亚实性结节血管及支气管异常与肺腺癌类病变侵袭性的相关性分析

The correlations between vascular and bronchial abnormality on high resolution CT and the invasiveness of lung adenocarcinoma in subsolid nodules

研究高分辨率CT(HRCT)上显示无或少量实性成分的亚实性结节内血管及支气管异常与肺腺癌类病变侵袭性的相关性.方法回顾性分析我院2014年1月至2016年6月的315个HRCT显示为纯磨玻璃结节或实性成分≤6 mm且手术证实为肺腺癌类病变的亚实性结节,其中226个为pGGN,89个为部分实性结节.腺癌浸润前病变(PIL)48个,微浸润性腺癌(MIA)29个;浸润性腺癌(IAC)238个.IAC中附壁为主型145个(附壁成分≥50%),非附壁为主型93个(附壁成分<50%).观察结节内血管及支气管形态改变,采用卡方检验分析结节HRCT征象与病理类型及腺癌亚型的相关性.采用单因素方差分析检验不同病理类型组中结节最大径差异.结果结节为纯磨玻璃密度或部分实性与结节的PIL、MIA、IAC分类无相关性(χ^2=3.759,P=0.153).IAC组中血管形态异常率及支气管异常率分别为59.24%(141/238)、18.49%(44/238),MIA中分别为13.79%(4/29)、3.45%(1/29);PIL中均为0%;结节内血管、支气管形态异常与结节PIL、MIA、IAC类型相关(χ^2=69.797,P<0.001;χ^2=14.213,P=0.001).在非附壁为主型腺癌中血管及支气管形态异常率分别为78.49%(73/93)、26.88%(25/93),显著高于附壁为主型腺癌[46.90%(68/145)、13.10%(19/145)],结节内血管、支气管形态异常与浸润性腺癌亚型相关(χ^2=22.139,P<0.001;χ^2=6.253,P=0.012).结论在HRCT上无或仅含少量实性成分的亚实性结节内肺血管及支气管异常与肺腺癌类病变侵袭性及腺癌亚型密切相关.

Objective To observe the vascular and bronchial abnormalities in subsolid nodules on high resolution CT(HRCT),and analyze its correlations with the classification and subtypes of lung adenocarcinoma.Methods Pathological and radiographic data of 315 surgically resected subsolid nodules(226 were pure ground-glass opacities,and 89 were part solid nodules with tiny solid components≤6 mm)were retrospectively reviewed.The morphologic changes of the blood vessels and bronchia/bronchioles in ground-glass opacity on HRCT were evaluated,and their correlations with histopathology classification were analyzed.Chi-square test was performed for analysis of correlations with categorical variables,whereas the one-way ANOVA analysis was performed for analysis of correlations with continuous variables(e.g.,lesion dimension).Results Forty-eight pre-invasive lesions(PILs),29 minimally invasive adenocarcinomas(MIAs),and 238 invasive adenocarcinomas(IACs)were analyzed.IACs were divided into 2 groups according to the percentage of lepidic pattern:lepidic predominant(lepidic pattern≥50%,n=145),and non-lepidic predominant(lepidic patten<50%,n=93).The prevalence of vascular and bronchial abnormalities was higher in IACs(59.24%&18.49%in IACs,13.79%&3.45%in MIAs,and 0%&0%in PILs).The abnormalities of vessels and bronchi in nodules on HRCT were correlated with the PIL/MIA/IAC classifications(χ^2=69.797,P<0.001,χ^2=14.213,respectively).Moreover the prevalence of valcular and bronchial abnormalities significantly increased from non-lepidic predominant IACs(78.49%,26.88%)compared to lepidic predominant IACs(46.90%,13.10%),these morphologic abnormalities correlated with a higher percentage of non-lepidic pattern,which were considered with higher invasiveness,in IACs(P<0.001,χ^2=22.139,P=0.012,χ^2=6.253,respectively).Conclusion The morphologic changes of blood vessels and bronchia/bronchioles within the subsolid nodules on HRCT help to differentiate IAC from PIL and MIA,also correlate with the proportion of non-lepidic pattern in IACs,even when the solid component undeveloped or very tiny.