CT征象对不同病理亚型肺腺癌的诊断价值

Diagnostic value of CT features in different pathological subtypes of lung adenocarcinoma

目的探讨纯磨玻璃结节(pGGN)的CT征象对不同肺腺癌亚型的诊断价值,为pGGN管理和治疗提供影像支持。方法分析2019年1月至12月解放军总医院第一医学中心手术切除直径≤2 cm的pGGN且病理证实为早期肺腺癌的215例(236个结节)患者的临床资料。按照pGGN的病理亚型将其分为浸润前病变-微浸润腺癌组(117个)、贴壁为主型肺腺癌组(77个)、非贴壁为主型肺腺癌组(42个)。比较三组的临床特征及CT特征;绘制直径、CT值及联合检测的受试者操作特征曲线,预测浸润性肺腺癌的诊断效能。结果三组分叶、毛刺、血管改变、直径、CT值比较,差异有统计学意义(P<0.05)。直径、CT值与病理亚型呈正相关(r=0.302、0.352,P<0.05)。分叶、血管改变、直径和CT值是发生浸润性肺腺癌的影响因素(OR>1,P<0.05)。直径、CT值联合检测诊断浸润性肺腺癌的曲线下面积大于各指标单独检测。结论pGGN的CT征象与其病理亚型有一定的关系,出现分叶、毛刺、血管改变等形态学改变时应引起注意。

Objective To investigate the diagnostic value of the CT features of pure ground-glass nodules(pGGN)in different pathological subtypes lung adenocarcinoma,and to provide imaging support for the management and treatment of pGGN.Methods The clinical data of 215 patients(236 nodules)with pGGN≤2 cm in diameter and pathologically confirmed early lung adenocarcinoma at the First Medical Center of General Hospital of the Chinese People’s Liberation Army from January to December 2019 were analyzed.According to the pathological subtypes of pGGN,they were divided into preinvasive lesions-minimally invasive adenocarcinoma group(117 nodules),lepidic predominant adenocarcinoma group(77 nodules),and non-lepidic predominant adenocarcinoma group(42 nodules).The clinical features and CT features of the three groups were compared;receiver operating characteristic curves of diameter,CT value,and combined detection were drawn to predict the diagnostic efficacy of invasive predominant adenocarcinoma.Results There were significant differences in lobulation,spiculation,vascular changes,diameter,and CT value among three components(P<0.05).Diameter and CT value were positively correlated with pathological subtype(r=0.302,0.352,P<0.05).Lobulation,vascular changes,diameter,and CT value were the influencing factors of invasive pulmonary adenocarcinoma(OR>1,P<0.05).The area under the curve of invasive predominant adenocarcinoma diagnosed by the combined detection of diameter and CT value was greater than that detected by each index alone.Conclusion The CT features of pGGN are related to its pathological subtype to some extent.Attention should be paid to morphological changes such as lobulation,spiculation,and vascular changes.