Computed tomography fluoroscopy guided percutaneous lung biopsy for ground-glass opacity pulmonary lesions:A meta-analysis

AIM:To obtain the diagnostic performance of percutaneous transthoracic needle biopsy(PTNB) under Computed tomography(CT) fluoroscopy guidance for lung ground-glass opacity(GGO).METHODS:We searched for English- and Chineselanguage studies in Pub Med,EMBASE,EBSCO,OVID,and CNKI(China National Knowledge Infrastructure) database.Data were calculated with Meta-Disc version 1.4 and Rev Man version 5.2 software.From the pooled data,we calculated sensitivity(Sen),specificity(Spe),positive likelihood ratio(+LR),negative likelihood ratio(-LR),and diagnostic odds ratio(DOR).Summary receiver operating characteristic(SROC) curves were constructed and incidence of complications was recorded.RESULTS:Four documents included in this present meta-analysis met the criteria for analysis.The pooled Sen,Spe,+LR,-LR and DOR with 95%CI were 0.91(0.86-0.95),1.0(0.91-1.0),18.64(4.83-71.93),0.11(0.05-0.26) and 153.17(30.78-762.33),respectively.The area under the SROC curve was 0.98.The incidence of pneumothorax and hemoptysis was 17.86%-51.80% and 10.50%-19.40%,respectively.CONCLUSION:CT fluoroscopy-guided PTNB,which has an acceptable incidence of complications,can be used as a primary examination method for lung GGO,with moderate sensitivity and specificity.

Which surgery for ground glass opacity lung nodules?

Objective:Pulmonary ground glass opacity(GGO)nodules represent a significant dilemma in oncology since its diagnosis in clinical practice has increased because of growing application of low dose computed tomography and screening program.The aim of this study is to analyze the clinical and pathological features,the overall survival(OS)and disease-free interval(DFI)in surgically resected solitary ground glass nodules in order to assess the surgical treatment of choice.Methods:We retrospectively analyzed 49 patients(M/F=25/24)with a mean age of 67.7(range,40-81)years who underwent lung resection for solitary GGO nodules among 570 reviewed CT of patients who were treated for lung neoplasms between 2010 and 2016.The cohort included 22 pure GGO nodules and 27 part solid GGOs(also called mixed GGOs).Results:Median maximum diameter of GGOs,defined as the largest axial diameter of the lesion on the lung-window setting,was 17(range,5-30)mm.GGO nodules were removed by wedge resection,segmentectomy,or lobectomy in 17(35%),9(18%),and 23(47%)cases,respectively.Pathologic diagnosis was atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),minimally invasive adenocarcinoma(MIA),invasive adenocarcinoma(IA)or multifocal adenocarcinoma(MAC)in 4(8.2%),9(18.4%),11(22.4%),22(44.9%)and 3(6.1%)cases,respectively.With a median follow up of 47 months the OS and DFI of the entire cohort was 46.3 and 43 months,respectively.The histotype(P=0.008),the dimension of GGO(P=0.014)and the PET-SUV max(P=0.001)were independent prognostic factors of worse survival.Sex,age,previous lung surgery,type of surgical resection and the mediastinal lymph-node evaluation did not impact on OS and DFI.Analyzing the 22 pure GGO nodules,we found a 3-year OS and DFI of 98%and 100%respectively,significantly different from 80%and 75%respectively of part-solid GGOs(log-rank P=0.043 and P=0.011).Conclusion:Our data suggest an indolent behaviour of tumour presenting as solitary GGO nodules,especially in case of pure GGOs.In our series wedge resections guarantee the same results in terms of OS and DFI when compared to lobectomies.Sublobar resections without mediastinal lymph-nodes evaluation represent the treatment of choice for pure-GGO.More studies are needed to assess its role for part-solid GGO nodules.

