CAJ | 학술논문

目的探讨纯磨玻璃密度(pGGO)肺腺癌病变的病理分类与影像特点.方法回顾性分析2010年1月至2012年12月CT表现为pGGO,且病变大小≤3 cm,TNM分期为T1N0 M0的88例肺腺癌患者,共94处病变.病变均经外科手术切除且经病理检查证实.94处病变中有21个浸润前病变[不典型腺瘤样增生(AAH)和AIS]、35个微浸润腺癌(MIA)和38个浸润性腺癌.图像评价内容包括病变位置、大小、密度、均匀度、形状、边缘、瘤-肺界面、内部及周边征象(空泡征、空气支气管征、胸膜凹陷征、脐凹征).病变大小、密度间差异比较采用单因素方差分析,性别、位置分布及影像表现间差异比较采用x2检验和秩和检验,病变大小对浸润前(AAH+ AIS)和浸润性病变(MIA+AD)的鉴别诊断做ROC曲线分析.结果患者性别、病变位置和病变密度在不同病理类型间差异无统计学意义(P值均＞0.05).浸润前病变、MIA和浸润性腺癌的病变大小分别为(1.24 ±0.68)、(1.75 ±0.58)和(1.60 ±0.52)cm,3组间差异有统计学意义(F=5.08,P=0.008).不同病理类型的病变均匀度差异有统计学意义(x2 =19.42,P=0.001),浸润性腺癌均匀为3个病灶(3/38),浸润前病变为8个病灶(8/21),浸润病变越多,病变的均匀度越低.病理分类与病变边缘差异有统计学意义(x2 =15.80,P =0.02),AAH +AIS多表现为边缘光滑(7/21),MIA(8/35)和浸润性腺癌(14/38)则多表现为分叶+毛刺.瘤-肺界面差异有统计学意义(x2=16.70,P=0.001),AAH+ AIS、MIA和浸润性腺癌瘤-肺界面清晰的比率分别为38.10％ (7/21)、77.14％ (27/35)、86.84％(33/38).空气支气管征的比率差异有统计学意义(x2 =6.06,P=0.048),在不同病理类型中空气支气管征出现的比例为AAH+ AIS 9.52％ (2/21)、MIA 20.00％ (7/35)、浸润性腺癌36.84％ (14/38).ROC曲线显示,当病变＞1.05 cm时,诊断浸润性病变的敏感度、特异度和准确率分别为86.30％、61.90％和80.85％.结论小于3 cm pGGO肺腺癌的病灶大小、均匀度、瘤-肺界面、边缘及空气支气管征对病理分类有一定的预测价值. 目的探討純磨玻璃密度(pGGO)肺腺癌病變的病理分類與影像特點.方法迴顧性分析2010年1月至2012年12月CT錶現為pGGO,且病變大小≤3 cm,TNM分期為T1N0 M0的88例肺腺癌患者,共94處病變.病變均經外科手術切除且經病理檢查證實.94處病變中有21箇浸潤前病變[不典型腺瘤樣增生(AAH)和AIS]、35箇微浸潤腺癌(MIA)和38箇浸潤性腺癌.圖像評價內容包括病變位置、大小、密度、均勻度、形狀、邊緣、瘤-肺界麵、內部及週邊徵象(空泡徵、空氣支氣管徵、胸膜凹陷徵、臍凹徵).病變大小、密度間差異比較採用單因素方差分析,性彆、位置分佈及影像錶現間差異比較採用x2檢驗和秩和檢驗,病變大小對浸潤前(AAH+ AIS)和浸潤性病變(MIA+AD)的鑒彆診斷做ROC麯線分析.結果患者性彆、病變位置和病變密度在不同病理類型間差異無統計學意義(P值均＞0.05).浸潤前病變、MIA和浸潤性腺癌的病變大小分彆為(1.24 ±0.68)、(1.75 ±0.58)和(1.60 ±0.52)cm,3組間差異有統計學意義(F=5.08,P=0.008).不同病理類型的病變均勻度差異有統計學意義(x2 =19.42,P=0.001),浸潤性腺癌均勻為3箇病竈(3/38),浸潤前病變為8箇病竈(8/21),浸潤病變越多,病變的均勻度越低.病理分類與病變邊緣差異有統計學意義(x2 =15.80,P =0.02),AAH +AIS多錶現為邊緣光滑(7/21),MIA(8/35)和浸潤性腺癌(14/38)則多錶現為分葉+毛刺.瘤-肺界麵差異有統計學意義(x2=16.70,P=0.001),AAH+ AIS、MIA和浸潤性腺癌瘤-肺界麵清晰的比率分彆為38.10％ (7/21)、77.14％ (27/35)、86.84％(33/38).空氣支氣管徵的比率差異有統計學意義(x2 =6.06,P=0.048),在不同病理類型中空氣支氣管徵齣現的比例為AAH+ AIS 9.52％ (2/21)、MIA 20.00％ (7/35)、浸潤性腺癌36.84％ (14/38).ROC麯線顯示,噹病變＞1.05 cm時,診斷浸潤性病變的敏感度、特異度和準確率分彆為86.30％、61.90％和80.85％.結論小于3 cm pGGO肺腺癌的病竈大小、均勻度、瘤-肺界麵、邊緣及空氣支氣管徵對病理分類有一定的預測價值.
