肺结节交互印证式诊断准确性及可行性研究:1368例报告  

Accuracy and technical feasibility of mutual corroboration in the diagnosis of pulmonary nodule: A report of 1 368 cases

作　　者：耿国军[1,2] 米彦军 朱晓雷[1] 赵广 李宁 刘鸿鸣[1] 郭伟溪[1] 石思恩[1] 汪亮亮[1] 尹攀 马杰 于修义 姜杰[1] GENG Guojun;Ml Yanjun;ZHU Xiaolei;ZHAO Guang;LI Ning;LIU Hongming;GUO Weixi;SHI Sien;WANG Liangliang;YIN Pan;MA Jie;YU Xiuyi;JIANG Jie(Department of Thoracic Surgery,The First Affiliated Hospital to Xiamen University,Xiamen,361003,Fujian,P.R.China;Teaching Hospital of Fujian Medical University,Xiamen,361003,Fujian,P.R.China)

机构地区：[1]厦门大学附属第一医院胸外科,福建厦门361003 [2]福建医科大学教学医院胸部肿瘤外科,福建厦门361003

出　　处：《中国胸心血管外科临床杂志》2020年第6期669-674,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金项目(81871877)。

摘　　要：目的通过肺结节交互印证式诊断,提高术前影像诊断的准确率,选择合适的手术时机,指导肺小结节的随访时间。方法回顾性分析单中心2016年7月至2019年10月厦门大学附属第一医院胸外科1368例肺结节手术患者的临床资料,男531例、女837例,年龄44(21~67)岁。选择肺结节直径≤2 cm,术前行多学科会诊,详细阅读胸部CT,术中切开病灶剖面进行分析,快速病理诊断肺结节性质,术后常规行病理诊断。随后将肺结节影像特征、术中剖面特征与病理结果一一对照,通过两两对应,交互印证,把肺结节的影像病理及病变切面表现为一个动态变化的过程。结果在1368例肺小结节患者中,影像学表现为纯磨玻璃样结节的有376例(27.5%),混合性磨玻璃样结节共有729例(53.3%),实性结节共有263例(19.2%)。在纯磨玻璃样结节患者中,原位腺癌(adenocarcinoma in situ,AIS)占比最高,为156例,微浸润性腺癌(microinvasive adenocarcinoma,MIA)和不典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)比例相当,分别为90例和85例,其它良性肿瘤共20例。在混合性磨玻璃样结节中,浸润性腺癌(invasive adenocarcinoma,IA)共495例,其次是MIA 207例;且在实性结节中,病理结果主要为IA和其它良性肿瘤,分别为213例和50例,实性结节病理无AAH、AIS及MIA。结论肺结节交互印证式诊断可以提高术前诊断的准确率,对选择手术时机、随访时间的判断具有重要意义。Objective By applying the mutual corroboration in the diagnosis,we aimed to improve the accuracy of preoperative imaging diagnosis,select the appropriate timing of operation and guide the follow-up time for patients with pulmonary nodules.Methods Clinical data of 1368 patients with pulmonary nodules undergoing surgical treatment in our department from July 2016 to October 2019 were summarized.There were 531 males and 837 females at age of 44(21-67)years.The intraoperative findings,images and pathology were classified and analyzed.The imaging pathology and pathological changes of pulmonary nodules were shown as a dynamic process through mutual collaboration and interaction.Results Of 1368 patients with pulmonary nodules,376(27.5%)were pure ground-glass nodules,729(53.3%)were mixed ground-glass nodules and 263(19.2%)were solid nodules.Among the pure ground-glass nodules,adenocarcinoma in situ(AIS)accounted for the highest proportion(156 patients),followed by microinvasive adenocarcinoma(MIA,90 patients),atypical adenomatous hyperplasia(AAH,85 patients),and benign tumors(20 patients).Among mixed ground-glass nodules,495 patients were invasive adenocarcinoma(IA)and 207 patients of MIA.In solid nodules,patients were characterized by pathology of either IA(213 patients)or benign tumors(50 patients),and no patient was featured by AAH,AIS or MIA.Conclusion The mutual collaboration and interaction can improve the accuracy of preoperative diagnosis of pulmonary nodules,and it supports the choice of operation timing and the judgment of follow-up time.

关 键 词：肺结节 交互印证式诊断 病理类型 影像特征 

分 类 号：R655.3[医药卫生—外科学]