表现为周围型肺磨玻璃结节的浸润性腺癌影像学高危因素分析  

High risk factors in images for infiltrating lung adenocarcinoma manifesting as peripheral ground-glass nodules

作　　者：刘江江 于晓军 黄海涛[2] 陈少慕[2] 潘良彬[2] 冯宇 陈科[2] 毛国才 马海涛[1,2] LIU Jiangjiang;YU Xiaojun;HUANG Haitao;CHEN Shaomu;PAN Liangbin;FENG Yu;CHEN Ke;MAO Guocai;MA Haitao(Department of Thoracic Surgery,Du Shu Lake Hospital Affiliated to Soochow University,Suzhou,215006,Jiangsu,P.R.China;Department of Thoracic Surgery,The First Affiliated Hospital of Soochow University,Suzhou,215006,Jiangsu,P.R.China)

机构地区：[1]苏州大学附属独墅湖医院胸外科,江苏苏州215006 [2]苏州大学附属第一医院胸外科,江苏苏州215006

出　　处：《中国胸心血管外科临床杂志》2024年第1期85-91,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨周围型肺磨玻璃结节的影像学特征与肺腺癌浸润程度的相关性,明确磨玻璃结节表现的浸润性肺癌的高危因素,为规划肺结节手术方式及医患沟通提供参考依据,助力构建浸润性腺癌的临床预测模型。方法连续收集苏州大学附属第一医院2019年1月—2020年1月收治的胸部薄层CT表现为周围型肺磨玻璃结节(直径≤3 cm)患者的临床资料。全部患者于本中心行胸部薄层CT扫描及胸腔镜手术治疗。根据病理结果将患者分为两组:腺癌浸润前病变组和浸润性腺癌组。收集肺结节薄层CT影像学参数,包括结节直径、平均CT值、实性成分占比(consolidation tumor ratio,CTR)、结节形态、空泡征、支气管充气征、分叶征、毛刺征、病灶边界、胸膜凹陷征、血管集束征。通过单因素和多因素分析探讨浸润性腺癌的独立危险因素,分析其识别浸润性腺癌的临界值及效能。结果纳入患者190例。腺癌浸润前病变组110例[男21例、女89例,平均年龄(53.57±10.90)岁],浸润性腺癌组80例[男31例、女49例,平均年龄(56.45±11.30)岁]。两组平均CT值、结节直径、CTR、性别、空泡征、血管集束征、吸烟史、结节类型及形态、分叶征、毛刺征、病灶边界、胸膜凹陷征差异均具有统计学意义(P<0.05)。但年龄(P=0.081)、病灶位置(P=0.675)、细支气管充气征(P=0.051)差异无统计学意义。Logistic回归分析结果显示,结节直径、平均CT值、CTR及分叶征是鉴别浸润性腺癌的独立危险因素。约登指数计算阈值,结节直径为10.5 mm,平均CT值为–452 Hu,CTR为0.45。结论在周围型肺磨玻璃结节中,结合患者的CT影像学特征,即混合性磨玻璃结节、不规则形态、空泡、短毛刺、病灶边界清晰、胸膜凹陷、血管集束对判别结节的浸润程度具有一定参考价值。同时本研究发现,结节直径>10.5 mm,平均CT值>–452 Hu,CTR>0.45及伴有分叶征的周围型肺磨�Objective To explore the correlation between the imaging features of peripheral ground-glass pulmonary nodules and the invasion degree of lung adenocarcinoma,and the high risk factors for infiltrating lung adenocarcinoma under thin-slice CT,which provides some reference for clinicians to plan the surgical methods of pulmonary nodules before operation and to better communicate with patients,and assists in building a clinical predictive model for invasive adenocarcinoma.Methods Clinical data of the patients with peripheral ground-glass pulmonary nodules(diameter≤3 cm)in thin-slice chest CT in the First Affiliated Hospital of Soochow University from January 2019 to January 2020 were continuously collected.All patients underwent thin-slice CT scan and thoracoscopic surgery in our center.According to the pathological examination results,they were divided into two groups:an adenocarcinoma lesions before infiltration group,and an invasive lung adenocarcinoma group.The thin-slice CT imaging parameters of pulmonary nodules were collected.The nodular diameter,mean CT value,consolidation tumor ratio(CTR),nodular shape,vacuolar sign,bronchial air sign,lobulation sign,burr sign,lesion boundary,pleural depression sign,vascular cluster sign and other clinical data were collected.Univariate and multivariate analyses were conducted to analyze the independent risk factors for the infiltrating lung adenocarcinoma,and to analyze the threshold value and efficacy of each factor for the identification of infiltrating lung adenocarcinoma.Results Finally 190 patients were enrolled.There were 110 patients in the adenocarcinoma lesions before infiltration group,including 21 males and 89 females with a mean age of 53.57±10.90 years,and 80 patients in the invasive lung adenocarcinoma group,including 31 males and 49 females with a mean age of 56.45±11.30 years.There was a statistical difference in the mean CT value,nodular diameter,CTR,gender,smoking,nodular type,nodular shape,vacuolar sign,lobulation sign,burr sign,lesion boundary,pleura

关 键 词：肺磨玻璃结节 浸润性 肺腺癌 薄层CT 影像学特征 

分 类 号：R734.2[医药卫生—肿瘤]