磨玻璃结节样多灶性肺腺癌CT征象与病理对照

Comparison of CT features and pathology in multifocal lung adenocarcinoma with ground glass opacity

目的探讨磨玻璃结节样多灶性肺腺癌(MLA)的CT征象并与病理结果进行对照。方法收集16例(共36个病灶)经病理证实的MLA患者资料,并依据病理结果将病灶分为浸润前病变组(n=7)、微浸润腺癌组(n=20)、浸润性腺癌组(n=9),对3组病灶的CT征象进行分析并与病理结果对照。结果 36个病灶中,圆形/类圆形19个(52.78%),分叶征19个(52.78%),毛刺征12个(33.33%),空泡征13个(36.11%),血管集束征12个(33.33%),瘤肺界面清晰32个(88.89%)。浸润前病变组7个(7/7,100%)病灶均表现为纯磨玻璃结节;微浸润腺癌组12个(12/20,60.00%)病灶表现为纯磨玻璃结节,8个(8/20,40.00%)病灶表现为部分实性结节;浸润性腺癌组仅有1个(1/9,11.11%)病灶表现为纯磨玻璃结节,余8个(8/9,88.89%)病灶表现为部分实性结节。3组间纯磨玻璃结节、毛刺征、空泡征及血管集束征差异均有统计学意义(P均<0.05)。浸润前病变组与浸润性腺癌组间纯磨玻璃结节、毛刺征、血管集束征差异有统计学意义(P=0.001、0.003、0.001);微浸润腺癌与浸润性腺癌毛刺征、空泡征及血管集束征差异有统计学意义(P=0.014、0.014、0.001)。结论综合分析多发磨玻璃结节的CT征象,有助于术前诊断MLA。

Objective To investigate CT features of multifocal lung adenocarcinoma （MLA） with ground glass opacity and the relationships with pathology. Methods Totally 16 cases （36 lesions） of MLA confirmed by pathology were collected. Based on pathology, the lesions were divided into pre-invasive lesion group （n = 7）, minimally invasive adenocarcinoma （MIA） group （n= 20） and invasive adenocarcinoma （IAC） group （n=9）. CT features of all three groups were analyzed and compared with pathology. Results Among 36 lesions, there were 19 lesions （52.78%） with round shape, 19 （52.78%） with lobulation, 12 （33.33%） with spiculation sign, 13 （36.11%） with vacuole sign, 12 （33.33%） with blood vessel cluster sign, and 32 lesions （88.89%） with well defined interface. Seven pre-invasive lesions （7/7, 100%） were all pure ground glass opacity （pGGO） , while 12 lesions （12/20, 60.00%） were pGGO in MIA group, other 8 lesions （8/20, 40.00%） were mixed ground glass opacity （mGGO）. Only 1 lesion （1/9, 11.11%） in IAC group was pGGO, other 8 lesions （1/9, 88.89%） were mGGO. There were significant differences of pGGO, spiculation sign, vacu ole sign and blood vessel cluster sign among 3 groups （all P〈0.05）. There were significant differences of pGGO, spicula- tion sign and blood vessel cluster sign between pre-invasive lesion and IAC group （P=0. 001, 0. 003, 0. 001）. Significant differences were found in spieulation sign, vacuole sign and blood vessel cluster sign between MIA and IAC group （P= 0. 014, 0. 014, 0. 001）. Conclusion CT findings of multiple ground glass opacity are helpful to diagnosis of MLA before surgery.