混合磨玻璃结节的CT征象对肺腺癌病理亚型及分化程度的预测价值  

The predictive value of CT signs of mixed ground-glass nodules in pathological subtypes and differentiation of lung adenocarcinoma

作　　者：张潇文 赵紫维 刘经纬 方韶韩 冯义辉 朱晓雷 耿国军[3] 姜杰[3] ZHANG Xiaowen;ZHAO Ziwei;LIU Jingwei;FANG Shaohan;FENG Yihui;ZHU Xiaolei;GENG Guojun;JIANG Jie(The Second Department of Thoracic Surgery,The First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen,361003,Fujian,P.R.China;Department of Pathology,The First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen,361003,Fujian,P.R.China;The Second Department of Thoracic Surgery,The First Affiliated Hospital of Xiamen University,Xiamen,361003,Fujian,P.R.China)

机构地区：[1]厦门大学附属第一医院胸外二科、厦门大学医学院,福建厦门361003 [2]厦门大学附属第一医院病理科、厦门大学医学院,福建厦门361003 [3]厦门大学附属第一医院胸外二科,福建厦门361003

出　　处：《中国胸心血管外科临床杂志》2023年第2期191-197,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：福建省自然科学基金项目(2020J01122609);厦门市科技局项目(3502Z20189007)。

摘　　要：目的探讨混合磨玻璃结节的CT征象对肺腺癌病理亚型及分化程度的预测价值。方法回顾性分析2021年5月—12月厦门大学附属第一医院胸外二科术后病理为浸润性腺癌(invasive adenocarcinoma,IAC)的混合磨玻璃结节66例患者的临床资料,其中男20例、女46例,年龄35~75岁。术前分析其CT表现,术后切开病灶剖面,区分其磨玻璃成分与实性成分并得出不同位置的病理结果,按术后病理结果将患者分为低危组(贴壁型为主且没有微乳头亚型和实体亚型成分)16例,中危组(乳头或腺泡型为主且没有微乳头亚型和实体亚型成分)38例,高危组(含有微乳头或实体亚型)12例,分析比较三组患者CT特征与病理亚型及分化程度的关系。结果在66例IAC患者中,实性成分的浸润程度均大于磨玻璃成分,当实性成分比(consolidation tumor ratio,CTR)≥25%(敏感度为90.2%,特异度为64.0%,P=0.005),平均CT值>-283.95 HU(敏感度为82.9%,特异度为64.0%,P=0.000)时组织学分级更倾向于中、低分化。具有中、高危组亚型的IAC,其CTR、Ki-67、平均CT值及组织学分级都高于低危组结节。结论IAC混合磨玻璃结节中实性成分浸润程度高于磨玻璃成分,可根据其CT特征预测肺腺癌病理亚型、Ki-67表达程度及组织学分级,对于确定手术时机有重要的临床意义。Objective To explore the predictive value of CT signs of mixed ground-glass nodules in the pathological subtype and differentiation of lung adenocarcinoma.Methods The clinical data of 66 patients with mixed ground-glass nodules pathologically diagnosed as invasive adenocarcinoma(IAC)in the Second Department of Thoracic Surgery,the First Affiliated Hospital of Xiamen University from May to December 2021 were retrospectively analyzed,including 20 males and 46 females,aged 35-75 years.The CT findings were analyzed before operation,and the lesion profile was cut after operation to distinguish the ground-glass and solid components,and the pathological results of different positions were obtained.According to the postoperative pathological results,the patients were divided into a low-risk group(containing adherent type and no components of micropapillary subtype and solid subtype,n=16),a medium-risk group(containing niple or acinar type and no components of micropapillary subtype and solid subtype,n=38),and a high-risk group(containing micropapillary or solid subtype,n=12).The relationships between CT features and the pathological subtype and degree of differentiation were analyzed and compared.Results In 66 patients with IAC,the infiltration degree of solid components was greater than that of ground-glass components.When the solid component ratio(CTR)was≥25%(sensitivity 90.2%,specificity 64.0%,P=0.005),and the average CT value was>-283.95 HU(sensitivity 82.9%,specificity 64.0%,P=0.000),the histological grade was more inclined to medium and low differentiation.The CTR,Ki-67,average CT value and histological grade of IAC in the medium-and high-risk groups were higher than those of nodules in the low-risk group.Conclusion The infiltration degree of solid components is higher than that of ground-glass components in IAC mixed ground-glass nodules.The pathological subtype,Ki-67 expression and histological grade of lung adenocarcinoma can be predicted according to its CT characteristics,which has important clinical signifi

关 键 词：混合磨玻璃结节 肺腺癌 实性成分 病理亚型 诊断 治疗 

分 类 号：R734.2[医药卫生—肿瘤]