CT Imaging in Differentiating Non-Solid Lung Adenocarcinoma with cycstic airspaces: A Clinical and Diagnostic Study

Abstract Objective To study the correlation between clinical data, CT image characteristics, and histopathology of patients with three types of nodular lung adenocarcinoma. Methods In total, 2146 patients with pathologically confirmed nodular lung adenocarcinoma in 3 hospitals in Anhui and Zhejiang were retrospectively analyzed from July 2017 to June 2023. The patients were divided into three groups according to their status of lung adenocarcinoma associated with cystic airspaces (LACA): the LACA0 group (no cystic airspaces, 1821 patients), the LACA1 group (cystic airspace diameter of < 5 mm, 208 patients), and the LACA2 group (cystic airspace diameter of ≥ 5 mm, 117 patients). The relationships between the patients’ clinical data (e.g., sex, age, and smoking status), CT image characteristics (e.g., location, lobulation, and long-axis diameter), and postoperative histopathology were evaluated by univariate and multivariate analyses. Results In the LACA2 group, 66(56.4%) patients were male, 57(48.7%) patients’ lesions occurred in the lower lobe, 45(38.5%) patients’ lesions were associated with pulmonary (e.g., emphysema/bullae, ventilation–perfusion imbalance)disease, 99(84.6%) patients had lobulation signs, and 50(42.8%) patients had postoperative histopathology findings of papillary, solid, or micropapillary adenocarcinoma. Multivariate logistic regression showed that sex, lobulation, long-axis diameter, location, and pulmonary disease were independent risk factors for LACA2. Conclusion Follow-up time should be shortened for smoking male patients with lung disease who have lung nodules containing large cystic cavities (cystic airspaces ≥ 5 mm in diameter). Once the lesion shows signs of malignancy, such as lobulation, it is recommended that follow-up be discontinued, and elective surgery be performed.