中国癌症杂志
中國癌癥雜誌
중국암증잡지
CHINA ONCOLOGY
2015年
3期
199-204
,共6页
黄浩哲%李国栋%许立超%李文涛%王升平
黃浩哲%李國棟%許立超%李文濤%王升平
황호철%리국동%허립초%리문도%왕승평
亚实性肺结节%磨玻璃影%ⅠA期肺癌%影像诊断
亞實性肺結節%磨玻璃影%ⅠA期肺癌%影像診斷
아실성폐결절%마파리영%ⅠA기폐암%영상진단
Subsolid nodule%Ground-glass opacity%StageⅠA lung cancer%Imaging diagnosis
背景与目的:亚实性肺结节(subsolid pulmonary nodule,SSPN)作为一种特征性而非特异性的肺部病灶与早期肺癌关系密切,为探讨其对ⅠA期肺癌的诊断价值,本研究将分析不同性质SSPNs的CT诊断及鉴别诊断要点。方法:收集2008年4月—2014年4月在复旦大学附属肿瘤医院行CT引导Hookwire定位下胸腔镜手术(video assisted thoracic surgery,VATS)治疗的405例孤立性肺结节(solitary pulmonary nodule,SPN)患者的临床及影像学资料。根据磨玻璃影(ground-glass opacity,GGO)成分含量将SPNs分为单纯型磨玻璃影(pure ground-glass opacity,pGGO)、混合型磨玻璃影(mixed ground-glass opacity,mGGO)和实性结节(solid nodule,SN)3组,并统计各组恶性率。根据术后病理结果,再将SSPNs分为ⅠA期肺癌组和良性组,分析对比影响SSPN良、恶性的影像学特征。结果:共纳入405例SPN患者,其中SSPNs有367例(包括124例pGGOs和243例mGGOs),且在ⅠA期肺癌中的发生率明显高于良性组[95.9%(257/268) vs 80.3%(110/137),P<0.001]。SSPN的总恶性率为70.0%(257/367),且mGGO的恶性率(72.0%)要高于pGGO(66.1%)和SN(28.9%)。恶性SSPN多发生于中年女性肺上叶,且病灶边界不清、边缘毛刺、分叶和胸膜凹陷征的发生率高于良性组(P<0.05)。结论:SSPN是肺癌的重要征象,且以mGGO的恶性倾向最高。若中年女性伴有肺上叶的SSPN,且病灶边界不清、边缘出现毛刺、分叶或胸膜凹陷时,应高度怀疑恶性。
揹景與目的:亞實性肺結節(subsolid pulmonary nodule,SSPN)作為一種特徵性而非特異性的肺部病竈與早期肺癌關繫密切,為探討其對ⅠA期肺癌的診斷價值,本研究將分析不同性質SSPNs的CT診斷及鑒彆診斷要點。方法:收集2008年4月—2014年4月在複旦大學附屬腫瘤醫院行CT引導Hookwire定位下胸腔鏡手術(video assisted thoracic surgery,VATS)治療的405例孤立性肺結節(solitary pulmonary nodule,SPN)患者的臨床及影像學資料。根據磨玻璃影(ground-glass opacity,GGO)成分含量將SPNs分為單純型磨玻璃影(pure ground-glass opacity,pGGO)、混閤型磨玻璃影(mixed ground-glass opacity,mGGO)和實性結節(solid nodule,SN)3組,併統計各組噁性率。根據術後病理結果,再將SSPNs分為ⅠA期肺癌組和良性組,分析對比影響SSPN良、噁性的影像學特徵。結果:共納入405例SPN患者,其中SSPNs有367例(包括124例pGGOs和243例mGGOs),且在ⅠA期肺癌中的髮生率明顯高于良性組[95.9%(257/268) vs 80.3%(110/137),P<0.001]。SSPN的總噁性率為70.0%(257/367),且mGGO的噁性率(72.0%)要高于pGGO(66.1%)和SN(28.9%)。噁性SSPN多髮生于中年女性肺上葉,且病竈邊界不清、邊緣毛刺、分葉和胸膜凹陷徵的髮生率高于良性組(P<0.05)。結論:SSPN是肺癌的重要徵象,且以mGGO的噁性傾嚮最高。若中年女性伴有肺上葉的SSPN,且病竈邊界不清、邊緣齣現毛刺、分葉或胸膜凹陷時,應高度懷疑噁性。
배경여목적:아실성폐결절(subsolid pulmonary nodule,SSPN)작위일충특정성이비특이성적폐부병조여조기폐암관계밀절,위탐토기대ⅠA기폐암적진단개치,본연구장분석불동성질SSPNs적CT진단급감별진단요점。방법:수집2008년4월—2014년4월재복단대학부속종류의원행CT인도Hookwire정위하흉강경수술(video assisted thoracic surgery,VATS)치료적405례고립성폐결절(solitary pulmonary nodule,SPN)환자적림상급영상학자료。근거마파리영(ground-glass opacity,GGO)성분함량장SPNs분위단순형마파리영(pure ground-glass opacity,pGGO)、혼합형마파리영(mixed ground-glass opacity,mGGO)화실성결절(solid nodule,SN)3조,병통계각조악성솔。