肺磨玻璃结节的CT影像特征与病理分类的对照分析研究

Comparative analysis of ground glass nodular lung adenocarcinoma CT imaging features and pathologic classification

目的:探讨分析肺磨玻璃结节(GGN)的高分辨率CT(HRCT)影像特征与早期肺腺癌病理分类之间的关系。方法:回顾性分析116例经手术治疗的肺GGN患者的HRCT资料,按照最新的肺腺癌病理分类标准将其分为3组:浸润前组共41例,包括不典型腺瘤样增生(AAH)16例、原位腺体癌(AIS)25例;微浸润腺癌(MIA)组33例;浸润性腺癌(IAC)组42例。对各组GGN的大小、密度、分叶征、毛刺征、空泡征、胸膜牵拉征、血管集束征和空气支气管征进行评估并作统计学分析。结果:病变大小在3组间比较均有显著差异(P<0.01);毛刺征和分叶征在3组间比较均有显著差异(P<0.01);胸膜牵拉征在示浸润前组、MIA组与IAC组间比较差异有统计学意义(P<0.01),但在浸润前组与MIA组间比较无显著差异(P>0.05);血管集束征在MIA组、IAC组与浸润前组比较差异有统计学意义(P<0.01),但在MIA组与IAC组之间比较无显著差异(P>0.05);空泡征、空气支气管征和病变密度在3组之间比较差异均无统计学意义(P>0.05)。结论:病变大小、分叶征、毛刺征、胸膜牵拉征、血管集束征可作为区分浸润前病变、MIA和IAC的重要CT影像特征。

Objective: To study and compare the relationship between high-resolution computed tomography(HRCT) imaging signs of lung ground glass nodules (GGN) and the new pathological classification of early-stage lung adenocarcinoma in order to improve the diagnosis of GGN. Methods: The HRCT data of postperative 116 patients with pathologically confirmed pulmonary GGN were retrospectively analyzed. According to the newest pathological classification criteria for lung adenocarcinoma, they were divided into 3 groups: 41 in the infiltration group, including 16 cases of atypical adenomatous hyperplasia(AAH), 25 cases of carcinoma in situ (AIS);33 cases of micro-invasive carcinoma (MIA) group;42 cases of invasive adenocarcinoma(IAC) group. The GGN size, density, lobulation sign, burr sign, pleural stretch sign, vascular cluster sign, air bronchogram were evaluated for each group and statistical analysis was done. Results: The distribution of the lesion size had a significant difference among the three groups (P<0.01). The distribution of lobulation sign and burr sign had significant differences among the three groups (P<0.01). The comparison between the pleural stretch signs showed that there were significant differences between the infiltration group, the MIA group, and the IAC group (P<0.01), but there was no significant difference between the infiltration group and the MIA group (P>0.05). Compared between vascular cluster signs, MIA group and IAC group were higher than those before infiltration group, and the difference was statistically significant (P<0.01). There was no significant difference between MIA group and IAC group(P>0.05). The distribution of cavitation sign, air bronchogram and lesions density had no significant differences among the three groups. Conclusion: The lesion size, lobular sign, burr sign, pleural stretch sign, vascular cluster sign are important CT imaging features that distinguish pre-infiltrating lesion, MIA and IAC can improve the understanding of the new pathological classification of micro GGN-like lung adenocarcinoma.