浸润性肺腺癌不同病理亚型的临床病理及CT特征分析  

Clinicopathological characteristics and CT features of invasive adenocarcinoma of the lung with different pathological subtypes

作　　者：何小群[1] 罗天友[1] 李琦[1] 李娴 龚军伟 霍继文 HE Xiaoqun;LUO Tianyou;LI Qi;LI Xian;GONG Junwei;HUO Jiwen(Department of Radiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China;Department of Pathology,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院放射科,重庆400016 [2]重庆医科大学病理科,重庆400016

出　　处：《第三军医大学学报》2020年第19期1950-1956,共7页Journal of Third Military Medical University

基　　金：重庆市卫计委医学科研计划面上项目(2017MSXM010);重庆市科学技术委员会基础科学与前沿技术研究项目(CSTC2017jcyjAX0281)。

摘　　要：目的探讨浸润性肺腺癌不同病理亚型的临床病理特征及CT征象的差异,以期寻找一种有助于鉴别其病理亚型的无创性影像学方法。方法收集2013年7月至2019年7月我院经手术病理证实的单发浸润性肺腺癌患者422例,根据病理亚型将其分为A组(以贴壁/腺泡/乳头状生长方式为主)及B组(以实体/微乳头状生长方式为主),然后将A组细分为A1组(以贴壁状生长方式为主)和A2组(以腺泡/乳头状生长方式为主),分别比较A组和B组、A1组和A2组的临床病理及CT特征。结果 (1)A、B两组临床病理特征的比较:两组性别构成、吸烟史、分化程度、淋巴结转移率和病理TNM分期均存在统计学差异(P<0.05),其中B组以男性、吸烟、低分化、淋巴结转移及TNM分期Ⅲ~Ⅳ期多见;但两组远处转移率无统计学差异(P>0.05)。(2)A、B两组CT征象比较:两组病灶大小、密度、血管集束征、充气支气管征、钙化、坏死及胸腔积液发生率均存在统计学差异(P<0.05),其中B组病灶较大且更易表现为实性密度,B组钙化、坏死及胸腔积液发生率高于A组,但血管集束征及充气支气管征发生率低于A组;但两组病灶分布、含气腔、毛刺、分叶及胸膜牵拉征发生率均无统计学差异(P>0.05)。(3)A1与A2组临床病理特征及CT征象的比较:两组仅病灶密度有统计学差异(P<0.001),其中A1组以亚实性密度为主,A2组以实性密度为主;但两组其余特征均无统计学差异(P>0.05)。结论不同病理亚型浸润性肺腺癌患者具有不同的临床病理及影像学特征,特征性CT表现有助于鉴别浸润性腺癌的不同病理亚型。Objective To investigate the differences of clinicopathological characteristics and CT features among different pathological subtypes of invasive lung adenocarcinoma(ILA) in order to to find a noninvasive imaging method that can help to distinguish them. Methods A total of 422 patients confirmed with solitary ILA by surgical resection in our hospital from July 2013 to July 2019 were recruited in this study. According to the pathological growth patterns, the patients were divided into group A(with a lepidic/acinar/papillary predominant pattern) and group B(with a solid/micropapillary predominant pattern). Moreover, group A was further divided into subgroup A1(with a lepidic predominant pattern) and subgroup A2(with an acinar/papillary predominant pattern). The clinicopathological and CT features between group A and group B as well as between subgroup A1 and subgroup A2 were compared, respectively. Results(1)In comparison of clinicopathological characteristics between group A and B, the patients of group B had larger ratios of male, history of smoking, lower histological differentiation, more lymph node metastases and severe TNM stages(all P<0.05). But no such difference was observed in the distant metastasis between the 2 groups(P>0.05).(2)In comparison of CT features between the group, the patients of group B had larger lesion size, higher density, and higher incidences of calcification, necrosis and pleural effusion, but lower occurrences of vascular convergence sign and air bronchogram than those of group A(P<0.05). But, there were no significant differences in the distribution of tumors and appearances of air space, speculation, lobulation and pleural retraction between the 2 groups(P>0.05).(3) Tumors with subsolid density were more common in subgroup A1, while those with solid density were more common in subgroup A2(P<0.001). However, no significant differences were found in other clinicopathological characteristics and CT features between the 2 subgroups(all P>0.05). Conclusion ILA of different pathological

关 键 词：肺腺癌 病理亚型 体层摄影术 X线计算机 

分 类 号：R730.21[医药卫生—肿瘤] R730.44[医药卫生—临床医学]