磨玻璃影肺癌的临床特征分析

Clinical characteristics analysis of lung cancer with ground glass opacity

目的 探讨以磨玻璃影（GGO）为表现的早期肺癌影像学特征及临床特点,以指导肺癌的早发现、早诊断及早治疗.方法 回顾性分析宁夏医科大学总医院2010年1月至2016年12月高分辨率CT筛查肺影像学表现为GGO,且经手术病理证实为肺癌的56例患者的临床特征、影像学特征、病理分类的特点、治疗及预后,并采用t检验或x2检验对不同病理类型GGO肺癌患者的临床及影像学特点进行统计学分析.结果 GGO肺癌好发于女性,以不吸烟患者常见,临床表现常无特异性.56例GGO肺癌患者中,非典型腺瘤样增生（AAH）4例,原位腺癌（AIS） 10例,微浸润性腺癌（MIA） 15例,浸润性腺癌（IAC） 27例.不同病理类型GGO肺癌在病灶的直径大小方面差异有统计学意义（x2=19.246,P＜0.05）,IAC组的病灶直径明显大于AAH组,且浸润组（MIA＋IAC）病灶大小大于浸润前组（AAH＋AIS）;在病灶GGO含量方面差异有统计学意义（x2=20.001,P＜0.05）,AAH组的GGO含量明显高于MIA、IAC组,浸润前组（AAH＋ AIS） GGO含量高于浸润组（MIA＋ IAC）;不同病理类型在病灶发生位置及病灶边缘结构、内部结构及邻近结构方面差异均无统计学意义.结论 GGO肺癌无特异性临床症状,对于肺影像学表现为分叶、毛刺、空泡征、充气征、血管集束征及胸膜凹陷征的GGO应高度怀疑恶性病变,需及时干预获取病理学依据,早期诊断及治疗;GGO病灶越大、GGO含量越少,其恶性程度越高;GGO肺癌经手术治疗后远期生存期长,预后良好.

Objective To explore clinical characteristics of the lung cancer with ground glass opacity （GGO） and to guide the early clinical detection,diagnosis and treatment of lung cancer.Methods The clinical manifestation,imaging and morphological characteristics,treatment and prognosis of 56 patients diagnosed with lung cancer by histopathology and high resolution computed tomography （HRCT）showing GGO in General Hospital of Ningxia Medical University from January 2010 to December 2016 were retrospectively analyzed.Chi-square test or t test was used to analyse the clinical and imaging manifestation in different pathological classification.Results The incidence of GGO was more common in women and non-smokers.There was no difference in ages among four pathological groups.These cases had no special presentation.The 56 cases confirmed with lung cancer by pathology after surgery included four cases of the atypical adenomatous hyperplasia （AAH）,ten cases of adenocarcinoma in situ（AIS）,15 cases of minimally invasive adenocarcinoma （MIA） and 27 cases of invasive adenocarcinoma （IAC）.There was significant difference in the diameter of the lesion among different pathological groups （x2 =19.246,P 〈0.05）.The diameter of IAC group was greatly larger than that of AAH group.The lesion in invasive group （MIA＋IAC） was larger than that in preinvasive group （AAH-＋-AIS）.There was also significant difference in GGO content among different pathological groups （x2 =20.001,P 〈0.05）.The content of GGO in AAH group was significantly higher than that in MIA group and AIC group,and it was significantly higher in preinvasive group （AAH ＋ AIS） compared with invasive group （MIA＋ IAC）.There was no significant difference in the location of the lesion and the edge structure,internal structure and adjacent structure of lesion.Conclusions The lung cancer with GGO has few specific clinical symptoms.The GGO with imaging findings,such as lobulation,burr,cavitation,air-bronchogram,pleural indentation and vascular cluster,should be highly suspected malignant lesion.The pathological test should be performed timely.The larger diameter and less content of GGO are predictors of the malignant tumor.After surgery of lung cancer with GGO,the patient will have a longer lifetime and better prognosis.