肺腺癌浸润前病变的CT诊断评价

The value of imaging characteristics on CT in the diagnosis of preinvasive lesions of lung adenocarcinoma

目的:分析肺腺癌浸润前病变不典型腺瘤样增生(AAH)和原位腺癌(AIS)的CT表现特征,提高临床诊断水平。方法:回顾性分析经病理证实的28个AAH和57个AIS病灶的CT表现特征,包括病变的部位、大小、形态、边缘、平均CT值等。结果:AAH和AIS在血管穿行、大小及平均CT值方面差异均有统计学意义(均P<0.05),而在磨玻璃样结节类型、部位、形态、边界、分叶、空泡征及毛刺征方面差异无统计学意义(均P>0.05)。AAH的平均大小为(7.9±3.0)mm,AIS为(12.3±3.9)mm,对2组大小绘制受试者工作特征曲线(ROC)显示最佳截断值为8.5 mm(敏感度为82.5%,特异度为71.4%);AAH平均CT值为(-644±71)HU,AIS为(-492±87)HU,ROC曲线分析显示其最佳截断值为-549 HU(敏感度为77.2%,特异度为96.4%)。结论:综合分析肺磨玻璃结节的类型、大小、密度及形态等有助于AAH和AIS的鉴别诊断。

Objective： To analyze the computed tomography appearances of preinvasive leisions of lungadenocarcinoma and to improve the diagnosis of atypical adenomatous hyperplasia （AAH） and adenocarcinomain situ （AIS）. Methods： Twenty-eight cases of AAH and 57 cases of AIS confirmed pathologically were retrospectivelyrecruited. Comparison of CT features of lung nodules in the two groups, including location, shape,margin, diameter, solid component, internal characteristics and mean CT attenuation. Results： The blood vesselsthrough of focal ground glass nodule （fGGN）, diameter and the mean CT attenuation were significantly differentbetween the two diseases （P〈0.05 for all）, while no difference was found in the pattern of fGGN, location,shape, boundary, lobulation speculation and vacuole sign between AAH and AIS （P〉0.05 for all）. The average ofdiameters was （7.9±3.0） mm for AAH, which was smaller than （12.3±3.9） mm for AIS. The optimal cut-off valuefrom the receiver characteristic （ROC） curve was 8.5 mm, with sensitivity of 82.5% and specificity of 71.4%. Themean CT attenuation was （-644±71） HU for AAH, which was smaller than （-492±87） HU for AIS. The optimalcut-off value from ROC was -549 HU, with sensitivity of 77.2% and specificity of 96.4%. Concluion： Comprehensiveanalysis of the pattern, size, density, shape and internal characteristics of fGGN is helpful for differentialdiagnosis of AAH and AIS.