亚实性肺结节CT征象在良恶性鉴别及腺癌恶性侵袭程度评估中的价值  

Value of CT Features on Differential Diagnosis of Pulmonary Subsolid Nodules and Degree of invasion Prediction in Pulmonary Adenocarcinoma

作　　者：郭芳芳[1] 李欣菱 王欣悦 郑文松 王卿[1] 宋文静[4] 于铁链[1] 范亚光 王颖[1] Fangfang GUO;Xinling LI;Xinyue WANG;Wensong ZHENG;OJng WANG;Wenjing SONG;Tielian YU;Yaguang FAN;Ying WANG(Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China;Department of Radiology, Shijiazhuang First Hospital, Shijiazhuang 050011, China;Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang 050001, China;Department of Pathology, Tianjin Medical University General Hospital, Tianjin 300052, China;Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer InstitutG Tianjin Medical University General Hospital, Tianjin 300052, China)

机构地区：[1]天津医科大学总医院医学影像科,天津300052 [2]石家庄第一医院影像科,石家庄050011 [3]河北医科大学第三医院影像科,石家庄050001 [4]天津医科大学总医院病理科,天津300052 [5]天津肺癌转移与肿瘤微环境重点实验室、天津市肺癌研究所、天津医科大学总医院,天津300052

出　　处：《中国肺癌杂志》2018年第6期451-457,共7页Chinese Journal of Lung Cancer

基　　金：国家自然科学基金面上项目(No.81171345); 天津自然科学基金面上项目(No.17JCYBJC25400); 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：背景与目的亚实性肺结节为肺原发腺癌的常见计算机体层成像(computed tomography,CT)表现,依据其CT影像特征预测病理分型对确定临床治疗策略具有临床价值。本研究根据病理分类,回顾性分析良性、不典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)/原位腺癌(adenocarcinoma in situ,AIS)/微侵袭性腺癌(minimally invasive adenocarcinoma,MIA)、侵袭性腺癌三组亚实性肺结节的CT征象,评估其在良恶性鉴别及恶性侵袭程度判别中的价值。方法回顾性分析106例经手术切除亚实性结节的CT征象。依据手术病理分为良性和恶性组,恶性组根据侵袭程度分为无/微侵袭组(AAH/AIS/MIA)、侵袭性腺癌组,测量结节大小、实性成分比例、瘤肺界面、形状、边缘、胸膜牵拉征、空气支气管征、结节内血管异常等CT征象。根据单因素分析(χ2检验、非参数检验Mann-Whitney U检验)结果筛选有统计学差异的变量,纳入Logistic回归多因素分析。结果 Logistic回归分析显示清晰的瘤肺界面、空气支气管征以及结节内血管异常是恶性结节的重要预测指标,风险比分别为38.1(95%CI:5.0-287.7;P<0.01)、7.9(95%CI:1.3-49.3;P=0.03)、7.2(95%CI:1.4-37.0;P=0.02)。更大的实性成分所占比例是侵袭性腺癌与AAH/AIS/MIA组鉴别的重要指标,其风险比分别为1.04(95%CI:1.01-1.06,P=0.01)。结论亚实性结节中出现清晰的瘤肺界面、空气支气管征、结节内血管异常提示其恶性概率增加。恶性结节中实性成分所占比例越大预示着侵袭性更高。Background and objective Subsolid pulmonary nodules are common computed tomography（CT） findings of primary lung adenocarcinoma. It is of clinical value to determine the clinical treatment strategies based on CT features. The aim of this study is to find the valuable CT characteristics on differential diagnosis and the degree of invasion prediction by a retrospectively analysis of three groups subsolid nodules, including benign, and invasive adenocarcinoma. Methods The CT findings of 106 cases of resected sub-solid nodules were retrospectively analyzed. The nodules were firstly divided into benign and malignant groups and the malignant group was furtherdivided into non/micro-invasive group（atypical adenomatous hyperplasia/adenocarcinoma in situ/minimally invasive adenocarcinoma） and invasive adenocarcinoma group. The nodule size, proportion of solid components, tumor-lung interface, shape, margin, pleural traction, air bronchus sign, vascular abnormalities inside the nodule were evaluated. The univariate analysis（χ^2 test, non-parametric test Mann-Whitney U test） was performed to screen statistically significant variables and then enrolled in further multivariate Logistic regression analysis. Results Multivariate logistic regression analysis showed that a clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormalities were important indicators of malignant nodules with hazard ratios of 38.1（95%CI： 5.0-287.7; P〈0.01）, 7.9（95%CI： 1.3-49.3; P=0.03）, 7.2（95%CI： 1.4-37.0; P=0.02）, respectively. The proportion of solid components was the only significant indicator for identifying invasive adenocarcinoma from AAH/AIS/MIA, with a risk ratio of 1.04（95%CI： 1.01-1.06, P=0.01）. Conclusion SSNs with clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormality inside nodule are more likely to be malignant. A higher percentage of solid components indicates a higher likelihood to be an invasive lesion in malignant SPNs.

关 键 词：肺肿瘤 亚实性结节 计算机体层成像 定量变量 定性变量 良性 恶性 

分 类 号：R734.2[医药卫生—肿瘤]