoracic radiologists. Sixty HGGNs were classified into 17 IVAs, 26 MIAs, and 17 AISs. 181 PSNs were classified into 114 IVAs, 55 MIAs, and 12 AISs. Results: We found significant differences in area (P = 0.0024), relative size of solid component (P < 0.0001), circumference (P < 0.0001), mean CT value (P < 0.0001), standard deviation of the CT value (P < 0.0001), maximum CT value (P < 0.0001), skewness (P < 0.0001), kurtosis (P < 0.0001), and entropy (P < 0.0001) between HGGNs and PSNs. In HGGNs, we found significant differences in relative size of solid component (P < 0.0001), mean CT value (P = 0.0005), standard deviation of CT value (P = 0.0071), maximum CT value (P = 0.0237), and skewness (P = 0.0027) between IVAs and MIA+ AIS lesions. In PSNs, we found significant differences in area (P = 0.0029), relative size of solid component (P = 0.0003), circumference (P = 0.0004), mean CT value (P = 0.0011), skewness (P = 0.0009), and entropy (P = 0.0002) between IVAs and the MIA+ AIS lesions. Conclusion: Quantitative evaluations using grayscale histogram analysis can clearly distinguish between HGGNs and PSNs, and may be useful for estimating the pathology of such lesions.