| 乔弟,张永明,曾颖鸥,等.低剂量螺旋 CT对以亚实性肺结节为主要表现的早期肺腺癌的诊断意义[J].安徽医药,2022,26(3):591-594. |
| 低剂量螺旋 CT对以亚实性肺结节为主要表现的早期肺腺癌的诊断意义 |
| Significance of low-dose spiral CT in the diagnosis of early stage adenocarcinoma of the lung mainly manifested by the solid pulmonary nodules |
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| DOI：10.3969/j.issn.1009-6469.2022.03.040 |
| 中文关键词: 肺肿瘤 腺癌 低剂量螺旋 CT 病理状态，体征和症状 肺结节 |
| 英文关键词: Lung neoplasms Adenocarcinoma Low-dose spiral computed tomography Pathological conditions, signs and symptoms Pulmonary nodules |
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| 中文摘要: |
| 目的评价低剂量螺旋 CT对以亚实性肺结节为主要表现的早期肺腺癌的诊断意义。方法回顾性选择上海市浦东新区周浦医院 2018年 1月至 2019年 6月 46例 CT表现为亚实性肺结节并经手术确诊为早期肺腺癌病人的临床资料，根据肺结节的密度类型分为有实性成分的混合性磨玻璃结节组和纯磨玻璃结节组。根据病理结果分为浸润前组(包括微浸润性病灶)和浸润性病变组。比较两组病人年龄、性别、病灶长径、有无毛刺征、 CT值、实性成分比例、有无分叶征、有无胸膜牵扯征和有无空泡征的差异，分析浸润前组和浸润性病变组的 CT鉴别要点及其准确性。结果 46例病人中混合性磨玻璃结节 30个，磨玻璃结节 17个。纯磨玻璃结节组中，浸润前组和浸润性病变组病灶长径差异有统计学意义［( 10.8±4.1)mm比( 16.8±5.9)纯mm，P<0.05］年龄、性别，病灶毛刺征、 CT值、分叶征、胸膜牵扯征和空泡征差异无统计学意义( P>0.05)。对于混合性磨玻璃结节组，浸润前，组和浸润性病变组在实性成分比例［( 26.3±17.5)%比( 50.7±19.6)%］、病灶长径［( 14.9±5.5)mm比( 21.5±5.9) mm］、分叶征、毛刺征、胸膜牵扯征的均差异有统计学意义(均 P<0.05)。纯磨玻璃结节组病灶长径是分辨浸润前组和浸润性病变组的唯一显著特征( OR=1.31，P=0.013)两组病变区分最佳临界值病灶长径为 14.6 mm；混合性磨玻璃结节组实性成分比例(OR=201.936，P=0.006)、病灶长径( OR=1.16，5，P=0.041)是分辨浸润前组和浸润性病变组的独立危险因素，实性成分比例联合病灶长径受试者工作特征曲线下面积为 0.862(95%CI:0.761~0.957)此时灵敏度 73.5%，特异度 83.9%，高于单一区分。结论在低剂量螺旋 CT图像中，纯磨玻璃结节病灶长径 <14.6 mm是浸润前病，灶(包括微浸润性病灶)有别于浸润性病灶的一个较好 |
| 英文摘要: |
| Objective To evaluate the diagnostic significance of low-dose spiral CT in early stage lung adenocarcinoma mainly manifested by ascitic pulmonary nodules.Methods The clinical data of 46 patients with subsolid lung nodules by CT manifestations whowere diagnosed as early lung adenocarcinoma by surgery in Shanghai Pudong New District Zhoupu Hospital from January 2018 to June2019 were retrospectively enrolled. According to the density type of lung nodules, they were assigned into mixed ground glass nodulesgroup and pure ground glass nodules group. According to the pathological results, they were assigned into pre-invasion group (includingmicroinvasive foci) and invasive lesion group. The differences in age, gender, lesion length, presence of glitches, CT value, proportion ofsolid components, presence of lobulation signs, presence of pleural signs, and presence of vacuoles were compared between the twogroups. The main points and accuracy of CT identification of the pre-invasion group and invasive lesion group were analyzed.Results There were 30 mixed ground glass nodules and 17 pure ground glass nodules in 46 patients. In the pure ground glass nodule group, thedifference in lesion length between the pre-invasion group and the invasive lesion group was statistically significant [(10.8±4.1) mm vs. (16.8±5.9) mm, P<0.05]. There were no significant differences in age, gender, glitch sign, CT value, lobulation sign, pleural sign, andvacuole sign between the two groups (P>0.05). For the mixed ground glass nodule group, there were statistically significant differencesin the proportion of solid components [(26.3±17.5)% vs. (50.7±19.6)%], lesion length [(14.9±5.5) mm vs. (21.5±5.9) mm], defoliation sign, burr sign, and pleural pull sign between the pre-invasion group and invasive lesion group (all P<0.05). The length of the lesion in the pure ground glass nodules group was the only significant feature that distinguishes the pre-invasion group from the invasive lesion group (OR=1.31, P=0.013). The best cut-off value for the length of the lesion between the two groups was 14.6 mm. The proportion of solid components (OR=201.936, P=0.006) and lesion length (OR=1.165, P=0.041) in the mixed ground glass nodule group were independent risk factors for distinguishing the pre-invasion group from the invasive lesion group. The area under the receiver operating characteristic curves of the proportion of solid components combined with the length of the lesion was 0.862 (95%CI: 0.761-0.957). At this time, the sensitivity was 73.5% and the specificity was 83.9%, which was higher than the single distinction.Conclusions In the low-dose spiral CT image, the nodule lesion with pure ground glass<14.6 mm is a good distinguishing point between pre-invasion lesions (including microinvasive foci) and invasive foci. In the mixed ground glass nodular lesion, the ratio of solid components of the lesion combined with the length of the lesion is helpful to improve the diagnostic rate of differentiation. |
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