基于AI的肺磨玻璃结节中医临床特点研究

目的通过客观、规范的方法分析肺磨玻璃中医临床特点,利用人工智能(AI)分析肺磨玻璃结节恶性风险,初步探究不同风险肺磨玻璃结节中医临床特点,为中医药干预肺结节提供参考。方法采集75例肺磨玻璃结节患者中医四诊信息,运用证素辨证方法提取证素;利用AI判读患者胸部CT,分析不同风险肺磨玻璃结节中医临床特点。结果肺磨玻璃结节患者中医证素以阴虚(77.33%)、气虚(56.00%)、阳虚(54.67%)、血虚(52.00%)等证素多见,亦可见痰(40.00%)、寒(37.33%)、气滞(32.00%)等实性证素;AI判读为高风险组较中低风险组气虚证素权值差异有统计学意义(P<0.05)。结论肺磨玻璃结节患者中医辨证以虚证为主,中医病机为气虚或气滞导致肺之气机不畅,引起局部痰、湿聚集于肺络而形成,而热证、瘀血证较少。

不同浸润程度肺腺癌患者应用高分辨CT检测肺内磨玻璃密度结节及胸膜凹陷征和支气管阳性征的临床意义分析

目的探讨不同浸润程度肺腺癌患者应用高分辨CT(HRCT)检测肺内磨玻璃密度结节(CTGGO)及胸膜凹陷征、支气管阳性征的效果,分析HRCT对不同浸润程度肺腺癌的诊断价值。方法选取2021年7月至2022年7月瑞金市人民医院收治的80例肺腺癌(病理侵袭性)患者作为病理侵袭性组,随机选取同期80例肺腺癌(病理非侵袭性)患者作为病理非侵袭性组,所有患者均行HRCT检查。根据2015年WHO制定的《肺腺癌新分类》,将肺腺癌(病理侵袭性)患者分为浸润前病变(PI)、微浸润性腺癌(MIA)和浸润性腺癌(IA)。比较两组与病理侵袭性组不同浸润程度肺腺癌患者CTGGO、胸膜凹陷征、支气管阳性征占比情况及双侧肺部不同大小病灶的检出率。结果病理侵袭性组CTGGO、胸膜凹陷征、支气管阳性征占比均高于病理非侵袭性组(P<0.05)。病理侵袭性组双侧肺部不同大小病灶总检出率为93.75%,病理非侵袭性组为86.25%,两组比较差异无统计学意义。不同浸润程度肺腺癌患者CTGGO及胸膜凹陷征、支气管阳性征占比比较差异有统计学意义(P<0.05);IA患者CTGGO、支气管阳性征均低于PI患者,胸膜凹陷征、支气管阳性征均低于MIA患者,MIA患者CTGGO占比低于PI患者,差异有统计学意义(P<0.05)。病理侵袭性组PI、MIA、IA患者0~5、>5~10、>10~15、>15~20 mm病灶检出率比较差异无统计学意义。结论HRCT征象可应用于不同浸润程度的肺腺癌患者,通过HRCT图像中的CTGGO、胸膜凹陷征和支气管阳性征,进一步诊断肺腺癌。

Circulating tumor cells with epithelial-mesenchymal transition markers as potential biomarkers for the diagnosis of lung cancer

BACKGROUND Circulating tumor cells(CTCs) can be clustered into three subtypes according to epithelial-mesenchymal transition(EMT) markers: CTCs with epithelial markers(E-CTCs), CTCs with mesenchymal markers(M-CTCs), and CTCs with both markers(E&M-CTCs). CTC detection has clinical implications in the diagnosis of lung cancer(LC).AIM To clarify the diagnostic value of CTCs categorized by EMT markers in LC.METHODS The study included 106 patients with lung adenocarcinoma, including 42 groundglass opacities(GGO) and 64 solid lesions, who underwent surgery between July 2015 and December 2019. Eleven patients with benign tumors and seventeen healthy controls were included. CTCs in peripheral blood and associated EMT markers were detected preoperatively using the CanPatrol TM technique. The diagnostic power of CTCs for discriminating LC cases from controls was analyzed by the receiver operating characteristic(ROC) curve. The CytoploRare technique was used in 20 cases and 18 controls for validation, and Kappa values were calculated to evaluate consistency between techniques.RESULTS Of the 106 LC cases, 94(89.6%) had at least one CTC. CTCs were detectable in 35(83.3%) of 42 GGO cases. Total CTCs and E&M-CTCs were significantly more frequent in LC cases than in benign or healthy controls. The proportion of MCTCs plus E&M-CTCs increased gradually from healthy controls, to benign controls, to LC cases. The area under the ROC curve of total CTCs and E&M-CTCs was > 0.8 and > 10.75, respectively. The combined sensitivity of total-CTCs and E&M-CTCs was 85.85% for LC patients(80.95% for GGO patients) and the specificity was 78.57%.The Kappa value was 0.415,indicating relative consistency between CanPatrol TM and CytoploRare.CONCLUSION CTC detection is valuable for distinguishing LC from controls,and particularly E&M-CTC detection warrants further study.