근거술후병리결과,재장SSPNs분위ⅠA기폐암조화량성조,분석대비영향SSPN량、악성적영상학특정。결과:공납입405례SPN환자,기중SSPNs유367례(포괄124례pGGOs화243례mGGOs),차재ⅠA기폐암중적발생솔명현고우량성조[95.9%(257/268) vs 80.3%(110/137),P<0.001]。SSPN적총악성솔위70.0%(257/367),차mGGO적악성솔(72.0%)요고우pGGO(66.1%)화SN(28.9%)。악성SSPN다발생우중년녀성폐상협,차병조변계불청、변연모자、분협화흉막요함정적발생솔고우량성조(P<0.05)。결론:SSPN시폐암적중요정상,차이mGGO적악성경향최고。약중년녀성반유폐상협적SSPN,차병조변계불청、변연출현모자、분협혹흉막요함시,응고도부의악성。
Background and purpose: With characteristic but non-specific features, subsolid pulmonary nodules (SSPN) is closely associated with early lung cancer. This study aimed to estimate the imaging value of SSPN in stageⅠA lung cancer, and summarized the radiological features of various SSPNs, retrospectively. Methods:The clinical data and imaging data of 405 patients with solitary pulmonary nodules (SPNs) from Apr. 2008 to Apr. 2014 at Fudan University Shanghai Cancer Center were collected. According to ground-glass opacity (GGO) proportion, SPNs were divided into 3 groups:pure ground-glass opacity (pGGO), mixed ground-glass opacity (mGGO) and solid nodule (SN). The malignant ratios were calculated based on the postoperatively pathological results. Besides, SSPNs were classiifed into stageⅠA lung cancer group and benign lesions group aiming at identifying the differentiating computed tomography (CT) features. Results:Of the enrolled 405 SPN patients, there were 367 SSPNs (including 124 pGGOs and 243 mGGOs) whose incidence in stageⅠA lung cancer group was signiifcantly higher than those in benign group [95.9%(257/268) vs 80.3%(110/137), P<0.001]. The total malignant ratio of SSPN was 70.0%(257/367), mGGO had a higher malignant ratio (72.0%) than those of pGGO (66.1%) and SN (28.9%). The malignant SSPNs were frequently detected in upper lobe of middle-aged women with a higher incidence of irregular edge, spiculation, lobulation and pleural retraction than benign group (P<0.05). Conclusion:SSPN is one of the signiifcantly malignant indicators, and mGGO has the highest malignant tendency. Senility, female, irregular edge, spiculation, lobulation, pleural retraction and pulmonary upper lobe distribution are demonstrated the signiifcant discriminators from benign lesions.