磨玻璃结节中实性成分对肺腺癌术前CT诊断的价值

Diagnostic value of solid component for lung adenocarcinoma shown as ground-glass nodule on computed tomography

目的 探讨CT术前预判磨玻璃样肺腺癌病理类型的可行性.方法 回顾分析复旦大学附属华东医院2011年1月至2012年11月143例经手术病理证实的肺内磨玻璃结节患者,随机分成A、B两组,以手术病理又分为,浸润前病变、微浸润腺癌（MIA）及浸润性腺癌（IAC）.A组101例,在CT图像上测量病灶的大小、磨玻璃成分所占比例、病灶内实性成分的长径、最长径及大小,用来建立磨玻璃结节样肺腺癌的CT诊断标准.B组42例,评估上述CT诊断标准的准确性.用SPSS 17.0进行统计学分析.结果 各项诊断指标在浸润前组和MIA、MIA和IAC间差异均有统计学意义（均P＜0.05）;经Spearman检验病灶大小、实性成分长径、最长径、大小及病灶磨玻璃成分所占比例与病理类型均存在相关性（P=0.000）.通过绘制ROC曲线得浸润前组与MIA间各诊断指标的诊断价值中等（AUC在0.70 ～0.90）;MIA与IAC间病灶大小和实性成分最长径的诊断价值中等（AUC在0.70～0.90）,病灶实性成分长径、大小及磨玻璃成分所占比例诊断价值较高（AUC＞0.90）.将A组所得的诊断界值用于评估B组病灶的病理类型,经检验CT诊断结果与病理诊断标准间差异无统计学意义（P＞0.05）.病灶的大小、磨玻璃成分所占比例、病灶内实性成分的长径、最长径及大小的诊断正确率分别为71.43％、76.19％ 、90.05％、90.05％、88.10％.结论 术前CT检查可依据病灶内实性成分、磨玻璃成分所占比例及病灶大小评估病灶的病理类型.

Objective To explore the feasibility of making a preoperative diagnosis of lung adenocarcinoma shown as ground-glass nodule （GGN） on computed tomography （CT）.Methods A total of 143 GGN lesions proved pathologically were divided randomly into A and B groups.Then each group was further divided pathologically into preinvasive lesion,minimal invasive adenocarcinoma （MIA） and invasive adenocarcinoma （IAC） subgroups.Group A （n =101）,size of lesion,proportion of ground glass opacity （GGO） composition of lesion,long diameter,longest diameter and size of solid component in lesion were measured on CT so as to establish the CT diagnostic standard of lung adenocarcinoma shown as GGN on CT.Group B （n =42） was employed to evaluate the accuracy of the above CT diagnostic standard.SPSS 17.0 software was used for statistical analysis.Results Significant statistic significance existed in all parameters among all groups （P ＜ 0.05）.All parameters were correlated the pathologic type of lesion.The differences were statistically significant （P =0.000）.Through the receiver operating characteristic （ROC） curve,between groups of preinvasive lesion and MIA,each parameter had a medium diagnostic value of 0.70-0.90; between groups of MIA and IAC,size of lesion and long diameter of solid component in lesion had a medium diagnostic value of 0.70-0.90,longest diameter of solid component,size of solid component in lesion and proportion of GGO composition of lesion had a high diagnostic value with an AUC of ＞ 0.90.The CT diagnostic standard,derived from group A,was used to analyze the pathologic type of group B.And t no significant statistic significance existed between CT preoperative diagnosis and operative pathologic diagnosis （P ＞ 0.05）.The correct diagnosis rates of size of lesion,proportion of GGO composition of lesion,long diameter,longest diameter and size of solid component in lesion were 71.43％,76.19％,90.05％,90.05％ and 88.10％ respectively.Conclusion Based upon size of lesion,proportion of GGO composition of lesion,long diameter,longest diameter and size of solid component in lesion,preoperative CT examination may be used to determine the pathological types of lung adenocarcinoma shown as GGN.