薄层CT表现为磨玻璃结节的浸润与微浸润性肺腺癌的影像与病理的对照研究

A comparative study of imaging and pathology of invasive and minimally invasive lung adenocarcinoma with thin-slice CT manifestations of ground glass nodules

目的通过CT影像学为肺部磨玻璃结节与其术后病理确诊为微浸润腺癌(MIA)和浸润性腺癌(IAC)的对照,研究肺部CT磨玻璃结节对于术前诊断和鉴别诊断肺部MIA和IAC提供帮助的可能。方法对福州肺科医院2018年3月至2020年3月收治的200例肺部磨玻璃结节患者的CT图像进行回顾性分析,对病理诊断分为MIA组(109例)和IAC组(91例)两组病灶的大小,病灶密度、形状、边缘毛刺、边缘分叶,结节病灶内实性成分,实性成分大小,分布,边缘、内部空泡/空腔,支气管截断征,病灶内血管影,病灶内血管增粗,病灶内血管扭曲或模糊,胸膜凹陷征,血管集束征进行对比分析。采用chi-square检验。结果MIA影像多表现为纯磨玻璃影,圆形或类圆形,边界较清晰;IAC多为混合密度的磨玻璃结节,不规则形多见。边缘分叶的结节中是IAC比例比MIA比例高(96.1%比3.9%,χ^(2)=42.146,P<0.01);边缘毛刺的结节是IAC的比例比MIA比例高(95.0%比5.0%,χ^(2)=15.895,P<0.01);有实性成分的结节中IAC比例比MIA比例高(71.5%比28.5%,χ^(2)=20.190,P<0.05);内部空泡/空腔的结节中IAC比例比MIA比例高(88.9%比11.1%,χ^(2)=4.88,P<0.05);有支气管截断征的结节中IAC的比例比MIA比例高(80.0%比20.0%,χ^(2)=4.549,P<0.05);有病灶内血管增粗的结节中IAC的比例比MIA比例高(93.1%比6.9%,χ^(2)=22.979,P<0.05);有病灶内血管扭曲或模糊的结节中IAC比例比MIA高(100.0%比0.0%,χ^(2)=17.603,P<0.05);有胸膜凹陷征的结节中IAC的比例比MIA高(83.3%比16.7%,χ^(2)=6.496,P<0.05)。IAC中实性成分长径>5 mm的结节比例比MIA中实性成分长径>5 mm的结节比例高(79.5%比34.3%,χ^(2)=23.082,P<0.05)。IAC中实性成分边缘模糊的占IAC中有实性成分的比例高于MIA中实性成分边缘模糊的占MIA中有实性成分比例(48.9%比5.7%,χ^(2)=11.060,P<0.05)。结论磨玻璃结节的CT影像学形态特征,包括病灶内的实性成分的综合分析,可对术前诊断和鉴别诊断肺部MIA和IAC提供帮助。

Objective The comparison of pulmonary ground glass nodules and postoperative pathological diagnosis of minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC)by CT imaging was used to study the potential contribution of pulmonary CT ground glass nodules to the pre-op diagnosis and differential diagnosis between pulmonary MIA and IAC.Methods The CT images of 200 patients with pulmonary ground glass nodules admitted to Fuzhou Pulmonary Hospital from March 2018 to March 2020 were retrospectively analyzed,and the pathological diagnosis was divided into MIA group(109 cases)and IAC group(91 cases).The following were compared:lesion size,solid component size,lesion density,shape,edge lobulation,edge spiculation,intralesional solid component,size and distribution of solid component,internal encapsulated air,bronchial amputation,intralesional vascular shadows,intralesional vascular thickening,twisted or blurred blood vessels,pleural depression,and vascular bundle disease were compared in the two groups.SPSS 22.0 was used for statistical analysis.A chi-square test was used.P≤0.05 was considered statistically significant.Results MIA can be presented as pure ground-glass nodules or mixed-density ground-glass nodules,most of which are round or quasi-round with clear boundaries;IACs are more of mixed-density ground-glass nodules with irregular shapes.Of the nodules with lobulated edge,the proportion diagnosed as IACs is higher than that diagnosed as MIA(96.1%vs.3.9%,χ^(2)=42.146,P<0.01);of the nodules with spiculated edge,the proportion diagnosed as IACs is higher than that diagnosed as MIA(95.0%vs.5.0%,χ^(2)=15.895,P<0.01);of the nodules with solid component,the proportion diagnosed as IACs is higher than that diagnosed as MIAs(71.5%vs.28.5%,χ^(2)=20.190,P<0.05);of the nodules with internal encapsulated air,the proportion diagnosed as IACs is higher than that diagnosed as MIAs(88.9%vs.11.1%,χ^(2)=4.88,P<0.05);of the nodules with bronchial amputation,the proportion diagnosed as IACs is higher than that diagnosed as MIAs(80.0%vs.20.0%,χ^(2)=4.549,P<0.05);of the nodules with intralesional vascular thickening the proportion diagnosed as IAC is higher than that that diagnosed as MIA(93.1%vs.6.9%,χ^(2)=22.979,P<0.05);of the nodules with vascular distortion or blurring,the proportion diagnosed as IAC is than that diagnosed as MIA(10.0%vs.0.0%,χ^(2)=17.603,P<0.05);of the nodules with pleural depression in IAC is higher than that in diagnosed MIA(83.3%vs.16.7%,χ^(2)=6.496,P<0.05).Among the solid component nodules diagnosed as IAC,the proportion of solid component>5 mm is higher than the proportion of the solid component>5 mm among the solid component nodules diagnosed as MIA(79.5%vs.34.3%,χ^(2)=23.082,P<0.05).Among the solid component diagnosed as IAC,the proportion of the solid component with blurring edge is higher than the proportion of the solid component with blurring edge in the solid component diagnosed as MIA(χ^(2)=11.060,P<0.05).Conclusion The characteristics of ground glass nodules in CT imaging,including comprehensive analysis of intralesional solid components,can help pre-op diagnosis and differential diagnosis between pulmonary MIA and IAC.