胸部薄层CT在诊断Ⅰ期浸润性肺腺癌病理组织学亚型上的价值

The Value of Chest Thin Slice CT in the Diagnosis of Histopathological Subtypes of StageⅠInvasive Lung Adenocarcinoma

目的探讨胸部薄层CT形态学参数对Ⅰ期浸润性肺腺癌病理亚型中贴壁为主型(LPA)与非贴壁为主型(non-LPA)的鉴别诊断价值。方法选取手术前行胸部薄层CT扫描并进行肺癌根治手术切除的Ⅰ期浸润性肺腺癌患者103例,根据病理组织学亚型分为LPA组和非LPA组。搜集103例患者的临床资料并分析肺癌病灶CT形态学特征,测量大小、CT值等定量参数,应用SPSS 23.0软件进行统计分析。结果性别、年龄、病灶位置、吸烟史、毛刺征、血管集束等指标在鉴别Ⅰ期浸润性肺腺癌LPA和非LPA病理亚型上差异无统计学意义;空泡征、分叶征、胸膜凹陷征、CT值、长径和短径等指标在鉴别上述两种病理亚型上差异具有统计学意义。空泡征在LPA组中出现的概率更高(P<0.05),而分叶征和胸膜凹陷征征象在非LPA组中出现的概率更高(P值均<0.05)。LPA组的CT值、长径及短径(P值均<0.001)明显低于非LPA组;ROC曲线示,病灶CT值、长径和短径诊断LPA的最佳截断点分别为235.50 HU、15.50 mm及10.50 mm。多因素Logistic回归分析显示CT值、分叶征和空泡征是影响Ⅰ期肺腺癌LPA的独立预测因素。结论CT形态学特征中的空泡征、分叶征、胸膜凹陷征、长径、短径及CT值和Ⅰ期肺腺癌的不同病理亚型具有显著相关性,CT值、分叶征和空泡征联合判断对鉴别LPA与非LPA具有一定价值。

Objective To investigate the value of chest thin-layer CT morphological parameters in the differential diagnosis of lepidic predominant adenocarcinoma(LPA)and non-lepidic predominant adenocarcinoma(non-LPA)in the pathological subtypes of stageⅠinvasive lung adenocarcinoma.Methods 103 cases of stageⅠinvasive lung adenocarcinoma with thin-layer CT scan of chest before operation and radical resection of lung cancer were selected.They were divided into LPA group and non-LPA group according to histopathological subtypes.The clinical data of 103 patients were collected,the CT morphological characteristics of lung cancer lesions were analyzed,and the quantitative parameters such as size and CT value were measured.SPSS 23.0 software for statistical analysis.Results There was no significant difference in gender,age,lesion location,smoking history,hairpin sign and vascular bundle in differentiating LPA and non-LPA pathological subtypes of stageⅠinvasive lung adenocarcinoma.Vacuole sign,lobulation sign,pleural depression sign,CT value,long diameter and short diameter were statistically significant in distinguishing the above two pathological subtypes.The probability of vacuole sign was higher in LPA group(P<0.05),while the probability of lobulation sign and pleural depression sign was higher in non-LPA group(P<0.05).The CT value,long diameter and short diameter of LPA group were significantly lower than those of non-LPA group(P<0.001).The ROC curve showed that the best cut-off points of CT value,long diameter and short diameter in the diagnosis of LPA were 235.50 HU,15.50 mm and 10.50 mm respectively.Multivariate logistic regression analysis showed that CT value,lobulation sign and vacuole sign were independent predictors of LPA in stageⅠlung adenocarcinoma.Conclusion The vacuole sign,lobulation sign,pleural depression sign,long diameter,short diameter and CT value in CT morphological features are significantly correlated with different pathological subtypes of stageⅠlung adenocarcinoma.The combination of CT value,lobulation sign and vacuole sign is of certain value in distinguishing LPA from non-LPA.