To investigate the correlation of clinical, pathological and multi-slice spiral computed tomography (MSCT) findings and epidermal growth factor receptor (EGFR) mutations in the patients with lung adenocarcinoma.

A total of 157 patients with lung adenocarcinoma who underwent surgery and were confirmed to suffer from peripheral lung adenocarcinoma pathologically after operation in the Department of Chest Surgery in our hospital from September 2017 to April 2018 were collected for this study. The EGFR status was respectively tested for the postoperative specimens. Two senior radiologists independently analyzed the chest preoperative MSCT within one month and evaluated the relevant factors of EGFR mutations through analyzing the clinical information and the pathological features. All the data were analyzed with Chi-squared test, Fisher′s exact test, and Student′s t test. The ROC curves were statistically analyzed. And P<0.05 was considered statistically significant.

On the CT images, the mutation rates of EGFR in the tumors with spiculation, pleural indentation and ground-glass opacity (GGO) were 65.1% (P=0.012), 64.6% (P=0.044) and 70.3% (P=0.013), respectively, and statistical significant difference was found. The mutation rates of EGFR in the tumors accounted for 68.0% in the female patients (P=0.002) and 69.2% in the non-smoking patients (P=0.000). The pathological subtypes of lung adenocarcinoma in this cohort included: acinar, lepidic, micro-papillary, papillary, solid and infiltrating mucinous subtypes, whose mutation rates of EGFR were 68.5%, 60.9%, 50.0%, 43.8%, 22.2%, and 0.0%, respectively, and statistical significant difference was found (P=0.003). Multivariate logical analysis showed that when all the significant characteristics of EGFR mutations were correlated, the AUC of the ROC curve was 0.718.

Among the patients with primary lung adenocarcinoma, EGFR mutations tend to occur in women and non-smokers. Mutations of EGFR are mostly in genes 19 and 21, which are prone to occur in the acinar type and lepidic type of lung adenocarcinoma. Mutations of EGFR often occur in the early stage of lung adenocarcinoma. In the terms of MSCT appearance, EGFR mutations more likely occur in the tumors with GGO, spiculation and pleural indentation.