直径2cm以下肺磨玻璃结节微浸润与浸润性腺癌的高分辨率CT征象比较

Comparison of HRCT signs of lung ground glass nodules under 2 cm between microinfiltrating adenocarcinoma and infiltrating adenocarcinoma

目的探讨直径2 cm以下肺磨玻璃结节(GGN)微浸润癌(MIA)与浸润性腺癌(IAC)的高分辨率CT(HRCT)征象并进行分析。方法回顾性分析2015年6月至2020年3月杭州市萧山区第一人民医院手术治疗且经病理检查证实的203例肺GGN患者的HRCT图像,按病理类型分为MIA 101例和IAC 102例,对GGN的直径、实性成分、形态、胸膜凹陷征、空气支气管征、毛刺征、分叶征及空泡征进行对比分析;并筛选单因素分析中差异有统计学意义的变量进行二元logistic回归分析,采用ROC曲线确定MIA组和IAC组病灶直径的临界值。结果MIA组与IAC组的直径、实性成分、形状、胸膜凹陷征、空气支气管征、毛刺征、分叶征的差异均有统计学意义(均P<0.05),而空泡征差异无统计学意义(P=0.346),二元logistic回归分析结果显示较大的直径、混合磨玻璃结节(mGGN)、毛刺征、分叶征与IAC均显著相关(均P<0.05),ROC曲线分析结果显示鉴别MIA与IAC病灶直径的临界值为12.5 mm,灵敏度为0.68,特异度为0.77,AUC为0.784。结论直径2 cm以下的肺GGN,IAC与MIA相比直径较大(多>12.5 mm),且多见mGGN、毛刺征及分叶征。

Objective To compare the high resolution CT(HRCT)characteristics of lung ground glass nodules(GGN)under 2cm between microinvasive carcinoma(MIA)and invasive adenocarcinoma(IAC).Methods The HRCT images of 203 patients with lung GGN confirmed by pathology were retrospectively analyzed,including 101 cases of microinvasive carcinoma(MIA group)and 102 cases of invasive adenocarcinoma(IAC group).The nodule diameter,morphology,classification,and pleura of the patients,the depression sign,air bronchus sign,burr sign,lobular sign,and vacuole sign were compared between two groups.The values of HRCT signs in differentiation between MIA and IAC were analyzed with univariate and multivariate logistic regression analysis and ROC curve.Results There were significant differences in lesion diameter,solid composition,shape,pleural indentation sign,air bronchial sign,burr sign,and lobular sign between the MIA group and the IAC group(all P<0.05),while the difference in the vacuole sign was not statistically significant(P=0.346).The binary logistic regression analysis showed that the larger diameter,solid component,burr sign,and leaf sign were significantly correlated with IAC(all P<0.05).The AUC of ROC curve of the nodule diameter for distinguishing between the MIA group and the IAC group was 0.784,taking the cut-off value of 12.5 mm,the sensitivity was 0.68,specificity was 0.77.Conclusion For lung ground-glass nodules below 2 cm,GGN with a diameter greater than 12.5 mmis more likely to be IAC,which is also more likely to have burr and lobular signs in HRCT.