周围型小肺癌2年以上CT随访观察研究  

CT Follow-up of Pulmonary Nodules in Patients with Peripheral Small Lung Cancer

作　　者：杨国才[1] 柴振达 张善华[1] YANG Guo-cai;CHAI Zhen-da;ZHANG Shan-hua(Zhoushan Hospital of Zhejiang Province,Zhoushan 316000,China)

机构地区：[1]浙江省舟山医院,浙江舟山316000

出　　处：《肿瘤学杂志》2020年第4期323-328,共6页Journal of Chinese Oncology

基　　金：舟山市科技计划项目(2015C31030)。

摘　　要：[目的]通过随访观察肺小结节CT值及最大直径的变化,探讨不同类型肺结节(≤2cm)变化性质及危险度。[方法]回顾性分析经病理证实、术前随访时间超过2年的直径≤2cm的肺结节67例。分为原位腺癌(AIS)、微浸润性腺癌(MIA)、浸润性腺癌(IAC)三组,测量不同时间点结节的最大直径和CT值,绘制ROC曲线,确定三者之间CT值和直径的最佳截断值。[结果](1)鉴别AIS和MIA平均CT值最佳截断值为-544HU,鉴别MIA组和IAC组最佳截断值为-376HU。鉴别AIS和MIA直径最佳截断值为8.5mm,鉴别MIA组和IAC组最佳截断值为11.5mm。(2)分叶征、毛刺征、胸膜凹陷征、空气支气管征在随访过程中各组间差异有统计学意义,多因素回归分析显示充气支气管征、胸膜凹陷征是侵袭性肺腺癌的独立预测因子。[结论]肺结节平均CT值<-544HU及最大直径<8.5mm更倾向于AIS;随访过程中出现肺结节增大、CT值增加,出现充气支气管征、胸膜凹陷征应考虑结节侵袭性恶变的可能;肺结节随访时间建议至少5年以上。[Objective] To follow up the CT value and maximum diameter of pulmonary nodules in patients with different types of peripheral lung cancer. [Methods] Clinical and imaging data of 67 patients with pulmonary nodules of diameter ≤2 cm,who were followed up for ≥2 years before surgical treatment,were retrospectively analyzed. Surgical pathology confirmed adenocarcinoma in situ(AIS) in 27 cases,microinvasive adenocarcinoma(MIA) in 20 cases and invasive adenocarcinoma(IAC) in 19 cases and squamous cell carcinoma in 1 case. The maximum diameter and CT value of nodules were measured. ROC curve was generated to determine the best cut-off value of CT value and diameter for differentiating types of adenocarcinoma. [Results] The best cut-off value of average CT value for differentiating AIS and MIA was-544 HU,and that for differentiating MIA and IAC was-376 HU. The best cut-off value of the diameter for differentiating AIS and MIA was8.5 mm,and that for differentiating MIA and IAC was 11.5 mm. There were significant differences among the three groups in lobular sign,hairpin sign,pleural indentation sign and air bronchogram sign. Multivariate regression analysis showed that air bronchogram sign and pleural indentation sign were independent predictors of invasive lung adenocarcinoma. [Conclusion] The pulmonary nodules with average CT value <-544 hu and the maximum diameter < 8.5 mm are likely to be AIS. In the follow-up,the possibility of aggressive malignant change should be considered when the CT imaging of pulmonary nodule shows increased CT value,air bronchogram sign and pleural indentation sign.

关 键 词：肺小结节 CT值 直径 随访 

分 类 号：R734.2[医药卫生—肿瘤]