囊腔性肺癌的超高分辨率CT研究

Ultra-High-Resolution CT Study of Lung Cancers with Cystic Airspaces

目的:一般认为,影像学上囊腔性肺癌定义为病灶内有明显类圆形或不规则含气囊腔的肺癌,囊常常有壁,与空泡不同,后者一般来说无壁。本研究拟回顾性分析囊腔性肺癌的超高分辨率CT特征,以期准确判断肿瘤侵袭性。方法:62例手术切除病理证实的囊腔性肺癌纳入研究,男性39例,女性23例,年龄30-73岁(中位年龄61岁)。超高分辨率CT扫描技术:调整体位使病灶位于体轴重力线上,1024矩阵扫描,高对比分辨率算法及迭代算法重建。在多平面重组三维正交图像的肺结节最大截面上完成分析,根据病变的非囊性成分分为磨玻璃和实性囊腔性肺癌2组。结果:磨玻璃组55个(88.7%),包括49例侵袭性病变和6例侵袭前病变,实性组7个(11.3%),包括4例腺癌、2例鳞癌和1例大细胞癌。对于磨玻璃组,病灶最大径、囊腔最大径、囊腔数目(单囊或多囊)、最大囊壁厚度对确定肿瘤有无侵袭性具有统计学上显著性意义(P<0.05),多因素Logistic回归分析显示病灶最大径、多囊性是判断病变侵袭性的独立预测因子。ROC曲线分析显示病灶最大径〉13.5mm诊断侵袭性病变的曲线下面积为0.940,敏感度和特异度分别为87.8%、83.3%。结论:对于磨玻璃囊腔性肺癌,病灶最大径、囊腔最大径、多囊和最大囊壁厚度对提示肿瘤侵袭性有价值,其中病灶最大径、多囊是判断肿瘤侵袭性的独立预测因子,病灶最大径大于13.5mm提示肿瘤为侵袭性。

Purpose:It is generally believed that lung cancers with cystic airspaces are defined as lung cancers with obvious round or irregular air-contained and cystic cavities in the lung.The cysts are usually with walls,unlike vacuoles,which generally have no wall.This study is to retrospectively analyze the ultra-high resolution CT features of cystic lung cancers in order to accurately judge the invasiveness of the tumor.Methods:Sixty-two cases with cystic lung cancer confirmed by surgical resection and pathology results were included in the study with 39 males and 23 females,aged from 30 to 73 years(median age 61 years).Ultra-high resolution CT scanning technology including:adjusting the position to make the lesion locate on the axis gravity line,with the matrix of 1024x1024 and high contrast resolution algorithm reconstruction+iteration algorithm.Based on the non-cystic components of the lesions,the pulmonary nodules were divided into two groups:ground glass and solid with cystic change lung cancers.Results:There were 55 cases(88.7%)in the ground glass group,including 49 cases of invasive lesions and 6 cases of pre-invasive lesions;and 7 cases(11.3%)in solid group,including 4 cases of adenocarcinoma,2 cases of squamous cell carcinoma and 1 case of large cell carcinoma.For the ground glass group,the maximum diameter of the lesion,the maximum diameter of the cyst,the number of cyst(single or multiple cysts),the maximum thickness of the cyst wall were with statistical significant in determining the invasiveness of the tumors(P<0.05).Multivariate logistic regression analysis showed that the maximum diameter of the lesion and the multiple cysts were independent predictors of the invasiveness of the lesions.ROC curve analysis showed that the area under the curve(AUC)was 0.940,the sensitivity and specificity were 87.8%and 83.3%,respectively.Conclusion:For cystic lung cancer with GGO components,the largest diameter of the lesion,the largest diameter of the cyst,the largest thickness of the cyst wall and the largest diameter of the cyst are of value in indicating the invasiveness of the tumoi;The largest diameter and the largest thickness of the cyst wall are independent predictors of the invasiveness of the tumor.The largest diameter of the lesion of larger than 13.5 mm indicats the tumor invasiveness.