混合磨玻璃结节肺腺癌CT表现与病理对照研究
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摘要
目的探讨肺混合磨玻璃结节腺癌的CT征象及其内实性成分特征与原位癌、微浸润腺癌及浸润性腺癌病理分型间的相关性。方法回顾性分析CT表现为混合磨玻璃结节且病理证实的105例肺腺癌(111个结节)患者资料,其中原位癌15个,微浸润癌23个,浸润性癌73个,对比分析上述三组间混合磨玻璃结节的CT征象及其实性成分的特点。选取上述参数单因素分析有意义者为自变量,以病理结果是否为浸润性癌为因变量绘制受试者工作特征曲线(ROC)。结果 111个混合磨玻璃结节的大小、形态、分叶征、胸膜凹陷征、空气支气管征、血管改变、瘤肺界面以及实性成分的个数、形态、毛刺征、分叶征在三组病理类型间差异有统计学意义(P <0. 05);实性成分平均大小、实性占比及实性成分平均CT值在原位癌与浸润癌组、微浸润癌与浸润癌组差异有统计学意义(P <0. 05),在原位癌与微浸润癌组差异无统计学意义(P> 0. 05)。Spearman秩相关分析显示病灶平均大小、平均实性大小、实性占比、平均CT值均与病理类型呈正相关,相关系数分别为rs=0. 535、0. 544、0. 274、0. 587(P <0. 05)。原位癌+微浸润组与浸润癌组间ROC分析,结节平均大小、实性成分平均大小、实性占比及实性平均CT值的曲线下面积(AUC)分别为0. 815、0. 828、0. 681及0. 856,界值分别为16. 54 mm、4. 83 mm、46. 76%及-39. 66HU,敏感度分别为72. 6%、79. 5%、47. 9%及89. 0%,特异度分别为84. 2%、73. 7%、86. 8%及76. 3%。结论混合磨玻璃结节的CT征象与其病理类型有一定的关系,病灶越大,实性成分越多或实性平均CT值越高结节为浸润性癌的可能性越大。
Objective To investigate the relationship between CT manifestations,and features of the solid components of mixed ground-glass nodule( m GGN) and the pathological classification of adenocarcinoma in situ( AIS),microinvasive adenocarcinoma( MIA),and invasive adenocarcinoma( IAC). Methods CT data of 105 cases( with 111 nodules) confirmed to be lung adenocarcinoma were analyzed retrospectively. Based on the pathological findings,there were 15 AIS cases,23 MIA cases and 73 IAC cases. Many CT manifestations and features of the solid components from these three groups were analyzed. Receiver operating characteristic( ROC) curves were drawn with one factor analysis of variance as the independent variable and invasive findings as the dependent variable. Results There were significant statistical differences in many CT features among those three pathological groups,including m GGN size,shape,lobulation,pleural tag,bronchus sign,blood vessel change,tumor/lung interface,and the count,shape,lobulation,spiculation of the solid components. The average size/ratio/CT value of the solid components were significantly different( P < 0. 05) between AIS and MIA,MIA and IAC,while no significant difference( P > 0. 05) between AIS and MIA was observed. The Spearman rank correlation analysis showed positive correlation( P < 0. 05) between pathological classification and average m GGN size,average size of the solid components,average ratio of the solid components,and average CT value of the solid components,with coefficient being 0. 535,0. 544,0. 274 and 0. 587,respectively. The ROC curve analysis results between non-invasive( AIS and MIA) and invasive( IAC) groups in terms of,average m GGN size,average size of the solid components,average ratio of the solid components,average CT value of the solid components,were as following: area under curve( AUC) : 0. 815,0. 828,0. 681,0. 856; threshold: 16. 54 mm,4. 83 mm,46. 76%,-39. 66 HU; sensitivity:72. 6%,79. 5%,47. 9%,89%; specificity: 84. 2%,73. 7%,86. 8%,76. 3%. Conclusion There is a correlation between the CT manifestations of m GGN and pathological classification. The probability of IAS is higher with larger m GGN,higher CT value and ratio of the solid components.
Objective To investigate the relationship between CT manifestations,and features of the solid components of mixed ground-glass nodule( m GGN) and the pathological classification of adenocarcinoma in situ( AIS),microinvasive adenocarcinoma( MIA),and invasive adenocarcinoma( IAC). Methods CT data of 105 cases( with 111 nodules) confirmed to be lung adenocarcinoma were analyzed retrospectively. Based on the pathological findings,there were 15 AIS cases,23 MIA cases and 73 IAC cases. Many CT manifestations and features of the solid components from these three groups were analyzed. Receiver operating characteristic( ROC) curves were drawn with one factor analysis of variance as the independent variable and invasive findings as the dependent variable. Results There were significant statistical differences in many CT features among those three pathological groups,including m GGN size,shape,lobulation,pleural tag,bronchus sign,blood vessel change,tumor/lung interface,and the count,shape,lobulation,spiculation of the solid components. The average size/ratio/CT value of the solid components were significantly different( P < 0. 05) between AIS and MIA,MIA and IAC,while no significant difference( P > 0. 05) between AIS and MIA was observed. The Spearman rank correlation analysis showed positive correlation( P < 0. 05) between pathological classification and average m GGN size,average size of the solid components,average ratio of the solid components,and average CT value of the solid components,with coefficient being 0. 535,0. 544,0. 274 and 0. 587,respectively. The ROC curve analysis results between non-invasive( AIS and MIA) and invasive( IAC) groups in terms of,average m GGN size,average size of the solid components,average ratio of the solid components,average CT value of the solid components,were as following: area under curve( AUC) : 0. 815,0. 828,0. 681,0. 856; threshold: 16. 54 mm,4. 83 mm,46. 76%,-39. 66 HU; sensitivity:72. 6%,79. 5%,47. 9%,89%; specificity: 84. 2%,73. 7%,86. 8%,76. 3%. Conclusion There is a correlation between the CT manifestations of m GGN and pathological classification. The probability of IAS is higher with larger m GGN,higher CT value and ratio of the solid components.
