肺微小磨玻璃结节血管征及气管征对良恶性的鉴别意义

Value of vessel and bronchial signs on differential diagnosis of benign and malignant pulmonary ground glass nodules

目的探讨肺微小磨玻璃结节(GGN)的血管征及气管征对良恶性评估的价值。方法收集2016年1月至2018年1月,在江苏省肿瘤医院经手术或穿刺病理证实为肺腺癌的单发局灶性GGN 127例的临床资料。将GGN分为3组,良性组36例、浸润前组51例、浸润腺癌组40例。比较不同病理类型GGN大小与血管征及气管征的关系。结果 GGN良性组最大径(5.22±2.45)mm,浸润前组最大径(8.16±2.83)mm,浸润腺癌组最大径(13.15±3.41)mm,3组两两相比,差异有统计学意义(均P<0.05)。各型血管征在3组不同病理分型GGN所占比例均不同,差异有统计学意义(均P<0.05)。Ⅰ型、Ⅱ型血管征多见于良性组,Ⅲ型、Ⅳ型血管征多见于浸润前组与浸润腺癌组。各类型支气管征在3组不同病理分型GGN所占比例不同,差异有统计学意义(均P<0.05)。Ⅱ型、Ⅲ型气管征多见于浸润腺癌组,Ⅳ、Ⅴ型气管征多见于良性组、浸润前组。结论了解GGN与血管、支气管征的关系及其在微小GGN分类中的应用,对GGN良恶性的鉴别诊断具有重要意义。

Objective To evaluate vesses and bronchial signs on differential diagnosis of benign and malignant pulmonary ground glass nodules （GGN）. Methods A total of 127 cases with single focal GGN of lung adenocarcinoma were selected which were confirmed by surgery or puncture pathology in Jiangsu Cancer Hospital from January 2016 to January 2018. All patients were divided into 3 groups ： the benign group （ 36 cases）, the pre-invasive group （51 cases） and the invasive adenocarcinoma group （40 cases）. The relationship between GGN size, vascular sign and trachea sign were compared. Results The maximal diameter of the GGN benign group was （5.22±2.45） mm, that of the pre-invasive group was （ 8.16±2. 83） mm, and that of the invasive adenocarcinoma group was （13.15±3.41） mm. The difference among the 3 groups was statistically significant （P〈0. 05）. The proportion of each type of vessels sign was different in different pathological types of GGN, and the difference was statistically significant （P〈0. 05）. Type Ⅰ and type Ⅱ vascular signs were more common in the benign group, while type Ⅲ and type Ⅳ vascular signs were more common in the pre-invasive group and the invasive adenocarcinoma group. The proportion of each type of bronchial sign was different in different pathological types of GGN, and the difference was statistically significant （ P〈0. 05 ）. Type Ⅱ and type Ⅲ tracheal signs were more common in the invasive adenocarcinoma group, while type Ⅳ and Ⅴ tracheal signs were more common in the benign group and the pre-invasive group. Conclusions The relationship between GGN and vessels and bronchial signs and its application in GGN classification plays an important role in the differential diagnosis of benign and malignant GGN.