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We aimed to investigate the risk factors of invasive pulmonary adenocarcinoma, especially to report and validate the use of our newly identified arc concave sign in predicting invasiveness of pure ground-glass nodules (pGGNs). From January 2015 to August 2018, we retrospectively enrolled 302 patients with 306 pGGNs ≤ 20 mm pathologically confirmed (141 preinvasive lesions and 165 invasive lesions). Arc concave sign was defined as smooth and sunken part of the edge of the lesion on thin-section computed tomography (TSCT). The degree of
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