空洞性磨玻璃结节的CT表现与病理对照研究

Comparative study of cavitary GGN with computed tomography and pathological findings

目的探讨病理诊断为肺腺癌的空洞性磨玻璃结节的薄层CT表现与病理特征的相关性和空洞形成的病理基础。方法回顾性分析34例均经过手术治疗的空洞性磨玻璃结节患者影像和病理资料,CT图像分析包括磨玻璃结节和空洞的影像特征,病理切片分析包括病理亚型、空洞壁特征及空洞形成的病理基础,并对这些影像特征和组织病理特征进行对照分析。结果 34例空洞型磨玻璃结节患者中,6例为原位腺癌,10例为微浸润腺癌,18例为浸润性腺癌。混合磨玻璃结节、空洞内分隔、壁结节、瘤肺界面、毛刺征、胸膜凹陷征发生率与病理类型有关(P<0.05)。磨玻璃结节及空洞大小与病灶的恶性度呈正相关(r=0.455,P<0.05;r=0.668,P<0.05),且空洞大小与磨玻璃结节大小亦呈正相关(r=0.642,P<0.05)。18例患者的病理切片上可见空洞,表现为扩张的细支气管。结论恶性空洞性磨玻璃结节的CT征象与其病理类型有一定的相关性,空洞形成的病理基础是单向阀门引起的支气管扩张。

ObjectiveTo explore the correlation of thin-CT manifestations and pathologic characteristics and the pathological basis of the cavity of early lung adenocarcinoma manifesting as cavitary GGN. MethodsPreoperative CT data and postoperative pathological data for cavitary GGN were analyzed retrospectively. CT image analysis included the image characteristics of GGN and cavity. Pathological analysis included pathological subtype, the characteristics of cavity wall and the pathological basis of the cavity. The images and histopathologic features of cavitary GGN were analyzed by contrast. ResultsOf the 34 early lung adenocarcinomas, 6 were AIS (adenocarcinomain situ), 10 were MIA (minimally invasive adenocarcinoma) and 18 invasive adenocarcinoma. The incidence of mixed Ground Glass nodule (mGGN), compartments in the cavity, wall nodules, tumor lung interface, spiculation and pleural indentation were associated with pathologic subtype (P<0.05). The size of the GGN and cavity were positively correlated with the malignant degree of lesions (r=0.455,P<0.05;r=0.668,P<0.05). And the size of the GGN and cavity were positively correlated (r=0.642,P<0.05). Cavities could be seen on 18 pathological sections which manifested as dilated bronchiole. ConclusionThe CT signs and pathological subtypes of malignant cavitary GGN have certain relevance. The pathological basis of the formation of cavity was supposed to be dilated bronchiole induced by check-valve mechanism.