肺部磨玻璃结节的CT影像特征评估肺腺癌浸润性的价值
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摘要
目的探讨肺部磨玻璃结节的电子计算机断层扫描(CT)影像特征,对肺腺癌浸润性的评估价值。方法选取2016年2月-2018年10月来我院经CT扫描和病理检查确诊的62例磨玻璃结节患者,其中分为非浸润性腺癌组(n=34)和浸润性腺癌组(n=28),比较两组CT征象,采用Logistic回归分析法,分析影响肿瘤浸润的危险因素,采用受试者工作特征曲线(ROC)下面积(AUC)比较各危险因素对肺腺癌浸润性的预测价值。结果非浸润性腺癌组的病灶直径、CT值、相对CT值、病灶边缘、空气支气管征、胸膜凹陷征和磨玻璃类型与浸润性腺癌组比较,差异具有统计学意义(P <0. 05); Logistic回归分析显示,病灶直径和空气支气管征可作为评估浸润性腺癌的危险因素(P <0. 05);病灶直径的AUC值明显高于空气支气管征的AUC值(P <0. 05)。结论肺部CT扫描磨玻璃结节的病灶直径,有助于术前预测患者有无浸润性肺腺癌的可能,可用作临床治疗方案选择的参考。
Objective To investigate the evaluating value of CT scanning grinding glass nodules in invasive lung adenocarcinoma. Methods A total of 62 grinding glass nodules patients diagnosed by CT scanning and pathological examination in our hospital were selected from Feb. 2016 to Oct. 2018,and they were divided into two groups: the non-invasive lung adenocarcinoma group( n = 34) and the invasive lung adenocarcinoma group( n =28). The CT sign was compared between the two groups,and the logistic regression analysis was used to analyze the risk factors of tumor invasion. The predictive value of various risk factors to invasive lung adenocarcinoma were compared by using the area( AUC) under the receiver operator characteristics curve( ROC). Results There were significant differences in lesion diameter,CT value,relative CT value,lesion edge,air bronchogram,pleural indentation sign and glass-grinding type between the non-invasive lung adenocarcinoma group and the invasive lung adenocarcinoma group( P < 0. 05). Logistic regression analysis showed that lesion diameter and air bronchus sign could be used as risk factors for evaluating invasive adenocarcinoma( P < 0. 05). The AUC value of lesion diameter was significantly higher than the AUC value of air bronchogram( P < 0. 05). Conclusion According to CT scanning the lesion diameter of the grinding glass nodules,it is helpful to predict the possibility of invasive lung adenocarcinoma before operation,so it can guide the clinical rational choice of the treatment plan.
Objective To investigate the evaluating value of CT scanning grinding glass nodules in invasive lung adenocarcinoma. Methods A total of 62 grinding glass nodules patients diagnosed by CT scanning and pathological examination in our hospital were selected from Feb. 2016 to Oct. 2018,and they were divided into two groups: the non-invasive lung adenocarcinoma group( n = 34) and the invasive lung adenocarcinoma group( n =28). The CT sign was compared between the two groups,and the logistic regression analysis was used to analyze the risk factors of tumor invasion. The predictive value of various risk factors to invasive lung adenocarcinoma were compared by using the area( AUC) under the receiver operator characteristics curve( ROC). Results There were significant differences in lesion diameter,CT value,relative CT value,lesion edge,air bronchogram,pleural indentation sign and glass-grinding type between the non-invasive lung adenocarcinoma group and the invasive lung adenocarcinoma group( P < 0. 05). Logistic regression analysis showed that lesion diameter and air bronchus sign could be used as risk factors for evaluating invasive adenocarcinoma( P < 0. 05). The AUC value of lesion diameter was significantly higher than the AUC value of air bronchogram( P < 0. 05). Conclusion According to CT scanning the lesion diameter of the grinding glass nodules,it is helpful to predict the possibility of invasive lung adenocarcinoma before operation,so it can guide the clinical rational choice of the treatment plan.
引文
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[12]时兆婷,乐坚,陈雅玲,等.浸润性乳腺癌超声征象与腋下淋巴结转移的相关性研究[J].中华超声影像学杂志,2017,26(5):424-429.
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[14]姚克林,胡红杰,夏瑞明,等.空气支气管征和空泡征并存对非结节肿块型肺隐球菌病CT诊断价值的初步观察[J].浙江临床医学,2017,19(6):1121-1123.
