基于CT征象区别肺浸润前病变与浸润性病变的可行性临床研究

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摘要目的：回顾性分析肺磨玻璃结节（GGN）浸润前病变与浸润性病变的CT表现规律与差别，旨在探寻有助于两者鉴别诊断的有价值征象。方法：收集经病理证实的GGN病例122例，57例为纯GGN（pGGN），65例为混合性GGN（mGGN）。浸润前病变71例，包括13例非典型瘤样增生（AAH）和58例原位腺癌（AIS）；浸润性病变51例，包括39例微浸润腺癌（MIA）和12例浸润性腺癌（IAC）。比较两组CT征象差异，并行ROC曲线分析评估两组鉴别的最佳界值。结果：在pGGN组中，平均直径和分叶征对鉴别浸润前病变与浸润性病变差异有统计学意义（P<0.05），平均直径的界值为11.82 mm，诊断敏感度和特异度为73%和87%。在mGGN中，平均直径、实性比例、分叶征、毛刺征和胸膜凹陷征在两组间差异有统计学意义（P<0.05），平均直径的界值为12.5 mm，诊断敏感度和特异度为75％和80％。结论：基于CT征象是可以对肺部GGN的浸润前与浸润性病变进行预评估，重要因素主要体现在GGN病灶平均直径、实性成分以及边缘征象等。

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	吴光耀
	王克鑫
	苏拉
	伍建林

关键词 ：肺肿瘤；体层摄影术, 螺旋计算机

Abstract：Objective: To analyze the CT features in differentiating pre-invasive and invasive lesion appearing as ground-glass nodule(GGN) retrospectively and obtain signs of discrimination. Methods: A total of 122 cases of GGNs were confirmed by pathology, 57 cases were pure GGNs and 65 cases were part solid GGNs. Seventy-one cases of invasive lesions, including 13 cases of atypical adenomatous hyperplasia(AAH) and 58 cases of adenocarcinoma in situ(AIS); invasive lesion in 51 cases, including 39 cases of minimally invasive adenocarcinoma(MIA) and 12 cases of invasive adenocarcinoma(IAC), we analyzed the difference between two groups of CT characteristics, ROC curve was used to identify the two groups of the best cut-off values. Results: In pure GGNs, size and lobulation were significant(P<0.05) and the cut-off of average diameterwas 11.82 mm, sensitivity and specificity were 73% and 87%. In part solid GGN, average diameter, solid proportion grade, lobulation, speculation and pleural retraction were statistically significant(P<0.05) and the cut-off value for average diameter in invasive lesion was 12.5 mm, sensitivity and specificity were 75% and 80%. Conclusion: The CT features could be used to pre-assess pre-invasive and invasive lesion appearing as GGN, the important factors are mainly reflected in the average diameter of GGN lesions, solid components and edge signs.

Key words： Lung neoplasms Tomography, spiral computed

收稿日期: 2017-04-10

PACS:	Ｒ734.2
	Ｒ814.42

基金资助:大连市科技局项目（2015E12SF120）。

通讯作者: 伍建林，大连大学附属中山医院放射科，116001。E-mail：cjr.wujianlin@vip.163.com

作者简介: 吴光耀（1992-），男，四川乐山人，在读硕士研究生。E-mail：wuguangyao2010@163.com

引用本文:

吴光耀，王克鑫，苏拉，伍建林. 基于CT征象区别肺浸润前病变与浸润性病变的可行性临床研究[J]. 中国临床医学影像杂志, 2017, 28(12): 851-854.
WU Guang-yao, WANG Ke-xin, SU La, WU Jian-lin. Feasibility of differentiating pre-invasive and invasive lesion appearing as ground-glass nodule based on CT features: a clinical study. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(12): 851-854.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2017/V28/I12/851

[1]Austin JH, Müller NL, Friedman PJ, et al. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society[J]. Radiology, 1996, 200(2): 327-331.
[2]Matsuguma H, Mori K, Nakahara R, et al. Characteristics of subsolid pulmonary nodules showing growth during follow-up with CT scanning[J]. Chest, 2013, 143(2): 436-443.
[3]Nakajima R, Yokose T, Kakinuma R, et al. Localized pure ground-glass opacity on high-resolution CT: histologic characteristics[J]. J Comput Assist Tomogr, 2002, 26(3): 323-329.
[4]Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: international multidisciplinary classification of lung adenocarcinoma: executive summary[J]. Proc Am Thorac Soc, 2011, 8(5): 381-385.
[5]Lee HJ, Goo JM, Lee CH, et al. Predictive CT findings of malignancy in ground-glass nodules on thin-section chest CT: the effects on radiologist performance[J]. Eur Radiol, 2009, 19(3): 552-560.
[6]Lee SM, Park CM, Goo JM, et al. Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features[J]. Radiology, 2013, 268(1): 265-273.
[7]范丽，于红，刘士远，等. 3 cm以下肺恶性局灶性磨玻璃结节与实性结节螺旋CT征象对照[J]. 中华放射学杂志，2010，44（1）：16-19.
[8]Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society[J]. Radiology, 2013, 266(1): 304-317.
[9]Kim HY, Shim YM, Lee KS, et al. Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons[J]. Radiology, 2007, 245(1): 267-275.
[10]Gao F, Li M, Ge X, et al. Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels[J]. Eur Radiol, 2013, 23(12): 3271-3277.
[11]Xiang W, Xing Y, Jiang S, et al. Morphological factors differentiating between early lung adenocarcinomas appearing as pure ground-glass nodules measuring ≤10 mm on thin-section computed tomography[J]. Cancer Imaging, 2014, 14(1): 33.
[12]Koike T, Togashi K, Shirato T, et al. Limited resection for noninvasive bronchioloalveolar carcinoma diagnosed by intraoperative pathologic examination[J]. Ann Thorac Surg, 2009, 88(4): 1106-1111.
[13]Park CM, Goo JM, Lee HJ, et al. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up[J]. Radiographics, 2007, 27(2): 391-408.
[14]金鑫，赵绍宏，高洁，等. 纯磨玻璃密度肺腺癌病理分类及影像表现特点分析[J]. 中华放射学杂志，2014，48（4）：283-287.
[15]高丰，葛虓俊，李铭，等. 不同病理类型肺部磨玻璃结节的CT诊断[J]. 中华肿瘤杂志，2014，36（3）：188-192.
[16]刘佳，李文武，黄勇，等. 表现为磨玻璃密度结节的肺腺癌浸润前病变与微浸润腺癌的多排螺旋CT影像学征象及其鉴别诊断价值[J]. 中华肿瘤杂志，2015，37（8）：611-616.
[17]Aoki T, Tomoda Y, Watanabe H, et al. Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival[J]. Radiology, 2001, 220(3): 803-809.