Independent lung ventilation: Implementation strategies and review of literature

Independent lung ventilation,though infrequently used in the critical care setting,has been reported as a rescue strategy for patients in respiratory failure resulting from severe unilateral lung pathology.This involves isolating and ventilating the right and left lung differently,using separate ventilators.Here,we describe our experience with independent lung ventilation in a patient with unilateral diffuse alveolar hemorrhage,who presented with severe hypoxemic respiratory failure despite maximal ventilatory support.Conventional ventilation in this scenario leads to preferential distribution of tidal volume to the nondiseased lung causing over distension and inadvertent volume trauma.Since each lung has a different compliance and respiratory mechanics,instituting separate ventilation strategies to each lung could potentially minimize lung injury.Based on review of literature,we provide a detailed description of indications and procedures for establishing independent lung ventilation,and also provide an algorithm for management and weaning a patient from independent lung ventilation.

Prognostic value of ground glass opacity on computed tomography in pathological stage I pulmonary adenocarcinoma: A meta-analysis

BACKGROUND The clinical role of ground glass opacity(GGO)on computed tomography(CT)in stage I pulmonary adenocarcinoma patients currently remains unclear.AIM To explore the prognostic value of GGO on CT in lung adenocarcinoma patients who were pathologically diagnosed with tumor-node-metastasis stage I.METHODS A comprehensive and systematic search was conducted through the PubMed,EMBASE and Web of Science databases up to April 3,2021.The hazard ratio(HR)and corresponding 95%confidence interval(CI)were combined to assess the association between the presence of GGO and prognosis,representing overall survival and disease-free survival.Subgroup analysis based on the ratio of GGO was also conducted.STATA 12.0 software was used for statistical analysis.RESULTS A total of 12 studies involving 4467 patients were included.The pooled results indicated that the GGO predicted favorable overall survival(HR=0.44,95%CI:0.34-0.59,P<0.001)and disease-free survival(HR=0.35,95%CI:0.18-0.70,P=0.003).Subgroup analysis based on the ratio of GGO further demonstrated that the proportion of GGO was a good prognostic indicator in pathological stage I pulmonary adenocarcinoma patients,and patients with a higher ratio of GGO showed better prognosis than patients with a lower GGO ratio did.CONCLUSION This meta-analysis manifested that the presence of GGO on CT predicted favorable prognosis in tumor-node-metastasis stage I lung adenocarcinoma.Patients with a higher GGO ratio were more likely to have a better prognosis than patients with a lower GGO ratio.

Unilateral pleuroparenchymal fibroelastosis as a rare form of idiopathic interstitial pneumonia:A case report

BACKGROUND Pleuroparenchymal fibroelastosis(PPFE)is a rare idiopathic interstitial pneumonia characterized by predominantly upper lobe involvement with pleural fibrosis and subjacent parenchymal fibrosis.Recently,there have been increasing reports of PPFE,and PPFE might coexist with other interstitial lung diseases in the lower lobe and upper lobe.However,cases of unilateral PPFE are scarce.CASE SUMMARY A 75-year-old Korean male presented to our hospital with chronic dry cough and exertional dyspnea.The patient’s symptoms started 6 mo previously and had been gradually worsening.At the time of presentation,he felt dyspnea when walking at his own pace.Radiologic findings suggested PPFE,but the lesion was localized in the upper lobe of the right lung.After multidisciplinary discussion,a transbronchial lung biopsy in the right upper lobe revealed collapsed alveoli with parenchymal fibroelastosis,and elastic van Gieson staining demonstrated septal elastosis with intra-alveolar collagenosis,which met the histopathologic criteria of definite PPFE.After multidisciplinary discussion in an experienced interstitial lung disease center,we confirmed the diagnosis of unilateral PPFE.Furthermore,we confirmed the progression of PPFE on radiologic findings during the followup period.CONCLUSION Clinicians should consider PPFE,even in cases with unilateral,predominantly upper lung involvement in interstitial lung disease patients through multidisciplinary discussion.

