表现为磨玻璃结节的肺腺癌薄层CT征象分析及病理分型对照

Thin-slice CT analysis of lung adenocarcinoma presenting as ground glass nodules and comparison of pathological classification

探讨薄层CT(TSCT)表现为磨玻璃结节(GGN)的肺腺癌的CT征象,并与病理分型对照。回顾性搜集肺内TSCT发现的83个磨玻璃结节,根据病理结果分为浸润前病变组20个,微浸润腺癌组32个,浸润性腺癌组31个,分析不同病理分型的结节在薄层CT上的表现。83个结节中,34个表现为纯磨玻璃结节(pGGN),49个表现为混合磨玻璃结节(mGGN)。浸润前病变组共18个结节(18/20,90.0%)表现为pGGN,微浸润腺癌组共16个结节(16/32,50.0%)表现为pGGN,浸润性腺癌组无结节(0/31,0%)表现为pGGN。3组分叶征、空气支气管征、血管集束征、胸膜凹陷征的比例呈上升趋势,圆形/类圆形、瘤肺界面清晰征象的比例呈下降趋势。3组圆形或类圆形、分叶征、瘤肺界面清晰、空气支气管征、血管集束征、胸膜凹陷征的差异有统计学意义(P<0.05)。浸润前病变组与浸润性腺癌组比较,圆形或类圆形、分叶征、瘤肺界面清晰、空气支气管征、血管集束征、胸膜凹陷征差异有统计学意义(P<0.05);微浸润腺癌组与浸润性腺癌组间类圆形、分叶征、瘤肺界面清晰、血管集束征差异有统计学意义(P<0.05)。不同病理分型的GGN在TSCT上的表现具有一定的特异性,熟悉TSCT表现有助于浸润前病变、微浸润腺癌及浸润性腺癌的诊断及鉴别诊断。

To investigate the CT features of lung adenocarcinoma with ground glass nodules(GGN)on thin slice CT(TSCT)and to compare with the pathological classification.A total of 83 pulmonary ground glass nodules were collected retrospectively.According to the pathological results,the lesions were divided into pre-invasive lesions group with 20 lesions,microinvasive adenocarcinoma(MIA)group with 32 lesions,and invasive adenocarcinoma(IAC)group with 31 lesions.The appearance of nodules with different pathological types on thin-slice CT was analyzed.Among 83 lesions,341esions were pure ground glass opacity(pGGN),while 49 lesions were mixed ground glass opacity(mGGN).pGGN was observed in pre-invasive lesions group(18/20,90.0%),MIA group(16/32,50.0%)and IAC group(0/31,0%),respectively.Among the 3 groups,the proportion of foliation sign,air bronchi sign,vascular cluster sign and pleural depression sign showed an increasing trend,while the proportion of round/quasi-round sign and clear sign of tumor lung interface showed a decreasing trend.There were statistically significant differences in round or quasi-round,lobulated sign,clear lung interface of tumor,air bronchi sign,vascular cluster sign and pleural depression sign(P<0.05).There were statistically significant differences between pre-invasive lesions group and IAC group in round or round shape,lobulation sign,clear lung interface of tumor,air bronchi sign,vascular cluster sign and pleural depression sign(P<0.05).There were statistically significant differences between MIA group and IAC group in terms of roundness,lobulation sign,clear lung interface of tumor and vascular cluster sign(P<0.05).The manifestations of GGN of different pathological types on TSCT have certain specificity,and familiarity with the manifestations of TSCT is conducive to the diagnosis and differential diagnosis of pre-invasive lesions,micro-invasive adenocarcinoma and invasive adenocarcinoma.