[15]杨越清,高杰,金梅,等.纯磨玻璃密度肺腺癌内异常空气支气管征预测病理亚型的价值[J].中华放射学杂志,2017,51(7):489-492.
[16]王武明,刘玉珍,刘翼军,等.中央型肺鳞癌沿支气管壁侵犯的临床与病理研究[J/OL].中华临床医师杂志(电子版),2015,9(4):687-689[2019-02-20]. http://med. wanfangdata. com. cn/Paper/Detail? id=PeriodicalPaper_zhlcyszz201504038&dbid=WF_QK. DOI:10. 3877/cma. j. issn. 1674-0785. 2015. 04. 038.
[17]左玉强,冯平勇,孟庆春,等.纯磨玻璃密度肺腺癌病灶内部CT影像特点[J].实用医学杂志,2017,33(4):576-579.
[2]刘丽,姜建威.肺腺癌新增分类及研究新进展[J/OL].中华临床医师杂志(电子版),2014,8(6):115-119[2019-02-20]. http://www. cqvip. com/read/read. aspx? id=49622214. DOI:10.3969/cma. j. issn. 1674-0785. 2014. 06. 029.
[3]马毅兵.浸润性微乳头型肺腺癌的临床病理分析及预后评估[J].中国医药指南,2016,14(35):34-35.
[4]董科,舒锦尔,王利霞,等.不同病理阶段肺腺癌性磨玻璃结节PET/CT表现差异分析[J].中国临床医学影像杂志,2017,28(11):793-797.
[5]胡碧波,闫昆,华奇峰.微浸润型肺腺癌的高分辨率CT表现及病理特征[J].中国医刊,2014,49(6):78-80.
[6]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.
[7] TRAVIS W D,BRAMBILLA E,NICHOLSON A G,et al. The 2015World Health Organization Classification of Lung Tumors:impact of genetic,clinical and radiologic advances since the 2004 Classification[J]. J Thorac Oncol,2015,10(9):1243-1260.
[8]石祥宇,庞青松,赵纲,等.伴微乳头结构肺腺癌的研究进展[J].中国肺癌杂志,2015,18(11):701-705.
[9]杨海,陈盈,李欣,等.最大径1~3cm的纯磨玻璃肺腺癌CT特征与病理类型相关性研究[J].中华全科医学,2018,16(6):969-973.
[10]李西,肖湘生,于红,等. CT图像纹理特征分析对肺部纯磨玻璃结节侵袭性的诊断价值[J].山西医药杂志,2016,45(12):1411-1414.
[11]刁晓鹏,于华龙,刘世合,等.肺多发肿瘤性局灶性磨玻璃结节CT征象与病理结果的对照分析[J].中国医学影像技术,2017,33(S1):29-33.
[12]时兆婷,乐坚,陈雅玲,等.浸润性乳腺癌超声征象与腋下淋巴结转移的相关性研究[J].中华超声影像学杂志,2017,26(5):424-429.
[13] LIU L H,LIU M,WEI R,et al. CT findings of persistent pure ground glass opacity:can we predict the invasiveness?[J]. Asian Pac J Cancer Prev,2015,16(5):1925-1928.
[14]姚克林,胡红杰,夏瑞明,等.空气支气管征和空泡征并存对非结节肿块型肺隐球菌病CT诊断价值的初步观察[J].浙江临床医学,2017,19(6):1121-1123.
[15]杨越清,高杰,金梅,等.纯磨玻璃密度肺腺癌内异常空气支气管征预测病理亚型的价值[J].中华放射学杂志,2017,51(7):489-492.
[16]王武明,刘玉珍,刘翼军,等.中央型肺鳞癌沿支气管壁侵犯的临床与病理研究[J/OL].中华临床医师杂志(电子版),2015,9(4):687-689[2019-02-20]. http://med. wanfangdata. com. cn/Paper/Detail? id=PeriodicalPaper_zhlcyszz201504038&dbid=WF_QK. DOI:10. 3877/cma. j. issn. 1674-0785. 2015. 04. 038.
[17]左玉强,冯平勇,孟庆春,等.纯磨玻璃密度肺腺癌病灶内部CT影像特点[J].实用医学杂志,2017,33(4):576-579.