肺部磨玻璃结节CT特征对肺腺癌类型及病理分期的临床应用价值探究

目的:研究肺部磨玻璃结节(Ground-glassopacity,GGO)CT特征对肺腺癌类型病理分期的临床应用价值。方法:回顾性分析112例已确诊为肺腺癌患者的CT影像学检查,总结和分析GGO的影像学特征,采用统计学方法对比分析不同类型肺腺癌患者中的GGO影像学特征差异,采用ROC曲线评价GGO的临床应用价值。结果:112例肺腺癌患者平均年龄43.05?6.78岁,不同类型肺腺癌患者无年龄和性别差异,纯磨玻璃结节(p GGO)在原位腺癌中检出率较高,混合磨玻璃结节(m GGO)在浸润性肺腺癌中检出率较高,GGO的直径大小、密度、体积、质量在浸润性肺腺癌中均较高。m GGO的实性百分比和结节密度在浸润性肺腺癌Ⅰ期、Ⅲ期中具有较高诊断效能。结论:肺部GGO的CT影像学特征是临床鉴别肺腺癌类型的主要手段之一,m GGO的CT影像学特征可作为浸润性肺腺癌病理分期的主要依据之一。

Clinical outcomes and lipid-laden macrophages in Electronic cigarette/Vaping product use-Associated Lung Injury(EVALI)in a South Texas population

Objective:To describe the clinical features,proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage(BAL),and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping product use-Associated Lung Injury(EVALI).Methods:Retrospective review of clinical characteristics,radiographs,and BAL samples for all patients with a history of vaping who presented with acute hypoxemic respiratory failure to the University Hospital in San Antonio,Texas from 9/2019 to 6/2020 was performed.Results:We report 16 cases(15 men;median age,30 years[range 19-75])of EVALI with a history of vaping Tetrahydrocannabinol(THC),nicotine,or both.The most common presenting symptoms were tachycardia,dyspnea,cough,and fever.All patients required supplemental oxygen,including two who required noninvasive positive pressure ventilation,and five who required mechanical ventilation.All 16 patients had bilateral ground-glass opacities(GGO)with peripheral sparing on chest computerized tomography(CT).Cultures were negative,except for one patient who tested positive for rhinovirus.COVID-19 PCR was done in one individual which was negative.Cytology demonstrated lipid-laden macrophages on Oil-Red-O stain on fresh(i.e.,without fixative)BAL in the majority of patients(N=12)with a mean lipid-saturation percentage of 78%[range,44%-100%]and the mean Colombo count of 194[range,101-359].Fifteen patients were treated with systemic corticosteroids.The median length of hospital stay was 10 days.At discharge,three patients required supplemental oxygen.Eight of those who had follow-up imaging showed resolution of GGO.One patient had a relapse of symptoms and was again treated with systemic corticosteroids and mycophenolate,with resolution of symptoms.Fourteen patients who were evaluated after discharge denied vaping post-discharge(two patients were not able to be contacted and did not keep follow-up appointments).Conclusions:Successful diagnosis and management of EVALI requires a high clinical suspicion,thorough evaluation to rule out infectious etiologies,and aggressive treatment with systemic corticosteroids,along with sustained abstinence from vaping.

