The Solid Volume Ratio is Better Than the Consolidation Tumor Ratio in Predicting the Malignant Pathological Features of cT1 Lung Adenocarcinoma.

Background:  More effective methods are urgently needed for predicting the pathological grade and lymph node metastasis of cT1-stage lung adenocarcinoma.

Methods:  We analyzed the relationships between CT quantitative parameters (including three-dimensional parameters) and pathological grade and lymph node metastasis in cT1-stage lung adenocarcinoma patients of our center between January 2015 and December 2023.

Results:  A total of 343 patients were included, of which there were 233 males and 110 females, aged 61.8 ± 9.4 (30-82) years. The area under the receiver operating characteristic (ROC) curve for predicting the pathological grade of lung adenocarcinoma using the consolidation-tumor ratio (CTR) and the solid volume ratio (SVR) were 0.761 and 0.777, respectively. The areas under the ROC curves (AUCs) for predicting lymph node metastasis were 0.804 and 0.873, respectively. Multivariate logistic regression analysis suggested that the SVR was an independent predictor of highly malignant lung adenocarcinoma pathology, while the SVR and pathological grade were independent predictors of lymph node metastasis. The sensitivity of predicting the pathological grading of lung adenocarcinoma based on SVR >5% was 97.2%, with a negative predictive value of 96%. The sensitivity of predicting lymph node metastasis based on SVR >47.1% was 97.3%, and the negative predictive value was 99.5%.

Conclusion:  The SVR has greater diagnostic value than the CTR in the preoperative prediction of pathologic grade and lymph node metastasis in stage cT1-stage lung adenocarcinoma patients, and the SVR may replace the diameter and CTR as better criteria for guiding surgical implementation.