肺部磨玻璃结节样腺癌的MSCT特征与病理对照分析

Comparative Analysis of MSCT Features and Pathology of Ground-glass Nodules of Lung Adenocarcinomas

目的:探讨磨玻璃结节样肺腺癌的多排螺旋CT(MSCT)表现及病理基础,旨在提高对该病良恶性诊断的准确性。方法:回顾性分析经病理证实为肺腺癌的21个磨玻璃密度结节(GGNs)病灶的CT资料,分析病灶的大小、性质、瘤肺界面、病灶边缘、空泡征、胸膜凹陷征及穿行支气管、血管的表现,并将病理结果分为浸润前病变和浸润性病变两组进行CT特征的对照。结果:浸润前病变14个,其中13个长径小于2.0 cm,10个为纯磨玻璃结节(pGGNS)、9个瘤肺界面清晰光滑、8个有分叶征、3个有毛刺征;浸润性病变7个,其中4个长径大于2.0 cm,5个为混合型磨玻璃结节(mGGNs)、7个瘤肺界面清晰毛糙、6个有分叶征、6个有毛刺征及4个有棘突征;另外浸润性病变空泡征、胸膜凹陷征及穿行支气管、血管走行及形态的改变较多见。结论:磨玻璃结节样肺腺癌的MSCT表现有一定特征性,GGNs体积较大、呈混合密度(有实性成分)、瘤肺界面清晰毛糙、出现深分叶征、毛刺征或棘突征、空泡征、胸膜凹陷征、病灶内穿行的支气管和血管出现异常改变,提示浸润性病变概率明显增加。

Objective： To explore the Multi-slice CT（MSCT） manifestations and pathological basis of ground-glass nodules of lung adenocarcinomas, so as to improve the accuracy of the diagnosis of benign and malignant diseases. Methods： the CT data of 21 ground-glass nodules（GGNs） lesions proved to be lung adenocarcinoma by pathology were analyzed retrospectively, and included analysis of tumor size, nature, interface of tumor and lung,edge, vacuole sign, pleural indentation sign, bronchi and blood vessels through the tumor imaging features. The pathological findings were divided into two groups： preinvasion lesions and invasive lesions, and the CT features of the two groups were compared. Results： preinvasive lesions were 14, of which 13 were smaller than 2.0 cm in length-diameter, 10 were pure ground-glass nodules（p GGNs）, 9 interface of tumor and lung were clear and smooth, 8 edges appeared lobular sign and 3 edges showed spicule sign; Invasive lesions were 7, of which 4 length-diameter were greater than 2.0 cm, 5 were mixed ground-glass nodules（m GGNs）, 7 interface of tumor and lung were clear and coarse, 6 edges showed lobulation, 6 edges burred spiculation, 4 edge display spinous protuberance; In addition, vacuole sign, pleural indentation sign, bronchi and blood vessels through the tumor in walking and morphologic changes are more common in the invasve lesions. Conclusion： MSCT showed ground-glass nodules of lung cancer have certain characteristics. The probability of invasive lesions is obviously increased when GGNs have larger size, a mixed density, clear and coarse interface of tumor and lung, or when the CT signs, such as deep vacuole sign, lobular sign, spicule sign, spinous protuberant sign, the abnormal changes of bronchi and blood vessels through the tumor.