62例纯磨玻璃结节患者手术切除后的病理分析及预后观察

Pathologic analysis and prognosis observation of 62 cases of pure ground-glass opacity after surgical resection

目的观察纯磨玻璃结节(p GGO)恶性比例及预后情况。方法选取2010年1月至2012年10月间行手术切除的62例p GGO患者,同时符合三个条件:(1)影像学表现为p GGO;(2)随访时间超过2年;(3)排除多发p GGO。分析患者术后病理结果,并观察预后。结果 62例p GGO中,恶性肿瘤48例(77.4%),不典型腺瘤样增生(AAH)8例(12.9%),良性疾病6例(9.7%)。44例p GGO在术前的随诊观察中持续稳定,此亚组p GGO的术后病理:恶性肿瘤33例(75.0%),其中原位腺癌(AIS)31例,微浸润腺癌(MIA)1例,腺癌1例;AAH(15.9%)7例,良性病变4例(9.1%)。10例p GGO在术前观察期间病变增大或密度增加,在此亚组中术后病理为恶性肿瘤的有9例,恶性率90.0%。术后随访中位时间为30.7个月。1例患者在随访期间于不同肺叶出现新发病灶,仍表现为p GGO,目前仍在随诊观察中,病变稳定,暂未手术治疗。其余所有患者未发现局部复发及远处转移,亦无死亡患者。结论对随诊观察没有变化的p GGO应相对积极进行手术治疗,观察过程中增大尤其是密度增加的p GGO,手术治疗是非常必要的。

Objective To observe the malignance proportion and prognosis of pure ground- grass opacity（ p GGO）. Methods All cases of p GGO were surgical resected between January 2010 to October2012 in the People＇s Liberation Army General Hospital,at the same time,comply with the requirements for the following three cases included in this study：（ 1） on the imaging performance for p GGO,（ 2） postoperative follow-up time more than 2 years,（ 3） to elimilate multiple p GGO and then analyze the postoperative pathologic results,prognosis and observation. Results Participants included 62 cases of p GGO,48 cases were malignant tumors（ 77. 4%）,8 patients were atypical adenomatous hyperplasia（ AAH）（ 12. 9%）,6 cases were benign disease（ 9. 7%）. In the preoperative follow-up,44 cases of p GGO were steady,and in this subgroup of p GGO pathology： 33 cases with malignant tumors（ 75. 0%）,including 31 cases with adenocarcinoma in situ（ AIS）,1 case with minimally invasive adenocarcinoma（ MIA）,1 case with adenocarcinoma; 7 cases with AAH（ 15. 9%）,4 cases with benign lesions（ 9. 1%）. In 10 cases of p GGO before surgery,lesions or the density increases during the observation period,in this subgroup,pathology of 9 cases（ 90. 0%） showed malignant tumor. The median postoperative follow-up time was 30. 7 months. During follow-up,1 case emerged new lesions in a different lobe,still p GGO,and it is still in follow-up observation and with stable disease. All the remaining patients were found no local recurrence and distant metastasis,and no patient died. Conclusion The p GGO that follow-up with no change should be relatively positive for surgery,and the p GGO that follow-up with lesions especially the density increased in the observation process is necessary of surgical treatment.