肺部纯磨玻璃结节浸润性肺腺癌与浸润前病变的高分辨靶扫描CT鉴别诊断

Differential diagnosis of pulmonary invasive adenocarcinoma and preinvasive lesions in pure ground- glass nodules on high resolution targeted CT scan

目的探讨肺部纯磨玻璃结节(p GGN)高分辨率CT影像特征,鉴别诊断浸润性肺腺癌与浸润前病变。方法分析85例高分辨靶扫描影像表现为p GGN且最大径>5mm的99个结节,根据手术病理分为浸润前病变组(AAH+AIS;79个)和浸润性病变组(MIA+IAC;20个)。图像评价内容包括病变部位、大小、密度、边界、病变边缘、形状、病变内部和周边征象(空泡征、支气管充气征、胸膜凹陷征、血管集束征)。结果两组患者病变部位、密度、边界、空泡征及空气支气管征差异均无统计学意义(均P>0.05)。浸润性病变组分叶/毛刺出现率(80.0%)高于浸润前病变组(38.0%)(P<0.01),胸膜凹陷征及血管集束征出现率(35.0%、50.0%)也高于浸润前病变组(2.5%、25.3%)(均P<0.05)。ROC曲线显示以病变直径10mm为分割值,其曲线下面积为0.78,区分浸润性病变的敏感度和特异度分别为60.0%和75.9%。结论 p GGN病灶>10mm,有分叶/毛刺、胸膜凹陷征及血管集束征,提示肿瘤有浸润性。

Objective To assess the high resolution CT（HRCT） findings of pure ground-glass pulmonary nodules （pGGN） in differential diagnosis of invasive adenocarcinoma and preinvasive lesions. Methods Eighty five subjects underwent targeted CT scan and 99 pGGNs with diameter 〉5mm were detected, among which 79 nodules were preinvasive lesions （AAH＋AIS） and 20 nodules were invasive lesions（MIA＋IAC） according to pathological examination. Image evaluation included the lesion location, size, density, interface, edge, shape, internal and peripheral signs （vacuole, bronchogram, pleural indentation, vascular convergence）. Results There was no significant difference in lesion location, vacuole and bronchogram between the two groups （P 〉0.05）. The invasive lesions presented more lobulation and spiculation （80.0% vs. 38.0%, P〈0.01）, more pleura indentation （35.0% vs. 2.5%, P〈0.05） and more convergence sign（50.0% vs. 25.3%,P〈0.05） on CT images than preinvasive lesions did. The ROC analysis showed that the area under the curve（AUC） was 0.79; when the threshold was 10mm in diameter, and the sensitivity and specificity of differential diagnosis was 60.0% and 75.9%, respectively. Conclusion The size （〉10mm）, Iobulation or spicu- lation, pleural indentation and convergence sign of pGGN on HRCT scan may be of value in predicting the invasiveness of lung adenocarcinoma.