早期浸润性肺腺癌HRCT形态学征象与血管、淋巴管浸润的相关性研究

Correlation of the HRCT Morphologic Features with Blood and Lymphatic Vessels Invasion in Early Stage of Invasive Lung Adenocarcinoma

目的:探讨早期浸润性肺腺癌高分辨率计算机体层x线摄影术(HRCT)的形态学征象与血管、淋巴管浸润的相关性。方法:选择我院2013年9月至2016年5月收治的早期肺腺癌患者共60例,所有研究对象按病灶中有无血管、淋巴管浸润分为浸润组、无浸润组两组,采用单因素和多因素分析筛选CT形态学表现与血管、淋巴管浸润有关的因素,然后进一步对mGGN的实性成分直径及C/T值等运用ROC曲线分析判断其诊断能力。结果:浸润组和无浸润组差异有统计学意义的CT形态学征象包括结节直径、毛刺征、胸膜凹陷征、支气管充气征、血管集束征、静脉受累、病理分类(P<0.05)。其中,毛刺征和静脉受累为血管、淋巴管浸润的独立危险因素(优势比分别为2.737,3.894,P<0.05)。肺结节直径诊断血管、淋巴管浸润的ROC曲线下面积为0.885,而mGGN实性成分直径、C/T值及两者联合检测的ROC曲线下面积分别为0.855,0.801,0.909。结论:早期浸润性肺腺癌HRCT形态学征象中毛刺征和静脉受累为血管、淋巴管浸润的独立危险因素。

Objective： To explore the correlation between the HRCT morphologic features and blood and lymphatic vessels inva- sion in early stage invasive lung adenocarcinoma. Methods： Totally 60 patients with early stage lung adenocarcinoma were involved in our hospital from 2013/9 to 2016/5. They were divided into invasion and non-invasion group according to whether the blood and lymphatic vessels were invaded or not. Single factor and multiple factors analysis were used to find the related factors about the CT morphologic features and blood and lymphatic vessels invasion. Furtherly, ROC analysis were used to evaluate the diagnostic abilities of the diameter of the consolidation part in the mix ground glass nodule （mGGN） and C/T values and so on. Results： The significantly different CT morphologic features between the invasion and non-invasion group were： tumor diameter, spiculation sign, pleural indentation, air bronchogram, vascular convergence, abnormal vein, pathological classification （P 〈 0.05）. Among them, spiculation sign and abnormal vein were independent risk factors of blood and lymphatic vessels invasion （OR=2.737, 3.894, P 〈0.05）. The AUC of tumor diameter was 0.885, and the AUC of consolidation part of mGGN, C/T value and the joint detection were 0.855, 0.801, 0.909. Conclusion： The spiculation sign and abnormal vein are independent predictors for blood and lymphatic vessels invasion in early stage invasive lung adenocarcinoma.