肺部纯磨玻璃样病变的诊断与病理分型

Diagnosis and Pathological Types of Pulmonary Pure Ground-Glass Opacity

目的分析肺部纯磨玻璃样病变的CT影像表现(直径及CT值)与病理类型,寻找二者之间的关系,术前初步判断病理类型,为手术方式的选择提供依据。方法回顾研究19个月收治的经过筛选考虑恶性肿瘤可能性较大的92个肺部纯磨玻璃样结节(pGGO)病例,测量其直径及CT值,将病变直径大小及CT值与病理学结果进行对照分。结果 (1)不典型腺瘤样病变(AAH)平均直径明显小于其他三组平均直径(P<0.05);原位癌(AIS)与微浸润性腺癌(MIA)的平均直径没有明显差异(P>0.05);浸润性腺癌(IAC)的平均直径均大于AIS和MIA(P<0.05);(2)AAH的CT值均小于AIS、MIA、IAC;将AIS、MIA、IAC进行比较(P均大于0.05),故考虑三者之间不存在明显差异;(3)d<0.9且CT值<-600的癌前病变所占的比率明显高于d≥0.9或CT值≥-600的癌前病变所占的比率。结论纯磨玻璃样病变的病理类型不仅仅是AAH,也存在原位癌、微浸润性癌和浸润性癌,只是所占比例不同;不同病理类型之间CT值没有明显差异,不能作为术前初步鉴别病理类型的依据,但可以初步区别良恶性病变;而病变大小却明显随着病理类型的变化不断增大,因此病变直径可以在一定程度上鉴别不同的病理类型。

Objective To explore the relation between CT imaging manifestation （diameter and CT values） and pathological typing of pulmonary pure ground - glass opacity （ pGGO）. Methods A retrospective analysis was made 29 pulmonary pGGO selected out from the screen of malignant tumor within a period of 19 months; the pGGO diameter and CT values were measured and comparatively studied with the pathological results. Results The average diameter of AAH is much smaller than those of AIS, MIA and IAC （P 〈0.05） ; there existed no obvious difference in diameter between AIS and MIA （P 〉 0.05） ; the average diameter of IAC was bigger than those of AIS and MIA （ P 〈 0.05 ） ; the CT values of AAH were smaller than those of AIS, MIA and IAC; the comparison among AIS, MIA and IAC showed P 〉 0.05, which indicated that there existed no obvious difference among the 3 ; Precancerous lesion ratio of the pGGO with d 〈 0.9em and CT value 〈 - 600Hu was significantly higher than the ratio of the pGGO with d 〉 0.9cm or CT value ≥- 600Hu. Conclusions The pathological type of pGGO includes AAH and AIS, MIA and IAC as well but the 4 share different proportion; as there exists no obvious difference between different pathological typing and CT values, CT value can not be applied in identifying the pathological types, however it can give primary differentiation of malignant and benign lesions; the lesion areas keep enlarging with the changes of pathological typing, thus the lesion diameter can identify the different pathological types at certain degree.