CAJ | 학술논문

目的：探讨肺部单发纯磨玻璃密度影( pure ground-glass opacity,pGGO)临床及病理学特征。方法收集38例经手术切除的pGGO患者的临床资料,回顾性分析患者的年龄情况、性别构成、吸烟状况、手术方式、病灶大小、病灶分布、影像学特征、组织学类型。结果本组女性和不吸烟患者明显多于男性和吸烟患者,38例患者全部在电视胸腔镜下进行肺楔形切除术或肺段、肺叶切除术,术后病理学检查显示：恶性肿瘤31例(原位腺癌13例,微浸润性腺癌13例,浸润性腺癌5例),均无淋巴结转移。非恶性病变(不典型腺瘤样增生3例、炎症3例、出血1例)7例。 pGGO病灶<10 mm有18例,其中12例为恶性肿瘤(66．67%),病灶≥10 mm有20例,其中19例为恶性肿瘤(95%),当病灶≥10 mm时,pGGO的恶性肿瘤机率明显增大(P<0．05)。确诊为恶性肿瘤的病例,可以显示一种或多种恶性征象(包括边缘清晰、分叶、毛刺、病灶内部血管插入等),高于非恶性病变。复习31例初诊pGGO并最终手术病理证实为恶性肿瘤的患者的随访情况,显示随访期为3-48个月,随访过程中pGGO无变化的有21例,随访过程中出现病灶体积增大和/或密度增高有10例。结论持续存在的pGGO,若病灶≥10 mm恶性肿瘤可能性大。初诊无法判断良恶性时,定期随访非常重要,随访过程中若出现病灶体积增大和/或密度增加,高度怀疑恶性可能,需积极手术干预。若随访过程中病灶稳定,仍需坚持随访4年以上。
목적：탐토폐부단발순마파리밀도영( pure ground-glass opacity,pGGO)림상급병이학특정。방법수집38례경수술절제적pGGO환자적림상자료,회고성분석환자적년령정황、성별구성、흡연상황、수술방식、병조대소、병조분포、영상학특정、조직학류형。결과본조녀성화불흡연환자명현다우남성화흡연환자,38례환자전부재전시흉강경하진행폐설형절제술혹폐단、폐협절제술,술후병이학검사현시：악성종류31례(원위선암13례,미침윤성선암13례,침윤성선암5례),균무림파결전이。비악성병변(불전형선류양증생3례、염증3례、출혈1례)7례。 pGGO병조<10 mm유18례,기중12례위악성종류(66．67%),병조≥10 mm유20례,기중19례위악성종류(95%),당병조≥10 mm시,pGGO적악성종류궤솔명현증대(P<0．05)。학진위악성종류적병례,가이현시일충혹다충악성정상(포괄변연청석、분협、모자、병조내부혈관삽입등),고우비악성병변。복습31례초진pGGO병최종수술병리증실위악성종류적환자적수방정황,현시수방기위3-48개월,수방과정중pGGO무변화적유21례,수방과정중출현병조체적증대화/혹밀도증고유10례。결론지속존재적pGGO,약병조≥10 mm악성종류가능성대。초진무법판단량악성시,정기수방비상중요,수방과정중약출현병조체적증대화/혹밀도증가,고도부의악성가능,수적겁수술간예。약수방과정중병조은정,잉수견지수방4년이상。
Objective To investigate the clinical and pathological characteristics of pulmonary single pure ground-glass opacity ( pGGO) . Methods The clinical data of 38 patients with pGGO were retrospectively analyzed, including age, gender, smoking status, surgical procedures, lesion size, lesion distribution, iconography characteris-tics, and histological types of lesions. Results The number of females and non-smokers was significantly higher than those of males and smokers. 38 patients received wedge resection, segment resection or lobectomy in video-assisted thoracoscopic surgery. Pathological examinations after operation revealed that there were 31 cases of malignant tumor without lymph node metastasis (13 adenocarcinoma in situ, 13 microinvasive adenocarcinoma infiltrating and 5 adeno-carcinoma infiltrating) , and 7 cases of non-malignant disease ( 3 atypical adenomatous hyperplasia, 3 inflammation and 1 bleeding). Of 18 patients with pGGO smaller than 10mm, 12 cases were diagnosed as malignant tumor. Of 20 cases larger than 10mm, 19 cases were diagnosed as malignant tumor. When the lesion was larger than10mm, the prevalence of malignant tumor was much higher (P<0. 05). Lesions, which were pathologically confirmed as canc-er, displayed one or more signs of malignancy ( including sharp edges, leaf, burr, internal vascular lesions insert, etc. ) , and had a higher prevalence of malignancy signs than the non-malignant lesions. The 31 patients with patho-logical-demonstrated cancer and presented as pGGO had a 3-48 months follow-up before surgery, and 21 cases had no changes during follow-up, whereas 10 cases had obvious changes. Conclusion The results show that if the lesion is≥10 mm, it is more likely to be malignant tumor. If the nature of the lesion cannot be determined, regular follow-up is very important. Once the lesions progressed in volume and/or in density, malignancy is highly suspected and sur-gery might be necessary. On the other hand, if the lesion is stable during follow-up period, a follow-up of at least four years is still necessary.