“磨玻璃影”特征的早期肺腺癌中MPP成分的突变特征分析及ZNF469基因的探索

背景与目的目前,肺癌依然是我国发病率和死亡率最高的恶性肿瘤。而在早期肺腺癌(lung adenocarcinoma,LUAD)中,微乳头(micropapillary,MPP)成分尤其常见,且通常表现出高侵袭性,其与早期转移、淋巴浸润的风险以及患者的5年生存率显著相关。本研究旨在探究以磨玻璃影(ground-glass opacities,GGOs)为特征的早期LUAD中MPP成分和非MPP成分的异同,寻找MPP成分所特有的突变特征,并分析锌指蛋白家族的ZNF469基因与早期LUAD预后以及免疫浸润的关系。方法收集31例LUAD恶性肺结节,采用显微解剖法将其分为成对的MPP和非MPP成分。对早期恶性肺结节组分进行全外显子组测序(whole-exome sequencing,WES),利用maftools、非负矩阵分解(Nonnegative Matrix Factorization,NMF)法、Sigminer等方法进行突变特征分析,以揭示侵袭性LUAD中MPP组分相比于其他肿瘤组织所特有的基因组突变特征。利用癌症基因组图谱(The Cancer Genome Atlas,TCGA)的LUAD数据库中ZNF469的表达情况,探讨其与肺癌预后的关系;利用GeneMANIA数据库以及基因本体(Gene Ontology,GO)、京都基因与基因组百科全书(Kyoto Encyclopedia of Genes and Genomes,KEGG)富集分析探索LUAD中与ZNF469相关基因的互作网络及信号通路;利用TIMER和TISIDB数据库分析ZNF469表达与LUAD中免疫细胞浸润水平的相关性。结果MPP成分具有较多的基因组变异,相比于非MPP成分的肿瘤组织,癌症体细胞突变目录(Catalogue of Somatic Mutations in Cancer,COSMIC)的13号突变特征(胞苷脱氨酶家族,APOBEC)是MPP成分所特有的,这提示其参与了MPP成分对LUAD早期侵袭过程的促进作用;并且APOBEC特征高的MPP样本具有更高的肿瘤突变负荷(tumor mutational burden,TMB),提示这些患者更能从免疫治疗中获益。LUAD中突变ZNF469的表达高于正常组织,与LUAD患者的不良预后有关。基因互作网络分析以及GO和KEGG富集分析发现,COL6A1、COL1A1、COL1A2、TGFB2、MMP2、COL8A2、C2CD4C等与ZNF469具有相互作用,且主要与编码胶原蛋白、参与细胞外基质构成有关。ZNF469表达与肿瘤的免疫浸润呈正相关。结论本研究揭示了中国人群侵袭性LUAD中MPP成分的特有突变特征,并发现突变ZNF469的高表达影响LUAD预后与免疫浸润,推测ZNF469可作为LUAD潜在的诊断及预后生物标志物。

术前CT引导下Hook-wire定位与医用胶定位在磨玻璃结节为主的早期肺癌术中的应用效果比较

目的 对比术前CT引导下Hook-wire与医用胶定位在磨玻璃结节为主的早期肺癌手术切除中的应用效果。方法 回顾性分析83例以磨玻璃结节为主的早期肺癌切除术患者的临床资料,根据其术前结节定位方法将其分为Hook-wire组(CT引导下Hook-wire定位,n=30)与医用胶组(CT引导下医用胶定位,n=53),比较两组定位成功率、平均定位耗时、病灶精确切除率、病灶平均切除时间、定位相关并发症、术后住院时间等。结果 医用胶组与Hook-wire组平均定位耗时、结节切除耗时、术后住院时间及手术相关并发症发生率比较,差异无统计学意义(P>0.05),医用胶组定位成功率高于Hook-wire组,定位相关并发症发生率低于Hook-wire组,结节精准切除率高于Hook-wire组,差异均有统计学意义(P<0.05)。结论 相比于Hookwire,CT引导下医用胶定位GGN的效果更好,安全性更高。

