超高分辨率CT(UHRCT)鉴别肺原位腺癌(AIS)与微浸润腺癌(MIA)

Ultra-high-resolution computed tomography(UHRCT) in differentiating between lung adenocarcinoma in situ(AIS) and minimally invasive adenocarcinoma(MIA)

目的分析早期肺腺癌的超高分辨率CT(ultra-high-resolution computed tomography,UHRCT)表现,探讨UHRCT鉴别肺原位腺癌(adenocarcinoma in situ,AIS)与微浸润癌(minimally invasive adenocarcinoma,MIA)的价值。方法回顾性分析经手术和病理证实、直径小于2 cm的早期肺腺癌结节(AIS 67个,MIA 62个)的UHRCT表现,分析和比较AIS与MIA在结节的形状、边缘、密度、直径、内部实性成分直径、血管异常、空气支气管征、空泡征、胸膜凹陷征以及是否多发等方面的差异。结果两组结节在形状、边缘、密度、直径、实性成分直径和密度、肺静脉异常、空气支气管征和胸膜凹陷征上的差异均有统计学意义(P<0.05)。AIS常表现为较小的圆形或类圆形的纯磨玻璃结节(ground-glass nodule,GGN),MIA常为较大、边缘毛刺、实性成分直径大于5 mm的混合GGN,并常伴肺静脉异常、支气管扩张和胸膜凹陷征。结论 UHRCT能显示早期肺腺癌的形态学特征,有助于鉴别肺AIS与MIA。

Objective To analyze ultra-high-resolution computed tomography （UHRCT） appearances of early lung adenocarcinoma and to evaluate UHRCT in the differentiation of adenocarcinoma in situ （AIS） and minimally invasive adenocarcinoma （MIA）.Methods UHRCT appearances of 129 nodules （less than 2 cm in diameter） of early lung adenocarcinoma were reviewed retrospectively.All these nodules （67 nodules of AIS and 62 nodules of MIA） were proven by surgery and pathology.UHRCT features of lung nodules in the two groups,including the shape,margin,density,diameter,diameter of internal solid component,vascular changes,air bronchogram,vacuole,pleural indentation and multiplicity,were analyzed and compared.Results Statistically significant differences were found in shape,margin,density,diameter,diameter and density of internal solid component,pulmonary vein changes,air bronchogram and pleural indentation （all P〈0.05）,respectively.AIS frequently appeared as a small,well-defined,round or oval,pure groundglass nodule （GGN）.In contrast,MIA was more often a larger,spiculated margin,mixed GGN with an internal solid component larger than 5 mm.In addition,MIA often had abnormal pulmonary vein,air bronchogram and pleural indentation.Conclusions UHRCT can demonstrate the morphological features of early lung adenocarcinoma and discriminate between AIS and MIA.