CT扫描对肺腺癌患者胸膜下纯磨玻璃结节浸润性的预测价值

Value of CT scanning in predicting the infiltration of subpleural pure ground glass nodules in patients with lung adenocarcinoma

目的通过CT扫描分析肺腺癌患者胸膜下纯磨玻璃结节(pGGN)的浸润性。方法经手术切除pGGN且病理证实为肺腺癌患者189例,结节距离胸膜≤20 mm。其中,157例(A组)的病理类型包括浸润前病变和微浸润性腺癌,32例(B组)的病理类型均为浸润性腺癌。根据结节与胸膜位置关系分为3型:Ⅰ型,与胸膜无关系;Ⅱ型,结节与胸膜相贴;Ⅲ型,结节与胸膜线状牵拉。分析两组结节与胸膜的关系、大小、平均密度及形态学特点,并采用多因素logistic回归分析结节为浸润性腺癌的影响因素。结果 A组患者结节长径与短径小于B组,有毛刺征的比例少于B组(P<0.05)。多因素分析显示,Ⅲ型结节与胸膜位置关系是判定pGGN为浸润性腺癌的独立危险因素(P<0.05)。结论Ⅲ型结节与胸膜位置关系是胸膜下pGGN判定为浸润性腺癌的独立危险因素。通过CT扫描观察结节与胸膜位置关系分型可以指导随访计划和选择手术适应证。

Objective To analyze the infiltration of pure ground glass nodules under the pleura by CT scanning in the patients with lung adenocarcinoma.Methods A total of 189 patients were with pure ground glass nodules≤20 mm beside pleura,which was surgically removed and pathologically confirmed as lung adenocarcinoma.Of 189 nodules,157 nodules(group A)were characterized pathologically as pre-invasive lesions and micro-invasive adenocarcinoma and 32 nodules(group B)were characterized pathologically as invasive adenocarcinoma.According to the relationship between the nodules and pleura,the nodules were classified into three types ofⅠ(no relationship with pleura),Ⅱ(attached to the pleura)andⅢ(linearly retracted by pleura).The relationship of the nodules with pleura and their size,average density and morphological characteristics were analyzed.Multivariate logistic regression was used to analyze the influencing factors of the nodules as invasive adenocarcinoma.Results The long diameter and short diameter of nodules in group A were smaller than those in group B,and the proportion of burr sign was lower than that in group B(P<0.05).The multivariate analysis showed that typeⅢrelationship between the nodules and pleura was an independent risk factor for determining nodules as invasive adenocarcinoma(P<0.05).ConclusionTypeⅢrelationship between the nodules and pleura is an independent risk factor for determining pure ground glass nodules as the invasive adenocarcinoma.By CT scanning,the classification of the relationship between nodule and pleural location can guide the follow-up plan and the selection of surgical indications.