纯磨玻璃密度浸润前病变与浸润性肺腺癌的临床及CT鉴别

Clinical and CT identification between preinvasive and invasive lung adenocarcinoma presented as pure ground-glass opacity

目的探讨CT对表现为纯磨玻璃密度结节(pGGN)的浸润前病变与浸润性肺腺癌(包括微浸润性肺腺癌和浸润性肺腺癌)的鉴别诊断价值。方法回顾性分析经手术病理证实的CT影像表现为pGGN的病灶156例,其中浸润前病变组58例,浸润性肺腺癌(TNM分期为T1N0M0)组98例,比较两组病灶的CT征象及患者的性别并进行统计学处理;对CT征象及患者性别之间的差异进行χ~2检验,对两组病灶大小做ROC曲线。结果病灶形态、空泡征、空气支气管征、血管穿行征、瘤-肺界面清晰及血管集束征在两组间差异有统计学意义(P<0.05);ROC曲线显示当病灶大于15.35 mm时,浸润性肺腺癌的准确率为75.0%。结论 pGGN的病灶大小、形态、空泡征、空气支气管征、血管穿行征、瘤-肺界面及血管集束征有一定预测价值。

Objective To investigate the diffevential diagnostic value of preinvasive and invasive lung adenocarcinoma（including minimally invasive adenocarcinoma and invasive adenocarcinoma）presented as pure ground-glass nodules（pGGN）by CT.Methods One hundred and fifty-six cases of pGGN verified by operative pathology were retrospectively analyzed,including 58 cases of preinvasive adenocarcinoma and 98 cases of invasive adenocarcinoma（TNM staging were T1N0M0）.The CT features and sex were statistically processed.The difference between the CT features and sex were performed by theχ~2 test.The ROC curve of lesion focus size was drawn.Results Statistically significant differences were found in the lesion shape,vacuole sign,air bronchogram,blood vessel through,tumor-lung interface and vascular cluster sign between the two groups（all P〈0.05）.The ROC curve showed that the accuracy rate of invasive adenocarcinoma was 75.0% when the size of the pGGN lesions was larger than 15.35 mm.Conclusion The lesion size,shape,vacuole sign,air bronchogram,blood vessels through and vascular cluster sign have some predictive value.