肺原位腺癌和微浸润腺癌的高分辨CT影像形态学特征研究
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摘要
目的探讨肺原位腺癌(adenocarcinoma in situ,AIS)和微浸润腺癌(minimally invasive adenocarcinoma,MIA)的高分辨CT形态学特征,与周围血管位置变化关系。方法选取127例经手术病理证实的AIS和MIA患者,分为AIS组(48例)和MIA组(79例),总结患者术前胸部的高分辨CT图像特征及术后的病理学资料,并分析其组间差异。结果两组术前肺部小结节病灶的大小、密度及是否有血管穿行组间差异均有统计学意义(P<0.05);AIS组小结节最大直径平均值为(9.1±0.8)mm,MIA组的最大值径为(9.6±1.1)mm,组间比较差异有统计学意义(P<0.05);AIS组中小结节密度不均,呈混合性磨玻璃结节(mixed ground-glass nodule,mGGN)有10例,占20.8%,MIA组mGGN为31例,占39.2%,组间比较差异有统计学意义(P<0.05);AIS组中结节周围有血管穿行的有13例,占33.3%,MIA组中结节周围血管穿行的有41例,占51.8%,两组比较差异均有明显统计学意义(P<0.05)。结论肺部小结节的高分辨CT形态学特征可以对AIS及MIA这两种病理亚型进行预判断,可为患者提供手术方案及预后治疗提供帮助。
Objective To investigate High-Resolution(HRCT)morphological feature of adenocarcinoma in situ(AIS)and minimally invasive adenocarcinoma(MIA),combined with the change of blood vessel location.Methods 127 AIS and MIA patients which confirmed by pathology and operation,Divided into two groups,Summarized the morphological feature of CT images before operation and pathological materials after operation.Results 48 cases of AIS and 79 cases of MIA were confirmed by pathology.The small pulmonary nodules' size,density and which passing through by vessels were significant in statistic(P<0.05).The averaging diameter of the lesion in the group of AIS was(9.1±0.8)mm.The MIA group was(9.6±1.1)mm,10 cases of mixed ground-glass nodule(mGGN)in AIS(20.8%),31 cases of mGGN in MIA(39.2%),13 cases of which nodules passing through by vessles in AIS(33.3%),41 cases in MIA(51.8%).There were significant in statistic(P<0.05).Conclusion The analysis of the imaging features of the lesions in pulmonary can predict the AIS and MIA,It would be helpful to provide individualized surgery and postoperative treatment.
Objective To investigate High-Resolution(HRCT)morphological feature of adenocarcinoma in situ(AIS)and minimally invasive adenocarcinoma(MIA),combined with the change of blood vessel location.Methods 127 AIS and MIA patients which confirmed by pathology and operation,Divided into two groups,Summarized the morphological feature of CT images before operation and pathological materials after operation.Results 48 cases of AIS and 79 cases of MIA were confirmed by pathology.The small pulmonary nodules' size,density and which passing through by vessels were significant in statistic(P<0.05).The averaging diameter of the lesion in the group of AIS was(9.1±0.8)mm.The MIA group was(9.6±1.1)mm,10 cases of mixed ground-glass nodule(mGGN)in AIS(20.8%),31 cases of mGGN in MIA(39.2%),13 cases of which nodules passing through by vessles in AIS(33.3%),41 cases in MIA(51.8%).There were significant in statistic(P<0.05).Conclusion The analysis of the imaging features of the lesions in pulmonary can predict the AIS and MIA,It would be helpful to provide individualized surgery and postoperative treatment.
引文
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[15]胡碧波,闫昆,华奇峰,等.周围型肺腺癌的高分辨CT表现与最新病例分型的相关分析[J].中国癌症杂志,2014,24:397-400.
[16]肖时满,张玉,强金伟,等.超高分辨率CT(UHRCT)鉴别肺原位腺癌(AIS)与微浸润腺癌(MIA)[J].复旦学报(医学版),2014,41(3):285-290.
[17]华奇峰,郑建军,胡碧波,等.肺微浸润腺癌与原位腺癌的HRCT表现及鉴别诊断[J].医学影像学杂志,2016,26(8):1413-1416.
[18]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.
[19]Fridman WII,Dieu-Nosjean MC,Pages F,et al.The immune micro-environment of human tumors:general significance and clinical impact[J].Cancer Microenviron,2013,6:117-122.
