基于Fleischner最新指南关于孤立性亚实性肺结节的CT随访与肺腺癌病理亚型的对照研究

Study of Diagnostic CT and Comparison with the Surgical Pathology Result in Subsolid Pulmonary Nodules according to Fleischner Society

目的探讨孤立性亚实性结节的CT随访和影像表现与肺腺癌病理亚型的关系。方法搜集83例孤立性肺结节患者,按照Fleischner学会最新指南回顾性分析,根据内部成分变化分3组,组1成分未变化,组2磨玻璃成分比例增大,组3实性成分比例增大。以往大量文献研究表明磨玻璃成分及实性成分均增大表明恶性程度增加,故本研究不列为分组对象。所有病例均经病理证实为腺癌,病理亚型划分按照WHO第4版肺肿瘤新分类,对CT表现与病理结果进行对照分析。结果 CT成分的变化表现为不同的病理亚型,经两两比较,组1及组2非浸润性病变比例高于组3,而前二者在病理类型中差异有统计学意义(P<0.05)。CT对病变浸润性及病理亚型的预测与病理结果进行比较,经一致性检验得出两种结果具有较好的一致性。结论不同病理亚型的孤立性亚实性结节其影像学特征不同,CT随访能在一定程度上对其浸润性及组织学亚型进行预判。

Objective To investigate the relationship between CT follow-up and imaging findings of solitary subsolid nodules and pathological subtypes of lung adenocarcinoma. Methods A total of 83 patients with solitary pulmonary nodules were retrospectively analyzed according to the Fleischner Institute’s latest guidelines. The internal components were divided into 3 groups. The composition of group 1 did not change, the proportion of group 2 ground-glass components increased, and the proportion of group 3 solid components increased. A large number of previous literature studies have shown that the increase in the composition of the ground glass and the solid components indicate an increase in the degree of malignancy. This study is therefore not classified as a group, so the cases were confirmed by pathology as adenocarcinoma pathological subtype according to March 2015.The fourth edition of the new classification of lung tumors published by WHO(see Table 2) was used to compare CT findings with pathological findings. Results The changes of CT components showed different pathological subtypes. After comparison, the proportion of non-invasive lesions in group 1 and group 2 was higher than that in group 3, and the difference between the two groups was statistically significant(P<0.05). Second, in CT prediction of pathological invasiveness and pathological subtypes compared with pathological results, the consistency of the test results show that the two results have good consistency. Conclusion The imaging features of solitary subsolid nodules of different pathological subtypes are different. CT follow-up can predict the invasiveness and histological subtype to some extent.