基于薄层CT扫描肺纯磨玻璃结节的病理分析

Postoperative Pathological Analysis of Pure Ground Glass Nodules of the Lung Based on Thin-section Chest CT Scan

目的 探索在胸部薄层CT(thin-section CT,TSCT)表现为肺纯磨玻璃结节(pure ground-glass opacity,p-GGO)患者的影像学特征对术后病理预判的可能性。方法 对笔者医院2019年1月~2020年6月行胸腔镜手术治疗的451例p-GGO患者的临床资料进行回顾性分析,依据TSCT扫描所表现的p-GGO内部特征将p-GGO分为Ⅰ型p-GGO和Ⅱ型p-GGO。结果 451例患者中包括Ⅰ型p-GGO 188例(41.7%),Ⅱ型p-GGO 263例(58.3%)。与Ⅱ型p-GGO比较,Ⅰ型p-GGO病变最大径度(8.86±5.10mm vs 11.24±5.80mm,F=8.247,P=0.004)、径度增大和密度增高的平均时间(30.50±14.30个月vs 9.74±16.40个月,F=6.945,P=0.009)、边缘分叶或毛刺征(P=0.000)、胸膜征(P=0.001)、血管征(P=0.009)等影像学表现的差异有统计学意义。Ⅰ型p-GGO组中的浸润前期病变例数(n=123)明显多于Ⅱ型p-GGO组(n=63),而微浸润期病变例数(20例vs 86例)和浸润期病变例数(17例vs 86例)明显少于Ⅱ型p-GGO组(P=0.000),且Ⅱ型p-GGO组中有更多的病例发生局部浸润(P=0.000)。结论 p-GGO在TSCT所表现的内部特征有助于对早期肺癌病理特性的预判。

Objective To explore the possibility of predicting postoperative pathology by imaging features of patients with pure ground glass nodules(p-GGO) in thin-section CT(TSCT) of the chest.Methods The clinical data of 451 patients with p-GGO who underwent single-port thoracoscopic surgery in our hospital from January 2019 to June 2020 were analyzed retrospectively.Results 451 patients included type Ⅰ p-GGO 188 cases(41.7%) and type Ⅱ p-GGO 263 cases(58.3%).The mean maximum diameter of type Ⅰ p-GGO was significantly smaller than that of type Ⅱ p-GGO(8.86±5.10 mm vs 11.24±5.80 mm,F=8.247,P=0.004).The average time of diameter and density increase of type Ⅰ p-GGO was significantly longer than that of type Ⅱ p-GGO(30.50±14.30 months,9.74±16.40 months,F=6.945,P=0.009),and there were significant differences in the imaging manifestations of the two types of p-GGO,such as lobulation or spiculation sign(P=0.000),pleural tag(P=0.001) and vessel convergence sign(P=0.009).The number of cases of pre-invasive lesions in type Ⅰ p-GGO group(123 cases) was significantly higher than that in type Ⅱ p-GGO group(63 cases),while the number of cases of MIA(20 cases vs 86 cases) and the number of cases of IA(17 cases vs 86 cases) was significantly less than type Ⅱ p-GGO group(P=0.000).Compared with type Ⅰ p-GGO group,there were significantly more cases of local infiltration in type Ⅱ p-GGO group(P=0.000).Conclusion The two types of p-GGO with internal characteristics as the main imaging differentiation based on TSCT scan,had obvious corresponding relationship with postoperative pathological features.