济南市区域成年健康查体人群胸部CT检出肺局灶性磨玻璃密度结节情况

Pulmonary focal ground glass nodules detected by chest CT in healthy adults in Jinan

目的探讨在正常健康体检人群中通过胸部低剂量螺旋CT检出肺局灶性磨玻璃密度结节(fGGN)及检出后随访或手术确诊为肺癌的情况。方法回顾性分析2019年7月至2020年12月在山东省中医药研究院附属医院、长清区人民医院接受健康体检的18657人的胸部低剂量螺旋CT资料,筛查检出fGGN患者,按结果分别按年龄段、性别、fGGN大小分组,比较fGGN及肺癌检出率。结果18657人共检出fGGN为3957例,总检出率为21.21%,其中男性检出1901例,占男性总人数18.90%;女性检出2056例,占女性总人数23.90%,男女检出率比较差异有统计学意义(χ^(2)=69.36,P<0.01)。3957例fGGN检出人群中,共发现fGGN 6003个,其中以左肺下叶检出率最高,占31.90%,径线≤5 mm fGGN检出率最高,占73.53%。随着年龄的增长,fGGN检出率增高,其中≤29岁组检出率最低,为8.47%;≥80岁组fGGN检出率最高,约为30.48%,fGGN检出率在不同年龄段差异有统计学意义(χ^(2)=529.89,P<0.01)。最终通过手术及穿刺等手段共42例患者取得明确病理学结果,其中37例病理诊断为肺癌,女性原位腺癌及微浸润腺癌占比较高,男性浸润性腺癌和鳞状细胞癌占比较高,女性和男性肺癌病理类型比较差异有统计学意义(P<0.01)。所有病例手术后均无肺门、纵隔淋巴结转移及远处转移。另外5例为良性病变,肉芽肿1例,肺内淋巴结1例,隐球菌感染1例,肺结核2例。结论在健康人群中进行胸部低剂量螺旋CT筛查对于初早期肺癌的检出利大于弊,对高危级别fGGN密切复查、诊治易发现初早期肺癌,尤其是腺癌。应该在40岁以上(有条件30岁以上)的健康人群中开展胸部低剂量螺旋CT筛查。

Objective To investigate the detection of pulmonary focal ground glass density nodules(fGGN)by chest low-dose spiral CT in healthy people and the diagnosis of lung cancer after follow-up or surgery.Methods The chest low-dose spiral CT data of 18657 people who received physical examination in the Affiliated Hospital of Shandong Academy of Chinese Medicine and Changqing District People′s Hospital from July 2019 to December 2020 were retrospectively analyzed.fGGN patients were screened and divided into groups according to age,gender and fGGN size.The detection rates of fGGN and lung cancer were compared.Results Among the 18657 people,there were 3957 patients who were detected as fGGN,and the total detection rate was 21.21%.Among them,1901 cases were male,accounting for 18.90%of the total number of men,and there were 2056 females,accounting for 23.90%of the total number of women.There was a significant difference in the detection rate between men and women(χ^(2)=69.36,P<0.01).Among 3957 patients with fGGN,6003 fGGNs were found,among which the detection rate of left lower lobe was the highest(31.90%),and the detection rate of diameter≤5 mm was the highest(73.53%).With the increase of age,the detection rate of fGGN increased,and the detection rate of fGGN was the lowest in≤29 years old(8.47%).The detection rate of fGGN was the highest in≥80 years old(30.48%).There was significant difference of fGGN detection rate in different age groups(χ^(2)=529.89,P<0.01).A total of 42 patients obtained definite pathological results by operation or puncture.Among them,37 cases were lung cancer.The proportion of adenocarcinoma in situ and micro invasive adenocarcinoma in women was higher,and the proportion of invasive adenocarcinoma and squamous cell carcinoma in men was higher.There was a significant difference in the pathological types of lung cancer between women and men(P<0.01).All cases had no hilar,mediastinal lymph node metastasis or distant metastasis after operation.And there were 5 cases being benign lesions,1 case of granuloma,1 case of lymph node in lung,1 case of Cryptococci infection and 2 cases of tuberculosis.Conclusion Low dose spiral CT screening in healthy population has more advantages than disadvantages for the detection of early lung cancer.Close review and diagnosis of high-risk fGGN are easy to find early lung cancer,especially adenocarcinoma.Low dose spiral CT screening should be carried out in healthy people over 40 years old(30 years old if possible).