CAJ | 학술논문

目的探讨CT术前预判磨玻璃样肺腺癌病理类型的可行性.方法回顾分析复旦大学附属华东医院2011年1月至2012年11月143例经手术病理证实的肺内磨玻璃结节患者,随机分成A、B两组,以手术病理又分为,浸润前病变、微浸润腺癌(MIA)及浸润性腺癌(IAC).A组101例,在CT图像上测量病灶的大小、磨玻璃成分所占比例、病灶内实性成分的长径、最长径及大小,用来建立磨玻璃结节样肺腺癌的CT诊断标准.B组42例,评估上述CT诊断标准的准确性.用SPSS 17.0进行统计学分析.结果各项诊断指标在浸润前组和MIA、MIA和IAC间差异均有统计学意义(均P＜0.05);经Spearman检验病灶大小、实性成分长径、最长径、大小及病灶磨玻璃成分所占比例与病理类型均存在相关性(P=0.000).通过绘制ROC曲线得浸润前组与MIA间各诊断指标的诊断价值中等(AUC在0.70 ～0.90);MIA与IAC间病灶大小和实性成分最长径的诊断价值中等(AUC在0.70～0.90),病灶实性成分长径、大小及磨玻璃成分所占比例诊断价值较高(AUC＞0.90).将A组所得的诊断界值用于评估B组病灶的病理类型,经检验CT诊断结果与病理诊断标准间差异无统计学意义(P＞0.05).病灶的大小、磨玻璃成分所占比例、病灶内实性成分的长径、最长径及大小的诊断正确率分别为71.43％、76.19％、90.05％、90.05％、88.10％.结论术前CT检查可依据病灶内实性成分、磨玻璃成分所占比例及病灶大小评估病灶的病理类型.
목적 탐토CT술전예판마파리양폐선암병리류형적가행성.방법 회고분석복단대학부속화동의원2011년1월지2012년11월143례경수술병리증실적폐내마파리결절환자,수궤분성A、B량조,이수술병리우분위,침윤전병변、미침윤선암(MIA)급침윤성선암(IAC).A조101례,재CT도상상측량병조적대소、마파리성분소점비례、병조내실성성분적장경、최장경급대소,용래건립마파리결절양폐선암적CT진단표준.B조42례,평고상술CT진단표준적준학성.용SPSS 17.0진행통계학분석.결과 각항진단지표재침윤전조화MIA、MIA화IAC간차이균유통계학의의(균P＜0.05);경Spearman검험병조대소、실성성분장경、최장경、대소급병조마파리성분소점비례여병리류형균존재상관성(P=0.000).통과회제ROC곡선득침윤전조여MIA간각진단지표적진단개치중등(AUC재0.70 ～0.90);MIA여IAC간병조대소화실성성분최장경적진단개치중등(AUC재0.70～0.90),병조실성성분장경、대소급마파리성분소점비례진단개치교고(AUC＞0.90).장A조소득적진단계치용우평고B조병조적병리류형,경검험CT진단결과여병리진단표준간차이무통계학의의(P＞0.05).병조적대소、마파리성분소점비례、병조내실성성분적장경、최장경급대소적진단정학솔분별위71.43％、76.19％、90.05％、90.05％、88.10％.결론 술전CT검사가의거병조내실성성분、마파리성분소점비례급병조대소평고병조적병리류형.
Objective To explore the feasibility of making a preoperative diagnosis of lung adenocarcinoma shown as ground-glass nodule (GGN) on computed tomography (CT).Methods A total of 143 GGN lesions proved pathologically were divided randomly into A and B groups.Then each group was further divided pathologically into preinvasive lesion,minimal invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) subgroups.Group A (n =101),size of lesion,proportion of ground glass opacity (GGO) composition of lesion,long diameter,longest diameter and size of solid component in lesion were measured on CT so as to establish the CT diagnostic standard of lung adenocarcinoma shown as GGN on CT.Group B (n =42) was employed to evaluate the accuracy of the above CT diagnostic standard.SPSS 17.0 software was used for statistical analysis.Results Significant statistic significance existed in all parameters among all groups (P ＜ 0.05).All parameters were correlated the pathologic type of lesion.The differences were statistically significant (P =0.000).Through the receiver operating characteristic (ROC) curve,between groups of preinvasive lesion and MIA,each parameter had a medium diagnostic value of 0.70-0.90; between groups of MIA and IAC,size of lesion and long diameter of solid component in lesion had a medium diagnostic value of 0.70-0.90,longest diameter of solid component,size of solid component in lesion and proportion of GGO composition of lesion had a high diagnostic value with an AUC of ＞ 0.90.The CT diagnostic standard,derived from group A,was used to analyze the pathologic type of group B.And t no significant statistic significance existed between CT preoperative diagnosis and operative pathologic diagnosis (P ＞ 0.05).The correct diagnosis rates of size of lesion,proportion of GGO composition of lesion,long diameter,longest diameter and size of solid component in lesion were 71.43％,76.19％,90.05％,90.05％ and 88.10％ respectively.Conclusion Based upon size of lesion,proportion of GGO composition of lesion,long diameter,longest diameter and size of solid component in lesion,preoperative CT examination may be used to determine the pathological types of lung adenocarcinoma shown as GGN.