IA期肺癌影像学中亚实性结节的诊断意义和临床价值

The diagnostic significance and clinical value of subsolid pulmonary nodules in stage IA lung cancer

目的探讨IA期肺癌影像学中亚实性结节的诊断意义和临床价值。方法回顾性分析我院2015年1月至2017年5月间收治的IA期肺癌118例CT影像学资料。根据磨玻璃影成分含量将亚实性肺结节分为单纯型磨玻璃影和混合型磨玻璃影结节。根据术后病理结果,分为T_(1a)N_0M_0、T_(1b)N_0M_0组,分析对比影响其分期的影像学特征。按照病理分型,分为AAH+AIS、微浸润腺癌(MIA)和浸润性腺癌组,分析对比影响其分型的影像学特征。结果T_(1a)N_0M_0期患者SSPN中pGGN比例较大,而T_(1b)N_0M_0期患者中mGGN占比例多(P<0.05)。T_(1a)N_0M_0期患者结节形状以椭圆形圆形居多,结节中有毛刺及毛刺+分叶的患者比例在T_(1b)N_0M_0期较高,邻近结构中有胸膜凹陷征的患者比例在T_(1b)N_0M_0期较高(P<0.05)。MIA及浸润性腺癌中mGGN占的比例较大(P<0.05),结节最大径大小与病理类型有关,不规则形多分布于MIA及浸润性腺癌,胸膜凹陷征在浸润性腺癌比例较大(P<0.05)。结论 SSPN大小、形状、边缘状态、内部结构与邻近结构与肺癌的分期、病理分型关系密切。

Objective To discuss the diagnostic significance and clinical value of subsolid pulmonary nodules(SSPN)in stage IA lung cancer.Methods 118 cases of IA lung cancer treated in our hospital from January 2015 to May 2017 with CT imaging data were retrospectively analyzed.According to the content of glass shadow,subsolid pulmonary nodules were divided into pureground-glass nodules(pGGN)and mixed ground-glass nodules(mGGN).According to the postoperative pathological results,patients were divided into stage T1aN0M0 and T1bN0M0 groups,the imaging features that affected their staging were analyzed and compared in these two groups.At the same time,the imaging features were analyzed and compared in different pathological classification groups,which were atypical adenomatous hyperplasia and adenocarcinoma in situ(AAH+AIS),microinvasive adenocarcinoma(MIA)and invasive adenocarcinoma groups.Results Among patients in the T1aN0M0 group,there were more pGGNs than mGGNs,while in T1bN0M0 gourp,there were more mGGNs than pGGNs(P<0.05).More SSPNs with oval or round shape were distributed in T1aN0M0 group,while more SSPNs with burr or lobulated sign and pleura hollow in T1bN0M0 group(P<0.05).MIA and invasive adenocarcinoma accounted for a large proportion of mGGN(P<0.05).The largest diameter of nodules was related to pathological type.Irregular shape was mostly distributed in MIA and invasive adenocarcinoma.SSPNs with pleural indentation was in a large proportion in invasive adenocarcinoma group(P<0.05).Conclusion The size,shape,edge state,internal structure and adjacent structure of SSPN were closely related to the staging and pathological classification of lung cancer.