CT三维定量分析对T1a期肺腺癌病理等级的预测价值

目的:评估CT三维定量分析对表现为磨玻璃密度结节(GGN)的T1a期肺腺癌病理等级的诊断价值。方法:回顾性分析经手术病理证实的51例T1a期肺腺癌患者的术前CT图像,其中原位腺癌20例(AIS组)、微浸润性腺癌19例(MIA组)及浸润性腺癌12例(IAC组),测量3组病灶的体积、最大正交直径、平均CT值、不同CT阈值下的病灶容积(V_(-100)、V_(-150)、V_(-200)、V_(-250)、V_(-300)、V_(-350)、V_(-400)、V_(-450)、V_(-500))。3组间计量资料的比较采用克鲁斯卡尔-沃利斯检验、两两比较采用曼-惠特尼U检验。运用ROC曲线评估组间比较有显著差异参数的诊断效能。结果:3组间病灶体积、最大正交直径差异均无统计学意义(均P>0.05),平均CT值、不同CT阈值下的病灶体积差异均有统计学意义(均P<0.05)。AIS与MIA组间,V_(-350)差异有统计学意义(P=0.032)。AIS与IAC组间,各参数值差异均有统计学意义(均P<0.05)。MIA与IAC组间,最大正交直径、平均CT值、不同CT阈值下的病灶体积(V_(-100)、V_(-150)、V_(-200)、V_(-300)、V_(-350)、V_(-400)、V_(-450)、V_(-500))差异均有统计学意义(均P<0.05),病灶体积、V_(-250)差异均无统计学意义(均P>0.05)。以CT值_(-450) HU作为实性成分与磨玻璃成分的界值,AIS与IAC组及MIA与IAC组均获得最大AUC(0.925、0.860),以实性成分体积25.5 mm^(3)作为AIS与IAC组、27.0 mm^(3)作为MIA与IAC组的诊断阈值,诊断效能最优,其敏感度、特异度、约登指数分别为91.7%、95.0%、0.867及91.7%、78.9%、0.706。结论:CT三维定量分析可定量测量GGN的实性成分、预测T1a期肺腺癌的浸润程度,有助于提高对T1a期肺腺癌术前病理分型的诊断准确率。

1cm以下磨玻璃密度肺腺癌的CT征象与病理亚型及免疫组织化学的相关性

目的探讨1 cm以下局灶性磨玻璃密度(f GGO)肺腺癌的CT征象与病理亚型及免疫组织化学的相关性。方法回顾性分析本院59例经手术病理证实为肺腺癌的最大直径≤1 cm的f GGO患者的CT、病理以及免疫组织化学资料,将CT征象(包括位置、大小、密度、形状、空泡征、空气支气管征、病灶边缘、胸膜凹陷征、瘤肺界面)与病理亚型[不典型腺瘤样增生(AAH)、原位腺癌(AIS)、微浸润性腺癌(MIA)及浸润性腺癌(IPA)]和免疫组织化学结果 [人表皮生长因子受体(HER)-1、HER-2、Ki-67、血管内皮生长因子(VEGF)、拓扑异构酶Ⅱα(Top-Ⅱα)]对照,患者年龄、病变大小、密度与病理亚型比较采用单因素方差分析或秩和检验;患者性别、病变位置、形状、空泡征、空气支气管征、病灶边缘、胸膜凹陷征、瘤肺界面与病理亚型和免疫组织化学结果对照采用卡方检验或Fisher精确检验。结果 CT表现为1 cm以下f GGO的肺腺癌各病理亚型间,性别分布、年龄大小、病变位置、形状、空气支气管征、胸膜凹陷征、瘤肺界面差异无统计学意义(P值分别为0.194、0.126、0.609、0.678、0.091、0.374、0.339),各病理亚型间病变大小、密度、空泡征的有无以及边缘情况差异有统计学意义(P值分别为0.028、0.002、0.003、0.046),Ki-67在不同形状结节间表达程度差异有统计学意义(P=0.015),HER-1在瘤肺界面是否清晰的结节间表达程度差异有统计学意义(P=0.019),HER-2在是否有空泡征的结节间表达程度差异有统计学意义(P=0.049),而CT征象与VEGF和Top-Ⅱα的表达无相关性(P均>0.05)。结论表现为1 cm以下f GGO的肺腺癌中,IPA的空泡征出现率最高,而AAH最低,且浸润前病变(AAH+AIS)多表现为边缘光滑,MIA和IPA则多表现为分叶征+毛刺征;且一些CT征象在特定免疫组织化学结果之间也有相关性。

胸腔镜治疗肺部微小结节(129例报告)

