亚厘米纯磨玻璃密度结节肺腺癌的CT特征对其浸润性的预测价值

doi:10.3969/j.issn.2095-9400.2019.11.010

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摘要目的：探讨亚厘米纯磨玻璃密度结节（pGGN）肺腺癌的CT特征对其浸润性的预测价值。方法：回顾性分析2012年1月至2017年12月124例（131个病灶）经手术病理证实为肺腺癌，且最大径≤1 cm的pGGN的影像、病理及临床资料。131个病灶依据病理结果分为浸润前病变组（87个）和浸润性病变组（44个）。比较2组间最大径和密度差异，以及病灶的位置、瘤肺界面、边缘形态、空气支气管征和血管异常改变的差异，分析评估亚厘米pGGN浸润性的独立危险因素；计算出鉴别浸润前病变和浸润性病变的最大径临界值。结果：2组间在最大径、血管异常改变和边缘形态等特征上的差异有统计学意义（均P＜0.05）。ROC曲线显示浸润前病变和浸润性病变的最大径临界值为8.5 mm。多因素logistics回归分析显示，亚厘米pGGN肺腺癌的最大径≥8.5 mm（OR=2.277，95%CI=1.006～5.152）、血管异常改变（OR=2.628，95%CI=1.140～6.059）、边缘形态为毛刺或不规则（OR=3.693，95%CI=1.251～10.901）为提示其浸润性的独立危险因素。结论：最大径≥8.5 mm、肿瘤血管异常改变及边缘为毛刺/不规则是亚厘米pGGN浸润性的独立危险因素，可提示其浸润性。

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	黄定品
	傅钢泽
	蔡蒙婷
	庄远迪
	陈丽芳
	刘瑾瑾
	夏天一
	杨运俊

关键词 ：纯磨玻璃密度结节；肺腺癌；体层摄影术, X线计算机；病理

Abstract：Objective: To evaluate the value of CT features in predicting the invasiveness of sub-centimeter lung adenocarcinoma presenting as pure ground-glass nodule (pGGN). Methods: The imaging, pathological and clinical data of 124 cases (131 lesions) of lung adenocarcinoma proved by surgery and pathology of pGGN (≤1 cm) from January 2012 to December 2017 were retrospectively analyzed. All lesions were divided into pre-invasive group (87 lesions) and invasive group (44 lesions) according to histopathology. The size and density differences between the two groups were compared, as well as the location, lung-tumor interface, margin morphology, air bronchogram and vascular changes of the lesions between the pre-invasive lesion group and the invasive lesion group. The independent risk factors for evaluating the invasiveness of sub-centimeter pGGN were analyzed. And the cut-off point of size for differentiating pre-invasive lesions from invasive lesions were calculated. Results: There were statistical differences in size, marginal morphology and vascular changes between the two groups (P<0.05). ROC curve showed that the cut-off point of size in pre-invasive and invasive lesions was 8.5 mm. Multivariate logistic regression analysis showed that maximum diameter (≥8.5 mm), vascular abnormalities and spiculate or irregular margin morphology were independent risk factors for lesion invasiveness, with odds ratios (95%CI) of 2.277(1.006-5.152), 2.628(1.140-6.059) and 3.693(1.251-10.901), respectively. Conclusion: Maximum diameter (≥8.5 mm), vascular abnormalities and spiculate or irregular margin are independent risk factors for subcentimeter pGGN invasiveness.

Key words： pure ground-glass nodule lung adenocarcinoma tomography, X-ray computed pathology

收稿日期: 2019-03-27

基金资助:浙江省卫生创新人才项目（2016-12）。

通讯作者: 杨运俊，主任医师，教授，Email：yyjunjim@163.com。

作者简介: 黄定品（1988-），男，浙江温州人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2019.11.010 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I11/837

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