The Value of CT Signs Combined with Serum Exosomal CDH5 in Identifying 5～30 mm Diameter Ground-glass Lung Adenocarcinoma Infiltration
Objective:To investigate the value of CT signs combined with serum exosomal cadherin 5(CDH5)in identifying 5～30 mm diameter ground-glass lung adenocarcinoma infiltration.Methods:104 patients with lung adenocarcinomas(glandular precursor le-sions and adenocarcinoma)showing ground glass on CT and 20 patients with benign lung nodules were selected as study subjects.Exo-somal CDH5 levels were detected by western blotting.Exosomal CDH5 levels were compared between patients with lung adenocarcino-mas and benign lung nodules.CT signs and differences in exosomal CDH5 levels were compared between patients with non-infiltrating and infiltrating lung adenocarcinomas.Risk factors for lung adenocarcinoma infiltration were analyzed by logistic regression.The risk models values were analyzed by receiver operating characteristic(ROC)curves,mean absolute error,and decision curve analysis(DCA).Results:Serum exosomal CDH5 levels were lower in patients with lung adenocarcinoma than in patients with benign lung nodules(P＜0.05).There were 67 cases of non-infiltrative lesions and 37 cases of infiltrative lesions in lung adenocarcinomas.The percentage of mixed ground-glass nodules,burr signs,vascular cluster signs,and the unclear tumor-pulmonary interface were higher in patients with infiltra-tive lesions than in patients with non-infiltrative lesions,and the level of exosomal CDH5 was lower than that in patients with non-infil-trative lesions(P＜0.05).Logistic regression analysis showed that mixed ground-glass nodules,burr signs,and the unclear tumor-pul-monary interface were all risk factors for lung adenocarcinoma without infiltration,and exosomal CDH5 ≥ 0.31 was a protective factor for lung adenocarcinoma without infiltration(P＜0.05).The area under the ROC curve for identifying lung adenocarcinoma infiltration was higher in model B(consisting of nodule type,burr sign,tumor-pulmonary interface,and exosomal CDH5)than in model A(consist-ing of nodule type,burr sign,and tumor-pulmonary interface,P＜0.05).The mean absolute error value of model B was lower than that of model A.The net benefit of model A was higher than that of model B for risk thresholds ranging from 0 to 0.08,and that of model B was higher than that of model A for risk thresholds ranging from 0.08 to 1.00.Conclusion:Mixed ground-glass nodules,burr signs,the un-clear tumor-pulmonary interface,and exosomal CDH5 were all associated with lung adenocarcinoma infiltration.The model consisting of these factors can assist in assessing whether 5～30 mm ground-glass lung adenocarcinoma is infiltrating.
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