高分辨率CT在不同病理分类微小磨砂玻璃结节样肺腺癌患者诊断中的应用

Application of high resolution CT in the diagnosis of small ground-glass nodular lung adenocarcinoma with different pathological classifications

目的分析高分辨率CT在不同病理分类微小磨砂玻璃结节样肺腺癌患者诊断中的应用价值。方法回顾性分析西京医院2016年2月至2019年5月收治的经手术病理检查证实的120例微小磨砂玻璃结节样肺腺癌患者的临床资料,根据术后病理检查结果将患者分为浸润性腺癌(IA)50例、微浸润腺癌(MIA)32例、完全沿肺泡间隔贴壁样生长的原位腺癌(AIS)20例和非典型腺瘤样增生(AAH)18例,术前全部患者均接受高分辨率CT检查,分析病理性分级与CT表现的相关性。结果IA组、MIA组、AIS组、AAH组患者的年龄比较差异无统计学意义(P>0.05);各组间性别比例比较差异有统计学意义(P<0.05)。IA组患者的胸膜凹陷征发生率为78.0%,明显高于MIA组的34.4%、AIS组的30.0%和AAH组的11.1%,差异均有统计学意义(P<0.05);IA组、MIA组、AIS组患者的支气管充气征发生率分别为54.0%、34.4%、20.0%,均明显高于AAH组的0,IA组明显高于MIA组、AIS组,差异均有统计学意义(P<0.05),MIA组与AIS组比较差异无统计学意义(P>0.05);IA组患者的空泡征发生率为96.8%,明显高于MIA组的68.8%、AIS组的70.0%和AAH组的66.7%,差异均有统计学意义(P<0.05);IA组患者的分叶征发生率为100.0%,明显高于MIA组的78.1%、AIS组的65.0%和AAH组的38.9%,而MIA组、AIS组则明显高于AAH组,差异均有统计学意义(P<0.05);AIS组和MIA组患者的毛刺征发生率分别为65.0%、84.4%,明显高于IA组的50%、AAH组的22.2%,而MIA组明显高于AIS组,IA组明显高于AAH组,差异均有统计学意义(P<0.05)。结论胸膜凹陷征、支气管充气征、空泡征、分叶征、毛刺征是对肺磨玻璃结节病理学分级进行鉴别的主要依据,通过综合分析磨玻璃结节的CT影像学特征,能准确鉴别病理学分级。

Objective To analyze the value of high resolution CT in the diagnosis of small ground-glass nodular lung adenocarcinoma with different pathological classification. Methods The clinical data of 120 cases of small ground-glass nodular lung adenocarcinoma confirmed by operation and pathology from February 2016 to May 2019 in Xijing Hospital were analyzed retrospectively. According to the results of postoperative pathology, the patients were divided into 50 cases of invasive adenocarcinoma(IA), 32 cases of microinvasive adenocarcinoma(MIA), 20 cases of adenocarcinoma in situ(AIS), and 18 cases of atypical adenomatous hyperplasia(AAH). All patients were examined with high-resolution CT before operation, and the correlation between pathological grading and CT manifestations was analyzed. Results There was no significant difference in age among IA group, MIA group, AIS group, and AAH group(P>0.05). The incidence of pleural indentation in IA group was 78.0%, which was significantly higher than 34.4% in MIA group, 30.0% in AIS group and 11.1% in AAH group(P<0.05). The incidence of bronchial inflation in IA group, MIA group, and AIS group was 54.0%, 34.4%, and 20.0%, respectively, significantly higher than 0 in AAH group(P<0.05);the incidence was significantly higher in IA group than MIA group and AIS group(P<0.05);there was no significant difference between the MIA group and the AIS group(P>0.05). The incidence of vacuoles in the IA group was 96.8%,which was significantly higher than 68.8% in the MIA group, 70.0% in the AIS group, and 66.7% in the AAH group(P<0.05). The incidence was 100.0%, significantly higher than 78.1% in MIA group, 65.0% in AIS group, and 38.9% in AAH group, while that in MIA group and AIS group was significantly higher than that in AAH group(P<0.05). The incidence of burr sign in AIS group and MIA group was 65.0%, 84.4%, significantly higher than 50.0% in IA group and22.2% in AAH group, while that in MIA group was significantly higher than that in AIS group, and that in IA group was significantly higher than that in AAH group(P<0.05). Conclusion Pleural depression, bronchiectasis, vacuole, lobulation, and hairpin syndrome are the main basis for the differentiation of pathological grade of lung ground glass nodule.Through the comprehensive analysis of CT imaging features of ground-glass nodule, pathological grade can be distinguished accurately.