多层螺旋CT对肺磨玻璃结节不同病理类型肺腺癌的诊断价值

The Diagnostic Value of Multi-slice Spiral CT in Different Pathological Types of Lung Adenocarcinoma of Lung Ground Glass Nodules

目的:研究多层螺旋CT(MSCT)对肺磨玻璃结节(GGN)不同病理类型肺腺癌的诊断价值。方法:回顾性分析2019年9月-2021年7月福州肺科医院收治的126例肺腺癌患者的临床资料为观察组,选取同期50例肺炎性病变患者的临床资料为对照组。以病理诊断结果为金标准,比较MSCT检查结果与病理诊断结果。对比两组GGN的MSCT征象,包括边界清晰、胸膜凹陷、分叶、晕厚度不均及血管聚集征。比较GGN不同病理类型肺腺癌MSCT征象,包括数量(单发、多发)、大小(<8 mm,≥8 mm)、部位(中心性生长,偏离中心性生长)、密度(与同层面血管相近,较同层面血管低)及形状(不规则、多边形或点状、椭圆或圆形)。结果:MSCT检查对肺腺癌诊断准确度、特异度及敏感度分别为89.20%(157/176)、78.00%(39/50)、93.65%(118/126)。观察组边界清晰、胸膜凹陷、分叶、晕厚度不均及血管聚集征比例均高于对照组(P<0.05)。三组大小、部位、密度、数量及形状比较,差异均有统计学意义(P<0.05)。浸润性腺癌(IAC)组大小≥8 mm、偏离中心性生长、密度与同层面血管接近、形状不规则占比均高于原位腺癌(AIS)组(P<0.05)。微浸润腺癌(MIA)组大小<8 mm、密度较同层面血管低、数量多发、形状椭圆或圆形占比均高于IAC组(P<0.05)。AIS组中心性生长、密度较同层面血管低、数量单发、形状多边形或点状占比均高于MIA组(P<0.05)。结论:MSCT对GGN不同病理类型肺腺癌的诊断价值较高,可预判混合性GGN肺腺癌病理类型,为临床诊治提供可靠依据。

Objective:To study the diagnostic value of multi-slice spiral CT (MSCT) in different pathological types of lung adenocarcinoma of lung ground glass nodules (GGN).Method:The clinical data of 126 patients with lung adenocarcinoma admitted to Fuzhou Pulmonary Hospital from September 2019 to July 2021 were retrospectively analyzed as the observation group,and the clinical data of 50 patients with pneumonia lesions during the same period were selected as the control group.The pathological diagnosis results was the gold standard,the results of MSCT examination were compared with the results of pathological diagnosis.The MSCT signs of GGN were compared between the two groups,including clear boundary,pleural depression,lobulation,uneven halo thickness and vascular aggregation signs.Types of lung adenocarcinoma MSCT signs were compared,including number (single,multiple),size (<8 mm,≥8 mm),location (central growth,deviated central growth),density (similar to the vessels at the same level,lower than the vessels at the same level) and shape (irregular,polygonal or punctate,oval or circular).Result:The accuracy,specificity and sensitivity of MSCT in the diagnosis of lung adenocarcinoma were 89.20% (157/176),78.00% (39/50) and 93.65% (118/126),respectively.The proportions of clear boundary,pleural depression,lobulation,uneven halo thickness and vascular aggregation signs in the observation group were higher than those in the control group (P<0.05).There were significant differences in size,location,density,number and shape among the three groups (P<0.05).The proportions of size ≥8 mm,deviated central growth,similar to the vessels at the same level and irregular shape in the invasive adenocarcinoma (IAC) group were higher than those in the adenocarcinoma in situ (AIS) group (P<0.05).The proportions of size <8 mm,lower than the vessels at the same level,the number was multiple and oval or round shape in the microinvasive adenocarcinoma (MIA) group were higher than those in the IAC group (P<0.05).The proportion of central growth and lower than the vessels at the same level,the number was single,polygonal or punctate shape in the AIS group were higher than those in the MIA group (P<0.05).Conclusion:MSCT has high diagnostic value for different pathological types of GGN lung adenocarcinoma,and can predict the pathological types of mixed GGN lung adenocarcinoma,providing a reliable basis for clinical diagnosis and treatment.