CT表现为磨玻璃样亚厘米孤立性肺结节的影像及相关临床特征分析  

Imaging and clinical features of sub-centimeter solitary pulmonary nodules with ground glass opacity on CT

作　　者：张云峰[1] 于磊[1] 柯冀[1] Zhang Yunfeng;Yu Lei;Ke Ji(Department of Thoracic Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院胸外科,北京100730

出　　处：《中华全科医师杂志》2022年第7期656-661,共6页Chinese Journal of General Practitioners

摘　　要：目的:分析CT表现为玻璃样亚厘米孤立性肺结节(SSPN)的CT影像与临床特点,初步判定病变性质及其与病理特征、基因靶点的关系。方法:回顾性分析2015年5月至2020年5月首都医科大学附属北京同仁医院胸外科手术治疗的258例SSPN患者资料。其中男性113例,女性145例;中位年龄45(30~84)岁。表现为CT影像磨玻璃样病灶,包括纯磨玻璃结节(pGGO,60例)和混合密度磨玻璃结节(GGO,198例),病灶最大径≤10 mm,均采用电视胸腔镜手术切除,根据术后病理检查确定诊断。统计并分析pGG、mGGO大小与肺恶性病变检出率的关系,CT影像学特征对判断SSPN良、恶性,免疫组化指标和基因靶点突变检测对区分原发性支气管肺癌和转移性肺癌的价值。结果:258例SSPN中,最大径<7 mm者59例、7~10 mm者199例;无术中死亡。(1)术后病理检查诊断为原发性支气管肺癌190例,转移性肺癌12例,肺良性病变56例。mGGO与pGGO的恶性病变患者检出率分别为81.31%(161/198)和68.33%(41/60),差异有统计学意义(χ^(2)=4.66,P=0.032)。(2)最大径7~10 mm的mGGO恶性病变检出率高于最大径<7 mm的mGGO[87.01%(134/154)与61.37%(27/44)],原发性支气管肺癌检出率亦高于最大径<7 mm的mGGO[83.77%(129/154)与56.82%(25/44)],差异有统计学意义(χ^(2)=14.82,χ^(2)=12.39,均P<0.001)。(3)恶性病变CT影像学表现为边界不规则率为47.03%(95/202),其中原发支气管肺癌为48.42%(92/190),均明显高于肺良性病变的17.86%(10/56)(χ^(2)=15.46,χ^(2)=16.64,均P<0.001);肺恶性病变血管征的发生率为56.44%(114/202),其中原发支气管肺癌为54.74%(110/190),均明显高于肺良性病变的5.35%(3/56)(χ^(2)=46.16,χ^(2)=48.07,均P<0.001)。(4)最大径<7 mm的mGGO,CT影像边界不规则、有血管征的病灶肺恶性病变率为91.30%(21/23),明显高于无上述影像学表现的28.57%(6/21)(χ2=18.22,P<0.001)。(5)免疫组化检查原发支气管肺癌组的新天冬氨酸蛋白酶A(Napsin A)和甲状腺转�Objective To analyze the clinical and CT imaging characteristics of sub-centimeter solitary pulmonary nodules(SSPNs)with ground glass opacity.Methods The clinical and imaging data of 258 patients with SSPN who underwent surgical treatment in Beijing Tongren Hospital from May 2015 to May 2020 were retrospectively reviewed.There were 113 males and 145 females with a median age of 45(range 30-84)years.The CT images of the lesions showed ground glass opacity,including 60 cases of pure ground glass nodule(pGGO)and 198 cases of mixed ground glass nodule(mGGO).The largest diameter of the lesion was≤10 mm,and the lesions were all resected by video-assisted thoracic surgery,and diagnosed by postoperative pathological examination.The relationship between the lesion size and the detection rate of malignancy;the diagnostic value of CT imaging features for differentiating benign and malignant SSPN,and postoperative immunohistochemical indexes and target gene mutations for differentiating primary from metastatic lung cancer were analyzed.Results Of the 258 patients,59 had lesions<7 mm in diameter and 199 between 7 and 10 mm in size.There were no intraoperative deaths.The postoperative pathological examination confirmed primary bronchial lung cancer in 190 cases,metastatic lung cancer in 12 cases,and benign lung lesions in 56 cases.The detection rates of malignant lesions in mGGO and pGGO were 81.31%(161/198)and 68.33%(41/60),respectively(χ^(2)=4.66,P=0.032).The detection rates of malignant lesions and primary cancer in mGGOS with diameter 7-10 mm was higher than those with diameter<7 mm[(87.01%(134/154)vs.61.37%(27/44)and 83.77%(129/154)vs.56.82%(24/44),χ^(2)=14.82,χ^(2)=12.93,all P<0.001].The border irregularity on CT imaging was presented in 47.03%(95/202)of malignant lesions,which presented in 48.42%(92/190)of primary lung cancers;while only presented in 17.86%(10/56)of benign lung lesions(χ^(2)=15.46,χ^(2)=16.64,all P<0.001).The frequency of vascular signs was 56.44%(114/202)in lung malignant lesions,54.74%(110/190)

关 键 词：肺肿瘤 腺癌 细支气管肺泡 胸腔镜检查 诊断显像 病理 临床 

分 类 号：R563[医药卫生—呼吸系统]