목적 탐토순마파리밀도(pGGO)폐선암병변적병리분류여영상특점.방법 회고성분석2010년1월지2012년12월CT표현위pGGO,차병변대소≤3 cm,TNM분기위T1N0 M0적88례폐선암환자,공94처병변.병변균경외과수술절제차경병리검사증실.94처병변중유21개침윤전병변[불전형선류양증생(AAH)화AIS]、35개미침윤선암(MIA)화38개침윤성선암.도상평개내용포괄병변위치、대소、밀도、균균도、형상、변연、류-폐계면、내부급주변정상(공포정、공기지기관정、흉막요함정、제요정).병변대소、밀도간차이비교채용단인소방차분석,성별、위치분포급영상표현간차이비교채용x2검험화질화검험,병변대소대침윤전(AAH+ AIS)화침윤성병변(MIA+AD)적감별진단주ROC곡선분석.결과 환자성별、병변위치화병변밀도재불동병리류형간차이무통계학의의(P치균＞0.05).침윤전병변、MIA화침윤성선암적병변대소분별위(1.24 ±0.68)、(1.75 ±0.58)화(1.60 ±0.52)cm,3조간차이유통계학의의(F=5.08,P=0.008).불동병리류형적병변균균도차이유통계학의의(x2 =19.42,P=0.001),침윤성선암균균위3개병조(3/38),침윤전병변위8개병조(8/21),침윤병변월다,병변적균균도월저.병리분류여병변변연차이유통계학의의(x2 =15.80,P =0.02),AAH +AIS다표현위변연광활(7/21),MIA(8/35)화침윤성선암(14/38)칙다표현위분협+모자.류-폐계면차이유통계학의의(x2=16.70,P=0.001),AAH+ AIS、MIA화침윤성선암류-폐계면청석적비솔분별위38.10％ (7/21)、77.14％ (27/35)、86.84％(33/38).공기지기관정적비솔차이유통계학의의(x2 =6.06,P=0.048),재불동병리류형중공기지기관정출현적비례위AAH+ AIS 9.52％ (2/21)、MIA 20.00％ (7/35)、침윤성선암36.84％ (14/38).ROC곡선현시,당병변＞1.05 cm시,진단침윤성병변적민감도、특이도화준학솔분별위86.30％、61.90％화80.85％.결론 소우3 cm pGGO폐선암적병조대소、균균도、류-폐계면、변연급공기지기관정대병리분류유일정적예측개치.
Objective To discuss the pathological classification and imaging characteristics of lung adenocarcinoma with pure ground-glass opacity (pGGO).Methods Ninety-four lesions with pGGO on CT of eighty-eight patients with T1 N0M0 lung adenocarcinoma were retrospectively recruited from January 2010 to December 2012.There were 33 males and 55 females,the age ranged from 26 to 78 years with average age of (53 ± 10) years.All lesions were resected and confirmed pathologically.Among these 94 lesions,there were 21 preinvasive lesions [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)],35 minimally invasive adenocarcinoma (MIA)and 38 invasive adenocarcinoma.CT manifestations were analyzed including lesion location,size,density,uniformity,shape (round,oval,polygonal,irregular),margin (smooth,lobular,spiculated,lobular and spiculated),tumor-lung interface,internal and surrounding malignant signs (bubble sign,air bronchogram,pleural tag,notch).Lesion size and density were compared between different pathologic types using analysis of variance (AVOVA).Gender of patients,lesion location and CT manifestations were compared using x2-test and Wilcoxon test.The sizes of preinvasive and invasivelesions were assessed using ROC curves.Results There were no significant statistical differences ingender,lesion location and density between pathological types (P ＞ 0.05).Mean size of each group was (1.24±0.68),(1.75 ± 0.58) and (1.60 ± 0.52) cm for preinvasive lesion,MIA and invasive adenocarcinoma respectively.Lesion size of different pathologic types was significantly different (F =5.08,P =0.008).There was a significant statistical difference in lesion uniformity between pathological types (x2 =19.42,P =0.001).Three lesions of invasive adenocarcinoma(3/38)and 8 of preinvasive lesions (8/21) were of homogeneous uniformity.Thus,the more invasive the lesion was the more heterogeneity it showed.There was a significant statistical difference in margin between different pathological types (x2 =15.80,P =0.02).Preinvasive lesion always showed smooth margin(7/21),while MIA (8/35) and invasive adenocarcinoma (14/38)were more inclined to present as lobulated and speculated.Tumor-lung interface between different pathological types was significantly different (x2 =16.70,P =0.001).Well defined tumorlung interface in three groups showed as follows:38.10％ (7/21)for preinvasive lesion,77.14％ (27/35)for MIA and 86.84％ (33/38)for invasive adenocarcinoma.There was a significant difference in air bronchogram between different pathological types (x2 =6.06,P =0.048).The air bronchogram was demonstrated in 9.52％ (2/21) of preinvasive lesion,20.00％ (7/35) of MIA,and 36.84％ (14/38) of invasive adenocarcinoma.The ROC curve showed that when diameter of lesion was more than 1.05cm,the sensitivity,specificity and accuracy was 86.30％,61.90％ and 80.85％ respectively.Conclusion The lesion size,uniformity,tumor-lung interface and the air bronchogram can help predict the invasive lesion of lung adenocarcinoma with pGGO less than 3 cm.