临床Ⅰ期浸润肺腺癌不同组织学亚型的三维CT值定量分析

Three-dimensional computerized quantification for lung invasive adenocarcinoma with different histopathological subtypes in clinical stage I

目的研究临床I期浸润肺腺癌不同组织学亚型三维CT值定量分析的特点，为患者术前评估及术中病理诊断提供影像参考。方法对2005年1月至2012年12月在我院行手术切除的273例临床I期浸润肺腺癌患者的影像、病理资料进行回顾性分析。利用3DcT值定量分析软件对病灶磨玻璃成分比例、实性成分比例进行计算。根据2011年腺癌国际新分类标准对病理切片进行复阅，并对浸润腺癌进行分级，其中附壁为主型评为1级、腺泡或乳头为主型评为2级、微乳头或实体为主型评为3级。采用Kruskal-Wallis检验比较磨玻璃成分比例、实性成分比例在浸润腺癌不同组织学亚型分级中的差异；采用Spearman相关分析检验浸润肺腺癌磨玻璃成分比例、实性成分比例与组织学亚型级别的相关性。结果273例浸润腺癌中组织学亚型分级1级49例（17．9％）、2级208例（76．2％）、3级16例（5．9％）。浸润腺癌1级、2级、3级的磨玻璃成分比例中位数（范围）分别为18．40％（10．00％～33．45％）、6．55％（2．00％～18．00％）、1．70％（0．20％-3．85％），差异具有统计学意义（x2=37．74，P〈0．01）；浸润腺癌1级、2级、3级的实性成分比例中位数（范围）分别为29．80％（11．75％～47．35％）、66．60％（35．40％～83．85％）、88．50％（75．28％-93．60％），差异具有统计学意义（X2=47．73，P〈0．01）；磨玻璃成分比例与浸润腺癌组织学亚型级别呈负相关（r=-0．37，P〈0．01），实性成分比例与浸润腺癌组织学亚型级别呈正相关（r=0．42，P〈0．01）。结论通过3DCT值定量分析有望对浸润腺癌的组织学亚型级别进行术前预判，从而为患者术前评估及术中病理诊断提供参考。

Objective To study three-dimensional computerized quantification for clinical stage I lung invasive adenocarcinoma with different histopathological subtypes. Methods Pathological and HRCT data of 273 patients within clinical stage I lung invasive adenocarcinoma underwent surgery from January 2005 to December 2012 were retrospectively collected. The proportion of ground glass opacity component and solid component in tumor were calculated by three-dimensional computerized quantification. All specimens were classified into 3 grades （grade 1 as the lepidic pattern of invasive adenocarcinoma, grade 2 acinar or papillary patterns, grade 3 micropapillary or solid patterns）. The proportion of different components among different histopathological grades was evaluated by Kruskal-Wallis test. The correlation between components in tumor and histopathologic subtypes grade were evaluated by Spearman correlation. Results In 273 patients, 49（17.9%） were assessed as grade 1, 208（76.2%） grade 2, and 16（5.9%） grade 3. The proportion of ground glass opacity component and solid component in grade 1, grade 2, and grade 3 were 18.40% （10.00%--33.45%）, 6.55% （2.00%--18.00%）, 1.70% （0.20%--3.85%） and 29.80% （11.75%-47.35%）, 66.60% （35.40%--83.85%）, 88.50% （75.28%--93.60%）, respectively. Significant differences among different histopathological grades were observed（~2=37.74,47.73,P〈0.01）. The proportion of ground glass opacity component was negative correlation with histopathologic grade（r= - 0.37, P〈O.01）, while the proportion of solid component was positive correlation with histopathologic grade（r=0.42, P〈0.01）. Conclusion Three-dimensional computerized quantification for lung invasive adenocarcinoma may predict histopathological grade.