不同类型肺结节的生长曲线分析  

Analysis of Growth Curve Type in Pulmonary Nodules with Different Characteristics

作　　者：王欣悦[1] 韩融诚 郭芳芳[1] 李欣菱 郑文松[1] 王卿[1] 宋文静[3] 于铁链[1] 王颖[1] 

机构地区：[1]天津医科大学总医院医学影像科,天津300052 [2]贵州省人民医院核医学科,贵阳550002 [3]天津医科大学总医院病理科,天津300052

出　　处：《中国肺癌杂志》2017年第5期334-340,共7页Chinese Journal of Lung Cancer

基　　金：国家自然科学基金面上项目(No.81171345);中央补助地方公共卫生专项资金肺癌早诊早治项目;2012年高等学校博士学科点专项科研基金(No.20121202110005)资助~~

摘　　要：背景与目的计算机断层扫描(computed tomography,CT)随访评估肺内结节的生长特性是临床判断结节良恶性的常用策略。不同生物学行为的肺结节可能具有不同的生长速度和生长模式。本研究的目的是绘制不同类型肺结节的体积生长曲线,了解其生长方式,为判断结节性质并制定肺结节随访方案提供依据。方法应用三维分析软件对111例接受2次及以上CT检查的肺结节(实性结节54例、亚实性结节57例)的影像资料进行回顾性分析。35例恶性及5例良性结节经病理或组织学确认,其余71例经两年随访无显著生长,经专家会诊确认为肺癌低危结节。所有结节按密度及性质分组:实性良性/低危结节、实性恶性结节、亚实性良性/低危结节、亚实性恶性结节。以随访间隔时间(d)为X轴,以随访结节的三维体积(mm3)和三维体积对数为Y轴,绘制体积线性及指数性生长曲线,由研究者主观观察曲线的形态。应用卡方检验比较不同性质肺结节的生长曲线的差异。结果实性恶性结节中12例(66.7%)生长曲线快速上升,3例(16.7%)先平缓-后上升,2例(11.1%)缓慢上升,1例(5.56%)平直。亚实性恶性结节中8例(47.1%)呈快速上升型,4例(23.5%)缓慢上升,3例(17.6%)平直,2例(11.8%)为先下降-后上升型。实性良性/低危结节中5例(13.9%)呈下降型,17例(47.2%)平直,8例(21.6%)缓慢上升,6例(16.7%)呈波浪型。亚实性良性/低危结节中4例(10%)呈下降型,21例(52.5%)平直,9例(22.5%)缓慢上升,6例(15%)呈波浪型。良性/低危结节与恶性结节生长曲线分布存在显著性差异(χ2=42.4,P<0.01)。结论肺癌生长曲线具有异质性,快速上升是恶性肺结节的特征性生长曲线,但部分可在一定时期内表现为平直、缓慢上升甚至下降。缓慢生长不能排除肺癌可能,尤其是亚实性结节。Background and objective Background and objective Follow up by computed tomography （CT） and growth evaluation are routine methods for the differential diagnosis of indeterminate pulmonary nodules in clinical practice. Pulmonary nodules with diverse biological behaviors may show different growth patterns and velocities.The aim of this study is to identify the volume growth curve of both benign and malignant pulmonary nodules. This work also intends to determine these nodules＇ growth patterns and provide evidence for the establishment of a follow-up strategy. Methods The CT data of 111 pulmonary nodules （54 solid, 57 subsolid） were retrospectively evaluated using 3D volumetric software. All of these nod- ules have been followed up at least twice. Of these nodules, 35 were confirmed as lung cancers, whereas 5 were confirmed as benign by pathology or histology. Moreover, 71 nodules showed no growth in more than 2 years. Stable nodules were defined as low-risk nodules, as confirmed by reevaluation from experts. On the basis of their densities and diameters, the nodules were classified into four types： benign/low-risk solid nodules, malignant solid nodules （diameter ≤ 1 cm and 〉 1 cm）, benign/low- risk subsolid nodules, and malignant subsolid nodules （diameter ≤1 cm and 〉 1 cm）. The foUow-up interval time （d） were plot ted on the x-axis, and the nodules＇ volume （ram3） and logarithmic volume were plotted on the y-axis. Two radiologists subjec tively determined the type of growth curve. Chi-square test was performed to compare the growth curves of benign/low-risk and malignant nodules. Results Of 18 solid cancers, 12 cases （66%） were found with steep ascendant growth curves. Those of 3 cases （16.7%） were flat ascendant, 2 cases （11.1%） slowly ascendant, and 1 （5.56%） case flat. Of 17 subsolid cancers, 8 cases （47.1%） manifested steep ascendant growth curves. Those of 4 cases （23.5%） were slowly ascendant, 3 （17.6%） flat, and 2 （11.8%） descendant-ascen

关 键 词：肺结节 计算机体层摄影 体积 三维体积分析 体积生长曲线 

分 类 号：R734.2[医药卫生—肿瘤]