20〜30mm磨玻璃肺结节的影像学特征及术后病理分析

Analysis of the Imaging Characteristics and Postoperative Pathology of 20 to 30mm Ground Glass Opacity Lung Nodules

目的分析20~30mm磨玻璃肺结节(GGO)的影像学征象及病理特征。方法对笔者医院2017年1月~2019年12月手术治疗的29例20~30mm磨玻璃肺结节患者的影像学特征和术后病理结果等进行回顾性研究。结果在29例患者中,男性13例,女性16例。平均年龄为64.7岁(49~78岁)。随访观察时间4~2190天,平均随访观察时间为261.76天。病变最大径21~30mm,平均病变最大径为24.7mm。形态规则的GGO为21例(72.40%),分叶状21例(72.7%),胸膜牵拉16例(55.2%),血管征象18例(62.1%)。术式包括亚肺叶切除3例、肺叶切除术26例。术后病理报告硬化性血管瘤1例,微浸润癌7例、浸润腺癌21例,其中腺泡为主型、贴壁为主型和乳头状生长为主型分别为7例(29.17%)、15例(62.5%)和2例(8.33%),这3种亚型的ki-67值分别为11.86%、8.53%和12.50%;发现肿瘤细胞累及脏层胸膜4例(19.05%),肺泡内浸润4例(19.05%),脉管浸润2例(9.52%)。结论GGO的形态、边缘征象、内部征象、PETCT所反映的病灶代谢征象和动态观察征象,与肿瘤细胞的ki-67值的关系更为密切。应该考虑把20~30mm GGO的最大径纳入TNM分期中“T”分期。

Objective To analyze the imaging signs and pathological features of 20-30mm ground glass opacity lung nodules(GGO).MethodsClinical data such as imaging characteristics and postoperative pathological results of 29 patients with 20-30mm GGOs were examined from January 2017 to December 2019.ResultsIn 29 patients,13 were male and 16 were women,with average age 64.7 years(49-78 years).Follow-up time was 4 to 2190 days(average 261.76 days).Lesion diameter was 21 to 30mm(average 24.7mm).21 cases(72.40%)GGO were spherical,9 cases with smooth margin(31.03%),16 cases with pleural retraction(55.2%).The extent of operation was Lobectomy 26,Segmentectomy 1,Wedge resection 2.Postoperative pathology reported 1 case of sclerosing pneumocytoma,7 cases of MIA and 21 cases of adenocarcinoma,7 cases of Acinar predominant pattern,15 cases of Lepidic predominant pattern and 2 cases of papillary predominant pattern.The ki-67 values of the subtype were 11.86%,8.53%and 12.50%,respectively,and local invasion was found including 4 cases of perineural invasion,4 cases of pleural invasion,2 cases of lymphovascular invasion.ConclusionThe imaging characteristics of GGOs were more closely related to the ki-67 value of tumor cells,and the size of 20-30mm GGO should be considered in the"T"stage of TNM.