背景与目的影像技术的发展导致肺部微小结节尤其是肺磨玻璃结节(ground-glass opacity,GGO)检出逐年增多,但术前定性困难。本研究探讨肺部微小结节的临床诊断及微创手术治疗的必要性和可行性、病理诊断,微创切除及淋巴结切除的手术方式。方法对2013年12月-2016年11月接受电视胸腔镜手术(video-assisted thoracic surgery,VATS)治疗并有明确病理诊断的共129例患者的临床资料回顾性分析。所有患者术前行薄层计算机断层扫描(computed tomography,CT)扫描,其中21个微小结节术前行CT引导下Hook-wire定位,并根据病理性质及患者身体状况采用不同手术方式。结果共129个微小结节,实性结节(solid pulmonary nodule,SPN)37个,恶性比例是24.3%(9/37),术后病理结果为:肺原发性鳞状细胞癌3个,浸润性腺癌(invasive adenocarcioma,IA)3个,转移癌2个,小细胞肺癌(small cell lung cancer,SCLC)1个,错构瘤16个,其他炎症等良性病变12个;49个混合性GGO(mixed ground-glass opacity,m GGO)的恶性比例是63.3%(31/49),术后病理结果为:IA 19个,微浸润腺癌(micro invasive adenocarcioma,MIA)6个,原位腺癌(adenocarcioma in situ,AIS)4个,非典型性腺瘤样增生(atipical adenomatous hyperplasia,AAH)1个,SCLC 1个,炎症等良性病变18个;43个纯GGO(pure ground-glass opacity,p GGO)的恶性比例是86.0%(37/43),术后病理结果为:AIS 19个,MIA 6个,IA 6个,AAH 6个,炎症等良性病变6个;GGO总的恶性比例是73.9%(68/92)。52个良性病变均采用VATS肺楔形切除;原发性非小细胞肺癌(non-small cell lung cancer,NSCLC)共73例,VATS肺叶切除和淋巴结清扫33例,VATS肺楔形切除和选择性淋巴结切除6例,VATS肺段切除和选择性淋巴结切除6例,VATS肺楔形切除28例;2个转移癌和2个SCLC,采用VATS肺楔形切除术。另有6例患者术中冰冻病理存在误差,其中2例选择二次手术行肺叶切除和淋巴结清扫。45例有淋巴结病理结果NSCLC只有两例以SPN为表现的IA出现纵隔淋巴结转移,其余均未出现淋巴结转移。术后随访1个月-35个月,平均(15.1±10.2)个月,无复发及转移。结论肺部微小结节尤其是GGO,是恶性病灶的概率大,应积极外科处理;围手术期应与患者及家属充分告知冰冻病理结果存在误差可能性,避免医疗纠纷。

34例肺单纯性磨玻璃样病灶的临床分析

目的探讨肺单纯性磨玻璃样病灶(pGGO)临床病理学特征、手术方式及预后。方法收集34例pGGO患者的临床资料,回顾性分析患者的性别构成、吸烟状况、手术方式、病灶大小、肿瘤组织学类型及淋巴结转移和患者预后情况。结果本组女性和不吸烟患者明显多于男性和吸烟患者(P<0.05,P<0.01)。34例患者中,接受局部切除(楔形切除或肺段切除)19例(电视胸腔镜下手术18例),肺叶切除15例。术后病理学检查显示:非典型腺瘤样增生13例,肺泡细胞癌21例;均无淋巴结转移。肺泡细胞癌病灶直径明显大于非典型腺瘤样增生病灶(P<0.05);局部切除与肺叶切除病灶大小比较差异无统计学意义。术后随访3个月～5年,患者均存活,无肿瘤复发及远处转移。结论 pGGO多发于不吸烟女性。pGGO中多数肺泡细胞癌病灶直径大于非典型腺瘤样增生病灶。电视胸腔镜下局部切除对pGGO的治疗效果良好。

