肺原位腺癌与微浸润腺癌的病理分化情况及超高分辨率CT鉴别效果

P athological Differentiation Between Orthotopic Adenocarcinoma and Microinvasive Adenocarcinoma of Lung and Differential Effect of Ultra-high Resolution CT

目的探析肺原位腺癌与微浸润腺癌两者的病理分化情况以及应用超高分辨率CT扫描对两者的临床鉴别指导价值。方法对2017年1月至2020年到本院就诊并经病理组织学确诊的肺腺癌患者资料进行回顾性分析,在肺原位腺癌与微浸润腺癌患者中各抽取46例、37例并设为原位组、浸润组,所有患者均接受超高分辨率CT扫描,分析扫描图像资料信息以及两种病灶内出现肺静脉异常、胸膜凹陷征以及空气支气管征的情况。结果所有患者均接受手术并在术后病理组织检验确认病情。在病理结果分析中,组间病灶分化程度虽有差异,但数据差异无统计学意义(P>0.05)。原位癌患者CT图像中病灶边界清晰以及边缘规则比例等高于浸润组,两组患者的病灶密度类型有明显差异(P<0.05)。原位组患者病灶平均直径短于浸润组,病灶平均CT值高于浸润组(P<0.05)。原位组患者病灶当中存在肺静脉异常、胸膜凹陷征以及空气支气管征等例数低于浸润组(P<0.05)。结论临床收治肺原位腺癌与微浸润腺癌两种病灶在病理分化方面并无典型差异,进行超高分辨率CT扫描后可得到清晰图像,呈现肺腺癌形态学特征,可作为医生鉴别两种病灶的重要指导依据。

Objective To analyze the pathological differentiation of adenocarcinoma in situ and adenocarcinoma with micro-invasion,and to evaluate the guiding value of ultra-high resolution CT scanning in clinical differentiation between them.Methods The data of patients with lung adenocarcinoma diagnosed by pathology from January 2017 to 2020 in our hospital were retrospectively analyzed.46 cases and 37 cases were selected from patients with in situ adenocarcinoma and micro-invasive adenocarcinoma of lung,respectively,and they were divided into in situ group and invasive group.All patients underwent ultra-high resolution CT scanning,and the scanned image information and abnormal pulmonary vein,pleural indentation sign and air bronchial sign in the two lesions were analyzed.Results The pathological data of patients in situ group and invasive group were analyzed.In the CT images of patients with carcinoma in situ,the clear boundary and regular proportion of the margin were higher than those of the invasive group,and there was a significant difference between the two groups(P<0.05).In situ group,the average diameter of lesions was shorter than that of invasive group,and the average CT value of lesions was higher than that of invasive group(P<0.05).The number of abnormal pulmonary vein,pleural indentation sign and air bronchial sign in patients in situ group was lower than that in invasive group(P<0.05).Conclusion There is no typical difference in pathological differentiation between in situ adenocarcinoma and microinvasive adenocarcinoma in clinical treatment.After ultra-high resolution CT scan,a clear image can be obtained,showing the morphological characteristics of lung adenocarcinoma,which can be used as an important guiding basis for doctors to distinguish the two lesions.