Quantification of Intratumoral Heterogeneity: Distinguishing Histological Subtypes in Clinical T1 Stage Lung Adenocarcinoma Presenting as Pure Ground-Glass Nodules on Computed Tomography

Jian Zhang; Jinlu Sha; Wen Liu; Yinjun Zhou; Haibo Liu; Zhichao Zuo

doi:10.1016/j.acra.2024.04.008

Quantification of Intratumoral Heterogeneity: Distinguishing Histological Subtypes in Clinical T1 Stage Lung Adenocarcinoma Presenting as Pure Ground-Glass Nodules on Computed Tomography

Acad Radiol. 2024 Apr 15:S1076-6332(24)00215-0. doi: 10.1016/j.acra.2024.04.008. Online ahead of print.

Authors

Jian Zhang¹, Jinlu Sha¹, Wen Liu², Yinjun Zhou³, Haibo Liu³, Zhichao Zuo⁴

Affiliations

¹ Department of Radiology, Wuhan Pulmonary Hospital, Wuhan 430000, Hubei, PR China.
² Department of Radiology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan, China.
³ Department of Radiology, Xiangtan Central Hospital, Xiangtan 411100, Hunan, PR China.
⁴ School of Mathematics and Computational Science, Xiangtan University, Xiangtan 411105, Hunan, China. Electronic address: zuo_z@smail.xtu.edu.cn.

PMID: 38627129
DOI: 10.1016/j.acra.2024.04.008

Abstract

Rationale and objectives: To quantify intratumor heterogeneity (ITH) in clinical T1 stage lung adenocarcinoma presenting as pure ground-glass nodules (pGGN) on computed tomography, assessing its value in distinguishing histological subtypes.

Materials and methods: An ITH score was developed for quantitative measurement by integrating local radiomics features and global pixel distribution patterns. Diagnostic efficacy in distinguishing histological subtypes was evaluated using receiver operating characteristic curve analysis and area under the curve (AUC) values. The ITH score's performance was compared to those of conventional radiomics (C-radiomics), and radiological assessments conducted by experienced radiologists.

Results: The ITH score demonstrated excellent performance in distinguishing lepidic-predominant adenocarcinoma (LPA) from other histological subtypes of clinical T1 stage lung adenocarcinoma presenting as pGGN. It outperformed both C-radiomics and radiological findings, exhibiting higher AUCs of 0.784 (95% confidence interval [CI]: 0.742-0.826) and 0.801 (95% CI: 0.739-0.863) in the training and validation cohorts, respectively. The AUCs of C-radiomics were 0.764 (95% CI: 0.718-0.810, DeLong test, p = 0.025) and 0.760 (95% CI: 0.692-0.829, p = 0.023) and those of radiological findings were 0.722 (95% CI: 0.673-0.771, p = 0.003) and 0.754 (95% CI: 0.684-0.823, p = 0.016) in the training and validation cohorts, respectively. Subgroup analysis revealed varying diagnostic efficacy across clinical T1 stages, with the highest efficacy in the T1a stage, followed by the T1b stage, and lowest in the T1c stage.

Conclusion: The ITH score presents a superior method for evaluating histological subtypes and distinguishing LPA from other subtypes in clinical T1 stage lung adenocarcinoma presenting as pGGN.

Keywords: Ground-glass nodules; Histological subtypes; Intratumor heterogeneity.