引文
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[9]涂文婷,范丽,顾亚峰,等.计算机辅助定量分析对磨玻璃密度型肺腺癌浸润性的诊断价值[J].临床放射学杂志,2018(3):497-502.
[10]张丽,李蒙,吴宁,等.临床Ⅰ期浸润肺腺癌不同组织学亚型的三维CT值定量分析[J].中华放射学杂志,2015,49(4):268-72.
[11]Cohen J G,Reymond E,Lederlin M,et al.Differentiating pre-and minimally invasive from invasive adenocarcinoma using CT-features in persistent pulmonary part-solid nodules in Caucasian patients[J].Eur J Radiol,2015,84(4):738-44.
[12]Zhang Y,Shen Y,Qiang J W,et al.HRCT features distinguishing pre-invasive from invasive pulmonary adenocarcinomas appearing as ground-glass nodules[J].Eur Radiol,2016,26(9:):2921-8.
[13]葛虓俊,高丰,李铭,等.磨玻璃结节中实性成分对肺腺癌术前CT诊断的价值[J].中华医学杂志,2014,94(13):1010-3.
[14]邹勤,范丽,李琼,等.肺磨玻璃密度结节MDCT定量与病理分型相关性的研究[J].实用放射学杂志,2016,32(11):1681-4.
[15]李琼,范丽,顾亚峰,等.三维平均CT值和PET/CT最大标准化摄取值预测磨玻璃密度结节型肺腺癌侵袭性的研究[J].实用放射学杂志,2016,32(6):867-70.
[2]Cho J H,Choi Y S,Kim J,et al.Long-term outcomes of wedge resection for pulmonary groung-glass opacity nodules[J].Ann Thorac,2015,99(1):218-22.
[3]曹捍波,张永奎,王善军,等.肺部混合磨玻璃结节实性成分的CT表现[J].中国医学影像学杂志,2015,23(8):587-90,595.
[4]Takahashi M,Shigematsu Y,Ohta M,et al.Tumor invasiveness as defined by the newly proposed IASLC/ATS/ERS classification has prognostic significance for pathologic stage IA lung adenocarcinoma and can be predicted by radiologic parameters[J].J Thorac Cardiovasc Surg,2014,147(1):54-9.
[5]Travis W D,Brambilla E,Burke A P,et al.Introduction to the2015 WHO Classification of tumours of the lung,pleura,thymus and heart[J].J Thorac Oncol,2015,10(9):1240-2.
[6]陈相猛,郝以秀,李荣岗,等.T1a期肺腺癌CT征象与病理对照研究[J].临床放射学杂志,2016,35(10):1502-6.
[7]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):188-92.
[8]范丽,李清楚,刘士远,等.肺部混杂性磨玻璃密度结节的MDCT表现[J].实用放射学杂志,2011,27(1):46-50,79.
[9]涂文婷,范丽,顾亚峰,等.计算机辅助定量分析对磨玻璃密度型肺腺癌浸润性的诊断价值[J].临床放射学杂志,2018(3):497-502.
[10]张丽,李蒙,吴宁,等.临床Ⅰ期浸润肺腺癌不同组织学亚型的三维CT值定量分析[J].中华放射学杂志,2015,49(4):268-72.
[11]Cohen J G,Reymond E,Lederlin M,et al.Differentiating pre-and minimally invasive from invasive adenocarcinoma using CT-features in persistent pulmonary part-solid nodules in Caucasian patients[J].Eur J Radiol,2015,84(4):738-44.
[12]Zhang Y,Shen Y,Qiang J W,et al.HRCT features distinguishing pre-invasive from invasive pulmonary adenocarcinomas appearing as ground-glass nodules[J].Eur Radiol,2016,26(9:):2921-8.
[13]葛虓俊,高丰,李铭,等.磨玻璃结节中实性成分对肺腺癌术前CT诊断的价值[J].中华医学杂志,2014,94(13):1010-3.
[14]邹勤,范丽,李琼,等.肺磨玻璃密度结节MDCT定量与病理分型相关性的研究[J].实用放射学杂志,2016,32(11):1681-4.
[15]李琼,范丽,顾亚峰,等.三维平均CT值和PET/CT最大标准化摄取值预测磨玻璃密度结节型肺腺癌侵袭性的研究[J].实用放射学杂志,2016,32(6):867-70.