CAJ | 학술논문

目的：分析表现为磨玻璃密度结节（ GGNs）的肺腺癌浸润前病变与微浸润腺癌的多排螺旋CT（ MDCT）影像学征象及其鉴别诊断意义。方法对93例共111个 GGNs的病理资料及其MDCT影像征象进行回顾性分析，并对其不同的影像学征象进行统计学分析。结果93例GGNs患者中，浸润前病变27例（38个GGNs），微浸润腺癌66例（73个GGNs）。肺腺癌浸润前病变和微浸润腺癌患者的性别、发病年龄和病灶数量间差异均无统计学意义（均P＞0．05）。浸润前病变和微浸润腺癌的病灶大小、实性成分大小和含量间的差异有统计学意义（ P＜0．05）。受试者工作特征（ ROC）曲线分析显示，肺腺癌浸润前病变与微浸润腺癌病灶大小的最佳界值为13．0 mm，其诊断浸润前病变的敏感度为83．0％，特异度为80．0％；浸润前病变与微浸润腺癌实性成分大小的最佳界值为2．0 mm，其诊断浸润前病变的敏感度为90．0％，特异度为97．0％；肺腺癌浸润前病变与微浸润腺癌实性成分含量的最佳界值为12．0％，其诊断浸润前病变的敏感度为88．0％，特异度为97．0％。在CT形态学特征中，浸润前病变和微浸润腺癌的病灶性质、有无分叶和有无毛刺间的差异均有统计学意义（均P＜0．05），而在病灶边界、有无支气管充气征、空泡征和胸膜凹陷征间的差异均无统计学意义（均P＞0．05）。结论GGNs的大小、实性成分大小、实性成分含量及边缘形态特征在肺腺癌浸润前病变与微浸润腺癌间有鉴别诊断意义。
목적：분석표현위마파리밀도결절（ GGNs）적폐선암침윤전병변여미침윤선암적다배라선CT（ MDCT）영상학정상급기감별진단의의。방법대93례공111개 GGNs적병리자료급기MDCT영상정상진행회고성분석，병대기불동적영상학정상진행통계학분석。결과93례GGNs환자중，침윤전병변27례（38개GGNs），미침윤선암66례（73개GGNs）。폐선암침윤전병변화미침윤선암환자적성별、발병년령화병조수량간차이균무통계학의의（균P＞0．05）。침윤전병변화미침윤선암적병조대소、실성성분대소화함량간적차이유통계학의의（ P＜0．05）。수시자공작특정（ ROC）곡선분석현시，폐선암침윤전병변여미침윤선암병조대소적최가계치위13．0 mm，기진단침윤전병변적민감도위83．0％，특이도위80．0％；침윤전병변여미침윤선암실성성분대소적최가계치위2．0 mm，기진단침윤전병변적민감도위90．0％，특이도위97．0％；폐선암침윤전병변여미침윤선암실성성분함량적최가계치위12．0％，기진단침윤전병변적민감도위88．0％，특이도위97．0％。재CT형태학특정중，침윤전병변화미침윤선암적병조성질、유무분협화유무모자간적차이균유통계학의의（균P＜0．05），이재병조변계、유무지기관충기정、공포정화흉막요함정간적차이균무통계학의의（균P＞0．05）。결론GGNs적대소、실성성분대소、실성성분함량급변연형태특정재폐선암침윤전병변여미침윤선암간유감별진단의의。
Objective The aim of this study was to retrospectively investigate the multi?detector computed tomography ( MDCT ) features of preinvasive lesions and minimally invasive adenocarcinoma (MIA) appearing as ground?glass nodules ( GGNs), and to analyze their significance in differential diagnosis. Methods The pathological data and MDCT images of 111 GGNs in 93 patients were reviewed and analyzed retrospectively, to identify the differentiating CT features between preinvasive lesions and MIA and to evaluate their differentiating accuracy. Results In the 93 patients included in the study, there were 27 cases with preinvasive lesions ( 38 GGNs) and 66 cases with MIA ( 73 GGNs) . No statistically significant difference was observed in terms of the gender, age and number of lesions between the two groups. There were significant differences (P<0.05) in the size of lesion, size of solid portion, content of solid portion, and morphological characteristics of the lesion edge between preinvasive lesions and MIA. ROC curve analysis showed that the optimal cut?off value of lesion size for differentiating preinvasive lesions from MIA was 13. 0 mm ( sensitivity, 83. 0%; specificity, 80. 0%) , and that of solid portion size was 2. 0 mm ( sensitivity, 90. 0%; specificity, 97. 0%) and that of solid proportion was 12. 0% ( sensitivity, 88. 0%;specificity, 97.0%) . The analysis of CT morphological features showed that there were significant differences in the terms of lesion nature (pGGO, mGGO), presence or absence of lobulated sign and spiculated sign ( P<0.05) between preinvasive lesions and MIA, but there were no significant differences in terms of the lesion edge, the presence or absence of vacuole sign, bubble lucency and pleural retraction ( P>0. 05 ) . Conclusions Preinvasive lesions can be accurately distinguished from MIA by the size of lesion, size of solid portion,solid proportion and morphological characteristics of the lesion edge. The size of lesion, size of solid portion, content of solid proportion and morphological characteristics of the lesion edge are of significance in the differential diagnosis of preinvasive lesions and minimally invasive adenocarcinoma of the lung.