肺原位腺癌与微浸润腺癌的病理分化情况及超高分辨率CT对疾病的鉴别诊断价值

The Pathological Differentiation of Adenocarcinoma in Situ and Minimally Invasive Adenocarcinoma and the Value of Ultra-high-resolution CT in the Differential Diagnosis of Diseases

目的研究肺原位腺癌与微浸润腺癌的病理分化情况及超高分辨率CT对疾病的鉴别诊断价值。方法回顾性分析80例肺腺癌患者的临床资料,所有患者均经病理组织学证实,肺原位腺癌46例、微浸润腺癌34例。观察比较肺原位腺癌与微浸润腺癌的超高分辨率CT图像,包括形状、边缘、密度,病灶直径和CT值,病灶内肺静脉异常、空气支气管征、胸膜凹陷征发生情况。结果病理结果提示肺原位腺癌、微浸润腺癌患者的病理分化程度差异无统计学意义(P>0.05)。肺原位腺癌患者的病灶边界清晰、边缘规则比例显著高于微浸润腺癌患者(P<0.05),并且2种病灶密度类型比较差异亦有统计学意义(P<0.05)。肺原位腺癌患者的病灶平均直径显著短于微浸润腺癌患者,病灶平均CT值显著高于微浸润腺癌患者,差异有统计学意义(P<0.05)。肺原位腺癌患者的病灶内肺静脉异常、空气支气管征、胸膜凹陷征发生率显著低于微浸润腺癌患者,差异有统计学意义(P<0.05)。结论肺原位腺癌与微浸润腺癌的病理分化程度未见显著差异,但超高分辨率CT成像清晰,能够清楚显示肺腺癌的形态学特征,有助于肺原位腺癌与微浸润腺癌的鉴别诊断。

Objective To investigate the pathological differentiation of adenocarcinoma in situ andminimally invasive adenocarcinoma and the value of ultra-high-resolution CT in the differential diagnosis of diseases,provide a reliable reference for clinical diagnosis and treatment.Methods The clinical data of 80 patients with lung adenocarcinoma diagnosed and treated were retrospectively analyzed,all patients were confirmed by histopathology,included 46 cases of adenocarcinoma in situ and 34 cases of minimally invasive adenocarcinoma.The ultra-high-resolution CT images of adenocarcinoma in situ and minimally invasive adenocarcinoma were observed and compared,included shape,edge,density,lesion diameter and CT value,pulmonary vein abnormalities,air bronchial signs,and pleural depression signs in the lesion.Results Pathological results suggested that there was no statistically significant difference in the degree of pathological differentiation between patients with adenocarcinoma in situ and minimally invasive adenocarcinoma(P>0.05).Patients with adenocarcinoma in situ had higher ratios of clear borders and regular marginal than patients with minimally invasive adenocarcinoma(P<0.05),and the difference in type of lesion density between the 2 groups was also statistically significant(P<0.05).The average diameter of lesions in patients with adenocarcinoma in situ was significantly shorter than that in patients with minimally invasive adenocarcinoma,and the average CT value of lesions was significantly higher than that in patients with minimally invasive adenocarcinoma,the differences were statistically significant(P<0.05).The incidence of pulmonary vein abnormalities,air bronchial signs and pleural depression signs in patients with adenocarcinoma in situ were significantly lower than that in patients with minimally invasive adenocarcinoma(P<0.05).Conclusion There is no significant difference in the pathological differentiation between adenocarcinoma in situ and minimally invasive adenocarcinoma.Ultra-high-resolution CT imaging is clear,it can clearly show the morphological characteristics of lung adenocarcinoma,and it is helpful for differential diagnosis of adenocarcinoma in situ and minimally invasive adenocarcinoma.