微小磨玻璃结节样肺腺癌HRCT与病理新分类对照分析

Comparison Analysis of Ground Glass Nodular lung Adenocarcinoma HRCT and Pathologic New Classification

目的对比分析肺微小磨玻璃结节（GGN）HRCT征象与肺腺癌病理新分类之间的关系,以提高对GGN的诊断水平。方法回顾性分析127例经病理证实的肺微小GGN患者HRCT资料,按照肺腺癌的病理新分类标准将其分为3组：浸润前组共35例,包括不典型腺瘤样增生（AAH）21例,原位癌（AIS）14例;微浸润癌（MIA）组45例;浸润性腺癌（IAC）组47例。对各组GGN大小、密度、瘤-肺界面（清晰、模糊）、胸膜凹陷征、脐凹征、空气支气管征、空泡征、分叶征、毛刺征、肿瘤微血管CT成像征进行评估并作统计学分析。结果病变大小组间比较显示差异均有统计学意义（P=0.032、0.000、0.000）;瘤-肺界面组间比较显示浸润前组与MIA组、IAC组差异均有统计学意义（P=0.013、0.005）,但MIA组与IAC组差异无统计学意义（P=0.716）;胸膜凹陷征组间比较显示浸润前组、MIA组与IAC组差异均有统计学意义（P=0.000、0.000）,但浸润前组与MIA组差异无统计学意义（P=0.119）;分叶征组间比较显示差异均有统计学意义（（P=0.000、0.000、0.001）;毛刺征组间比较显示差异均有统计学意义（P=0.008、0.000、0.001）。CT肿瘤微血管征组间比较显示MIA组、IAC组均高于浸润前组,差异有统计学意义（P=0.000、0.000）,MIA组与IAC组之间进行比较,差异无统计学意义（P=0.139）。病变位置分布、密度、空泡征、空气支气管征、脐凹征在3组之间差异无统计学意义。结论病灶大小、分叶征、毛刺征、胸膜凹陷征、瘤-肺界面、肿瘤微血管CT成像征可提高对于微小GGN样肺腺癌病理新分类的认识。

Objective To compare the relationship between HRCT signs of lung microscopic ground nodules（GGN）and the new pathological classification of lung adenocarcinoma in order to improve the diagnosis of GGN.Methods The HRCT data of 127 patients with pathologically confirmed pulmonary micro GGN were retrospectively analyzed.According to the new pathological classification criteria for lung adenocarcinoma,they were divided into 3 groups：35 in the infiltrating group,including atypical adenomatous hyperplasia（AAH）.In 21 cases,14 cases of carcinoma in situ（AIS）;45 cases of micro-invasive carcinoma（MIA） group;47 cases of invasive adenocarcinoma（IAC） group.The GGN size,density,tumorlung interface（clear,fuzzy）,pleural depression sign,umbilicus sign,air bronchogram,vacuolization sign,lobulation sign,burr sign,and tumor microangiography CT sign were evaluated for each group and Statistical analysis was done.Results There were significant differences in the difference between the lesion size group（P = 0.032,0.000,0.000）.The tumorlung interfacial comparison showed that there was a significant difference between the infiltration group and the MIA and IAC groups（P = 0.013）.,0.005）,but there was no significant difference between the MIA group and the IAC group（P= 0.716）;the comparison between the pleural indentation syndromes showed that there were significant differences between the infiltration group,the MIA group,and the IAC group（P = 0.000,0.000）,but there was no significant difference between the infiltration group and the MIA group（P = 0.119）;the difference between the lobulation syndromes showed statistically significant（P = 0.000,0.000,0.001）;There was a statistically significant difference between the two groups（P = 0.008,0.000,0.001）.Compared between CT tumor microvessel syndromes,MIA group and IAC group were higher than those before infiltration group,and the difference was statistically significant（P = 0.000,0.000）.There was no significant difference between MIA group and IAC group（P = 0.139）.The distribution of lesion location,density,cavitation sign,air bronchogram,and umbilical sign had no significant difference among the three groups.Conclusion The lesion size,lobular sign,burr sign,pleural indwelling sign,tumor-lung interface,and tumor micro-vessel CT imaging sign can improve the understanding of the new pathological classification of micro GGN-like lung adenocarcinoma.