不同病理类型肺部磨玻璃结节的CT鉴别诊断

目的 探讨肺部磨玻璃结节CT征象,对于鉴别浸润前病变及浸润性病变的诊断价值。方法 回顾性分析45例表现为肺部磨玻璃结节的患者术前CT图像。根据最终病理结果将病灶分为浸润前病变组和浸润性病变组,盲法阅片对两组病灶位置、形态、病灶密度、边缘及边界情况、内部实性成分以及三维大小进行对比分析。结果 两组病灶位置分布无明显统计学差异;浸润前病变与浸润性病变病灶形态、密度、边缘及边界情况、内部实性成分及大小均有统计学差异(P<0.05),即浸润前病变多表现为类圆形纯磨玻璃结节,而浸润性病变以不规则型混合磨玻璃结节为主;由浸润前病变到浸润性病变病灶边缘分叶、毛刺、边界毛糙比例逐渐升高;浸润前病变到浸润性病变病灶逐渐增大,且边缘光滑型结节及血管旁型结节体积测量具有更高稳定性。结论 肺部磨玻璃结节CT综合影像学征像有助于术前鉴别浸润前病变和浸润性病变,为术式选择提供参考依据;推荐应用体积测量评估结节大小。

肺部多发磨玻璃影的外科治疗

肺部磨玻璃影(ground glass opacity,GGO)的发病率近年来日益增高,很多患者发现有多发GGO,但多发GGO的诊疗还存在争议。肺部GGO是一种影像学表现,包含了多种病理类型,其中有一部分GGO是早期肺癌。GGO是一种惰性结节,只有少数GGO会发生变化,且随访不会影响外科治疗的效果。多发GGO的手术时机主要由主病灶决定,主病灶中实性成分大于5 mm时建议外科干预。手术方式可以选择肺叶切除或亚肺叶切除,除主病灶以外,其他GGO不必全部切除。具有高危因素的多发GGO需要纵隔淋巴结清扫或采样。

表现为磨玻璃结节的肺腺癌薄层CT征象分析及病理分型对照

探讨薄层CT(TSCT)表现为磨玻璃结节(GGN)的肺腺癌的CT征象,并与病理分型对照。回顾性搜集肺内TSCT发现的83个磨玻璃结节,根据病理结果分为浸润前病变组20个,微浸润腺癌组32个,浸润性腺癌组31个,分析不同病理分型的结节在薄层CT上的表现。83个结节中,34个表现为纯磨玻璃结节(pGGN),49个表现为混合磨玻璃结节(mGGN)。浸润前病变组共18个结节(18/20,90.0%)表现为pGGN,微浸润腺癌组共16个结节(16/32,50.0%)表现为pGGN,浸润性腺癌组无结节(0/31,0%)表现为pGGN。3组分叶征、空气支气管征、血管集束征、胸膜凹陷征的比例呈上升趋势,圆形/类圆形、瘤肺界面清晰征象的比例呈下降趋势。3组圆形或类圆形、分叶征、瘤肺界面清晰、空气支气管征、血管集束征、胸膜凹陷征的差异有统计学意义(P<0.05)。浸润前病变组与浸润性腺癌组比较,圆形或类圆形、分叶征、瘤肺界面清晰、空气支气管征、血管集束征、胸膜凹陷征差异有统计学意义(P<0.05);微浸润腺癌组与浸润性腺癌组间类圆形、分叶征、瘤肺界面清晰、血管集束征差异有统计学意义(P<0.05)。不同病理分型的GGN在TSCT上的表现具有一定的特异性,熟悉TSCT表现有助于浸润前病变、微浸润腺癌及浸润性腺癌的诊断及鉴别诊断。

肺癌伴多发磨玻璃密度结节的多层螺旋CT表现及其临床意义

背景与目的部分肺癌患者除原发灶外,还伴多发纯的磨玻璃影(pure ground-glass opacities,pGGO),本研究对pGGO的数目、分布、形态特征进行评估。对没有手术切除的pGGO进行CT随访,观察其变化。方法回顾性分析25例在CT图像上伴有多发pGGO的肺癌病例。结果pGGO的数目总共207个,最大直径2mm-31mm。原发灶和pGGO都可出现分叶。183(88.4%)处pGGO边缘清晰或为圆形。87处pGGO中,经外科手术切除17处病变,病理结果为:AAH13例,BAC3例,局灶性纤维化1例。120处随访的pGGO,CT随访的中位时间是61.5个月,113(94.2%)处病变没有变化,1处缩小,6处消失。结论肺癌和pGGO中可以出现在相同和/或不同的叶。大多数pGGO的大小在随访期间没有变化。很多小的病变在病理上诊断为AAH和BAC。这些数据证明外科手术切除原发肿瘤对余下的pGGO的预后没有影响。