肺部单发微小磨玻璃结节内部血管及支气管改变对肺腺癌侵袭性的诊断预测价值  

Diagnostic Prediction Value of the Internal Bronchial and Vascular Structure of Single Pulmonary Ground-Glass Micro-Nodules on the Invasiveness of Lung Adenocarcinoma

作　　者：陈琦[1,2] 杨文广[1] 郁义星[2] 郑梦龙[2] 刘雨蒙[2] 王希明[2] 胡春洪[2] CHEN Qi;YANG Wenguang;YU Yixing(Department of Radiology,Kunshan Third People's Hospital,Kunshan 215300,P.R.China)

机构地区：[1]昆山市第三人民医院放射科,215300 [2]苏州大学附属第一人民医院影像科,215006

出　　处：《临床放射学杂志》2019年第12期2322-2327,共6页Journal of Clinical Radiology

基　　金：国家重点研发计划项目(编号:2017YFC0114300);苏州市基于互联网的远程数字诊疗应用示范研究(编号:SS201808);2019年度昆山市重点研发计划项目(社会发展)

摘　　要：目的探讨肺部微小磨玻璃结节(GGN)内部血管及支气管改变对肺腺癌侵袭性的诊断预测价值。方法回顾性分析272例肺部单发GGN的多层螺旋CT(MSCT)图像特点,根据肺腺癌病理特征分为四组,包括非典型腺瘤样增生(AAH)31例,原位腺癌(AIS)64例,微浸润腺癌(MIA)153例和浸润性腺癌(IAC)24例。评价GGN内部血管及支气管改变,将血管改变和支气管改变分为四型和三型。通过卡方检验比较不同病理类型GGN内部血管及支气管关系的差异。结果血管改变不同分型与支气管改变不同分型之间存在统计学意义(χ^2=55.932,P=0.002)。不同血管关系及支气管关系分型在AAH、AIS、MIA和IAC四组不同病理分型中存在统计学意义(χ^2=131.965,P<0.001)。运用血管联合支气管分型诊断浸润前病变(AAH+AIS)和浸润性病变(MIA+IAC)的敏感度、特异度、阳性预测率、阴性预测率、诊断准确率分别为93.7%、86.9%、79.4%、96.2%和89.2%。结论GGN(<10 mm)内部血管及支气管的改变对于肺腺癌侵袭性具有较高的诊断预测价值。Objective To investigatethe diagnostic prediction value of the internal bronchial and vascular structure of single pulmonary ground-glass micro-nodules(GGN)on the invasiveness of the lesions.Methods A retrospective analy-sis of thin-slice thoracic MSCT examination was performed in a total of 272 pathologically confirmed single pulmonary GGN,including 31 AAH,64 AIS,153 MIA and 24 IAC.The types of GGN were respectively classified into 4 types and 3 types according to the relationship with adjacent blood vessels and the relationship with adjacent bronchus were divided into 3 types.Statistical analysis was performed by Chi-square test on the difference of internal bronchial and vascular structure a-mong different pathological types of GGN.Results Statistical significance was found between the different vascular types and the bronchial types(χ^2=55.932,P=0.002).Statistical significance was found between different vascular types,dif-ferent bronchial types and different pathological types of AAH,AIS,MIA and IAC(χ2=131.965,P<0.001).The sen-sitivity,specificity,positive predictive rate,negative predictive rate,and diagnostic accuracy of combined vascular and bronchial classification for pre-invasion(AAH+AIS)and invasive adenocarcinoma(MIA+IAC)were respectively 93.7%,86.9%,79.4%,96.2%and 89.2%.Conclusion Elucidation of theinternal bronchial and vascular structure of lung ground glass micronodules(<10 mm)has high diagnostic prediction value for invasiveness of lung adenocarcinoma.

关 键 词：多层螺旋CT 肺部微小磨玻璃结节 肺腺癌 血管及支气管类型 

分 类 号：R734.2[医药卫生—肿瘤]