Okuizumi M
Department of Radiology, Niigata University School of Medicine.
Nihon Igaku Hoshasen Gakkai Zasshi. 2000 Jul;60(8):419-27.
The detection and differential diagnosis of focal areas of ground-glass attenuation (FGGA) is becoming important for early diagnosis of lung cancer.
The purpose of this study is to clarify the correlation between FGGA (20 mm or less in diameter) on high-resolution CT (HRCT) and histopathology of surgically resected lesions.
Ninety surgically resected peripheral lung lesions 20 mm or less in diameter with a greater than 50% area of GGA on HRCT from 58 patients (34 men and 24 women; mean age, 60.5 years) were studied. Sixty-nine lesions were adenocarcinomas (type A; 31, type B; 5, type C; 32, type D; 1, according to Noguchi et al.), 11 were atypical adenomatous hyperplasias, and 10 were inflammatory lesions. HRCT findings were retrospectively evaluated with regard to maximum diameter, marginal character, internal dense attenuation domain, and linear density radiating into surrounding lung parenchyma. Statistical analysis was performed with Mann-Whitney's t-test, Pearson's correlation coefficient, and chi 2-test between each group of lesions.
The maximum diameters on HRCT were significantly larger in adenocarcinomas (mean, 12.7 +/- 5.5 mm) than in atypical adenomatous hyperplasias (4.6 +/- 1.9 mm, p < 0.01) and in inflammatory lesions (5.9 +/- 2.7 mm, p < 0.01). Among adenocarcinomas, the diameters of type C tumors (mean, 15.7 +/- 5.0 mm) were larger than those of type A tumors (9.0 +/- 3.1 mm, p < 0.01). Linear density radiating into surrounding lung parenchyma was not found in inflammatory lesions, atypical adenomatous hyperplasias or type A tumors. Dense attenuation domains were found more frequently in type C tumors (94%) than in type A or type B tumors. Linear density and dense attenuation domain were both correlated with size of lesion (p < 0.05, p < 0.01, respectively).
HRCT is useful in the diagnosis of early pulmonary adenocarcinomas presenting as small FGGA.
磨玻璃样密度增高影（FGGA）局部区域的检测及鉴别诊断对于肺癌的早期诊断愈发重要。
本研究旨在阐明高分辨率CT（HRCT）上直径20mm及以下的FGGA与手术切除病变组织病理学之间的相关性。
研究了58例患者（34例男性，24例女性；平均年龄60.5岁）手术切除的90个直径20mm及以下的外周肺病变，这些病变在HRCT上磨玻璃样密度增高区域面积大于50%。其中69个病变为腺癌（根据野口等人的分类，A型31个、B型5个、C型32个、D型1个），11个为非典型腺瘤样增生，10个为炎性病变。回顾性评估HRCT表现，包括最大直径、边缘特征、内部致密密度区域以及向周围肺实质放射的线状密度。对每组病变进行Mann-Whitney t检验、Pearson相关系数检验和卡方检验。
腺癌在HRCT上的最大直径（平均12.7±5.5mm）显著大于非典型腺瘤样增生（4.6±1.9mm，p<0.01）和炎性病变（5.9±2.7mm，p<0.01）。在腺癌中，C型肿瘤的直径（平均15.7±5.0mm）大于A型肿瘤（9.0±3.1mm，p<0.01）。在炎性病变、非典型腺瘤样增生或A型肿瘤中未发现向周围肺实质放射的线状密度。C型肿瘤中致密密度区域的出现频率（94%）高于A型或B型肿瘤。线状密度和致密密度区域均与病变大小相关（分别为p<0.05，p<0.01）。
HRCT对于诊断表现为小FGGA的早期肺腺癌很有用。
