To analyze the association between CT features and histopathology of lung adenocarcinoma presenting as pure ground-glass nodules under high-resolution CT examination conditions.

A retrospective analysis was conducted on the CT manifestations of lung adenocarcinoma with pure ground-glass nodules confirmed by pathology in our hospital from October 2021 to December 2024. The main objective factors to be observed are the size and density of ground-glass nodules, as well as the CT manifestations such as vacuole sign, bronchial changes, vascular changes, presence or absence of spicules, lobulation and nodule - lung interface. Compare the differences in CT features among different histopathological subtypes: pre-invasive group [including atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)] and invasive group [including minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma cancer (IAC)].

This study enrolled a total of 419 patients with pulmonary nodules. The pathological subtypes included 21 cases (5.0%) of AAH, 133 cases (31.7%) of AIS, 123 cases (29.4%) of MIA, and 142 cases (33.9%) of IAC. The invasive group showed significantly greater lesion size, long-to-short diameter ratio, mean CT attenuation, CT enhancement, and standard deviation of CT values than the pre-invasive group (P<0.05). The incidences of vascular abnormality, air-space change, and tumor–lung interface abnormality were also higher in the invasive group than in the pre-invasive group (P<0.05).

A diagnostic framework for the precise preoperative grading of pure ground-glass nodule pulmonary adenocarcinoma can be constructed from high-resolution CT features, providing important basis for assessment of invasion degree and treatment decision-making.