University of Oulu

Volmonen, K., Sederholm, A., Rönty, M., Paajanen, J., Knuuttila, A., & Jartti, A. (2023). Association of CT findings with invasive subtypes and the new grading system of lung adenocarcinoma. In Clinical Radiology (Vol. 78, Issue 3, pp. e251–e259). Elsevier BV.

Association of CT findings with invasive subtypes and the new grading system of lung adenocarcinoma

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Author: Volmonen, K.1; Sederholm, A.1; Rönty, M.2;
Organizations: 1Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS Helsinki, Finland
2Pathology Department, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, 00029 HUS, Helsinki, Finland
3Cancer Center and Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4,00029 HUS Helsinki, Finland
4Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Elsevier, 2023
Publish Date: 2023-09-04


Aim: To predict the differentiation between invasive growth patterns and new grades of lung adenocarcinoma (LAC) using computed tomography (CT).

Materials and methods: The CT features of 180 surgically treated LAC patients were compared retrospectively to pathological invasive subtypes and tumour grades as defined by the new grading system published in 2021 by the World Health Organization. Two radiologists reviewed the images semi-quantitatively and independently. Univariable and multivariable regression models were built from the statistical means of their assessments to predict invasive subtypes and grades. The area under the curve (AUC) calculation was used to select the best models. The Youden index was applied to determine the cut-off values for radiological parameters.

Results: The acinar/papillary patterns were associated with ill-defined margins, lower consolidation/tumour ratio and air bronchogram. The solid growth pattern was associated with a well-defined margin and hypodensity, and the micropapillary (MP) subtype with spiculation. From Grades 1 to 3, the amount of air bronchogram decreased and the consolidation/tumour ratio increased. In the sub-analyses, the best model for differentiating Grade 2 from Grade 1 had the following CT features: solid/subsolid type, consolidation/tumour ratio, well-defined margin, and air bronchogram (AUC = 0.783) and Grade 3 from Grade 2: size of the consolidation part/whole tumour ratio, size of the consolidation part, and well-defined margin (AUC = 0.759). The interobserver agreements between the two radiologists varied between 0.67 and 0.98.

Conclusions: Air bronchogram, consolidation/tumour ratio, and well-defined margin are among the best imaging findings to discriminate between both invasive subtypes and the new grades in LAC.

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Series: Clinical radiology
ISSN: 0009-9260
ISSN-E: 1365-229X
ISSN-L: 0009-9260
Volume: 78
Issue: 3
Pages: e251 - e259
DOI: 10.1016/j.crad.2022.11.011
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This study was supported by the Helsinki University Hospital Research Fund. Open access funding provided by University of Helsinki including Helsinki University Central Hospital. Kirsi Volmonen received a grant from the Finnish Society of Chest Radiologists which is a subsociety of Radiological Society of Finland.
Dataset Reference: Supplementary data to this article can be found online at
Copyright information: © 2023 The Authors. Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY license (