[20]Tsutani Y,Miyata Y,Nakayama H,et al.Prediction of pathologic node-negative clinical StageⅠA lung adenocarcinoma for optimal candidates undergoing sublobar resection[J].Thorac Cardiovasc Surg,2012,144(6):1365-1371.
[21]李予林,陈志军,喻微,等.肺原位腺癌和微浸润腺癌489例的临床病理和预后分析[J].中国胸心血管外科临床杂志,2017,(24)6:445-448.
[2]Jiang B,Wang J,Jia P,et al.The value of CT attenuation in distinguishing atypical adenomatous hyperplasia from adenocarcinoma in situ[J].zhongguo Fei AI Za Zhi,2013,16(11):579-583.
[3]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[J].Journal of Thoraciconcology,2011,6(2):244-285.
[4]Sasada S,Miyata y,Tsubokawa N,et al.Role of positron emission tomograpy/computed tomography findings for adjuvant ehemotherapy indications in stage T1b-2aNOMO lang adenocarcinoma[J].Ann Thorae Surg,2014,21(14):927-928.
[5]Fan L,Liu SY,Li QC,et al.Multidetector CT features of pulmonary focal ground-glass opacity:differences between benign and malignant[J].Br J Radilo,2012,85(1015)897-904.
[6]Lee HJ,Kim YT,Kang CH,et al.Epidermal growth factor receptor mutation in lung adenocarcinomas:relationship with CT characteristics and histologic subtypes[J].Radiology,2013,268(1):254-264.
[7]Chang B,Hwang J H,Choi Y H,et al.Natural History of Pure Ground-Glass Opacity Lung Nodules Detected by LowDose CT Scan[J].Chest,2013,143(1):172-178.
[8]IKeda K,Kusumoto M,Watanabe S,et al.Differential diagnosis of ground glass opacity nodules:CT number analysis by three-dimensional computerized quantification[J].chest,2007,132:984-990.
[9]孙姗姗,李惠民,庹崚葳,等.肺原位腺癌的超高分辨率CT表现[J].中国医学计算机成像杂志,2016,22(2):121-125.
[10]何慧,孙鹏飞,曹向荣,等.肺局灶性磨玻璃密度结节的多层螺旋CT诊断[J].中国医学影像学杂志,2014,22(2):121-123.126.
[11]吴芳,蔡祖龙,田树平,等.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[J].中国医学科学院学报,2015,37:163-170.
[12]彭光明,蔡祖龙,祝庆孚,等.空泡征的CT-病理再研究[J].中华放射学杂志,1996,30:392-395.
[13]Rocco R,Jones D R,Morabito A,et al.Validation of the new IASLC/ATS/ERS lung adenocarcinoma classification:a surgeon's perspective[J].Journal of Thoracic Disease,2014,6(5):547.
[14]严金岗,张善华,王善军,等.肺原位腺癌与微浸润腺癌实性成分鉴别诊断[J].医学影像学杂志,2016,26(11):2002-2004.
[15]胡碧波,闫昆,华奇峰,等.周围型肺腺癌的高分辨CT表现与最新病例分型的相关分析[J].中国癌症杂志,2014,24:397-400.
[16]肖时满,张玉,强金伟,等.超高分辨率CT(UHRCT)鉴别肺原位腺癌(AIS)与微浸润腺癌(MIA)[J].复旦学报(医学版),2014,41(3):285-290.
[17]华奇峰,郑建军,胡碧波,等.肺微浸润腺癌与原位腺癌的HRCT表现及鉴别诊断[J].医学影像学杂志,2016,26(8):1413-1416.
[18]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.
[19]Fridman WII,Dieu-Nosjean MC,Pages F,et al.The immune micro-environment of human tumors:general significance and clinical impact[J].Cancer Microenviron,2013,6:117-122.
[20]Tsutani Y,Miyata Y,Nakayama H,et al.Prediction of pathologic node-negative clinical StageⅠA lung adenocarcinoma for optimal candidates undergoing sublobar resection[J].Thorac Cardiovasc Surg,2012,144(6):1365-1371.
[21]李予林,陈志军,喻微,等.肺原位腺癌和微浸润腺癌489例的临床病理和预后分析[J].中国胸心血管外科临床杂志,2017,(24)6:445-448.