Radiological Predictors of Visceral Pleural Invasion in Lung Cancers With Ground-Glass Opacity and Pleural Contact

Visceral pleural invasion (VPI) remains a critical factor influencing surgical decision-making in non-small cell lung cancer (NSCLC). However, accurately predicting VPI on radiological images remains challenging in lung cancers.

This retrospective study analyzed 299 cases of NSCLC with pleural contact and ground-glass opacity (GGO) components on thin-section CT, all of which were surgically treated between 2012 and 2019. Clinical and radiological features were evaluated for their predictive value in detecting VPI.

VPI was confirmed in 14 cases (4.7%). Univariate analysis revealed significant associations between VPI and part-solid tumors (P = .025), larger tumor diameter (P = .006), greater solid component size (P < .001), higher consolidation-to-tumor ratio (CTR) (P = .001), increased pleural contact length (P < .001), elevated CT attenuation values (P < .001), and SUVmax on FDG-PET (P < .001). No cases of pathological VPI were observed in lesions where only the GGO component was in contact with the pleura.

Specific radiological features, particularly solid component-pleura contact length, may serve as practical predictors of VPI in ground-glass nodules with pleural contact. Notably, VPI was absent in tumors where only the GGO component contacted the pleura. These findings underscore the importance of careful preoperative evaluation for non-VPI, incorporating additional imaging parameters to enhance risk stratification and surgical decision-making.