表现为单纯磨玻璃密度结节的肺浸润性腺癌的影像学特征分析

Radiological features of invasive adenocarcinoma presenting as pure ground-glass nodules

目的分析表现为肺内pGGN的浸润性腺癌的影像学特征。方法回顾性分析2010年11月到2016年4月间哈尔滨医科大学附属肿瘤医院40例患者[男9例，女31例；平均年龄（56.31±3.44）岁]共45个病灶的临床特征、形态学征象、pGGN质量及SUVmax，所有病灶均经手术切除病理证实。采用χ^2检验和两样本t检验分析数据，并利用ROC曲线评估病灶大小、pGGN质量诊断浸润性腺癌的最佳阈值。结果40例pGGN患者中，原位腺癌（AIS）＋微浸润性腺癌（MIA）组20例（23个pGGN），浸润性腺癌组20例（22个pGGN），AIS＋MIA组与浸润性腺癌组病灶仅血管集束征情况（13/23和19/22）、病灶大小[（13.83±4.49）和（20.32±5.97） mm]、pGGN质量[（0.36±0.34）和（0.98±0.44） g]间差异有统计学意义（χ^2＝4.874，t值：4.131和5.355，均P〈0.01）。ROC曲线显示，病灶大小、pGGN质量诊断浸润性腺癌的最佳阈值分别为17.3 mm和0.69 g，对应灵敏度为73%（16/22）和77%（17/22），特异性为87%（20/23）和91%（21/23）。结论pGGN腺癌中的病灶大小、pGGN质量及血管集束征有助于浸润性腺癌的检出。

ObjectiveTo investigate the radiological features of invasive adenocarcinoma presenting as pGGN. MethodsThe pathological, clinical and imaging data of 45 pGGN lesions in 40 patients （9 males, 31 females; average age （56.31±3.44） years） with pulmonary adenocarcinoma in Tumor Hospital Affiliated to Harbin Medical University from November 2010 to April 2016 were analyzed retrospectively. All patients were confirmed by pathological diagnosis. χ^2 test and two-sample t test were used. ROC curve analysis was also used to evaluate the optimal cut-off points of lesion size and mass for diagnosing invasive adenocarcinoma.ResultsThere were 20 patients with adenocarcinoma of situ （AIS） and minimally invasive adenocarcinoma （MIA） in group 1 （23 pGGN lesions）, while another 20 patients with invasive adenocarcinoma in group 2 （22 pGGN lesions）. The vascular convergence sign between 2 groups was statistically significant （13/23 in group 1 and 19/22 in group 2; χ^2=4.874, P〈0.05）. Statistically differences in the lesion size （（13.83±4.49） mm in group 1 and （20.32±5.97） mm in group 2） and in the lesion mass （（0.36±0.34） g in group 1 and （0.98±0.44） g in group 2） were found between 2 groups （t values： 4.131, 5.355; both P〈0.01）. ROC curve analysis showed that the optimal cut-off points of the size and the mass were 17.3 mm and 0.69 g respectively, with the sensitivities of 73%（16/22） and 77%（17/22）, and the specificities of 87%（20/23） and 91%（21/23）.ConclusionThe size, mass, and vascular convergence sign are helpful to detect invasive adenocarcinoma present as pGGN.