高分辨率 CT 鉴别早期肺腺癌的微创成分。
High resolution CT in differentiating minimally invasive component in early lung adenocarcinoma.
机构信息
Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai 201508, China.
Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai 201508, China.
出版信息
Lung Cancer. 2014 Jun;84(3):236-41. doi: 10.1016/j.lungcan.2014.02.008. Epub 2014 Feb 24.
OBJECTIVES
To analyze high-resolution computed tomography (HRCT) appearances of early lung adenocarcinoma and evaluate HRCT in the differentiation of minimally invasive component in early lung adenocarcinoma.
MATERIALS AND METHODS
HRCT appearances of 140 nodules (less than 2 cm in diameter) of early lung adenocarcinoma were reviewed retrospectively. All these nodules were proven by surgery and pathology including 60 nodules of minimally invasive adenocarcinoma (MIA) and 80 nodules of preinvasive lesion (PL). HRCT features of two groups of lung nodules, including shape, margin, pattern, diameter, diameter of solid component, vascular changes, air bronchogram, vacuole, pleural indentation and multiplicity were analyzed and compared using univariate logistic regression analysis. Attenuation values of pure ground-glass nodule, pure ground-glass component and solid component of mixed ground-glass nodule were compared by using unpaired t-test or Wilcoxon rank-sum test.
RESULTS
The statistically significant differences were found in shape, margin, pattern, diameter, diameter of solid component, pulmonary vein changes, air bronchogram and pleural indentation (Odds ratio [OR] = 3.115 [P = 0.001], OR = 3.754 [P = 0.011], OR = 9.815 [P = 0.000], OR = 1.306 [P = 0.000], OR = 1.361 [P = 0.031], OR= 6.971 [P = 0.000], OR = 6.167 [P=0.000], OR = 2.296 [P = 0.027], respectively). The statistically significant difference was also found in attenuation value of solid component (t = 3.702, P = 0.000). By multivariate logistic analysis, attenuation value of solid component was significantly associated with MIA (OR = 1.005, P = 0.032). MIA was more often a larger, lobulated or irregular, mixed ground-glass nodule with a solid component larger than 5 mm, and higher attenuation values. In addition, MIA often had an abnormality in pulmonary vein, air bronchogram and pleural indentation.
CONCLUSIONS
HRCT can demonstrate the morphological features of early lung adenocarcinoma and identify minimally invasive component.
目的
分析早期肺腺癌的高分辨率 CT（HRCT）表现，评估 HRCT 对早期肺腺癌中微创成分的鉴别诊断价值。
材料与方法
回顾性分析 140 个直径小于 2cm 的肺腺癌结节的 HRCT 表现，所有结节均经手术和病理证实，包括 60 个微浸润腺癌（MIA）和 80 个浸润前病变（PL）。使用单因素 logistic 回归分析比较两组肺结节的形状、边缘、形态、直径、实性成分直径、血管变化、空气支气管征、空泡、胸膜凹陷和多发性等 HRCT 特征。采用配对 t 检验或 Wilcoxon 秩和检验比较纯磨玻璃结节、纯磨玻璃成分和混合磨玻璃结节实性成分的衰减值。
结果
形状、边缘、形态、直径、实性成分直径、肺静脉变化、空气支气管征和胸膜凹陷在统计学上存在显著差异（比值比[OR] = 3.115，P = 0.001；OR = 3.754，P = 0.011；OR = 9.815，P = 0.000；OR = 1.306，P = 0.000；OR = 1.361，P = 0.031；OR = 6.971，P = 0.000；OR = 6.167，P=0.000；OR = 2.296，P = 0.027）。实性成分的衰减值在统计学上也存在显著差异（t = 3.702，P = 0.000）。多因素 logistic 分析显示，实性成分的衰减值与 MIA 显著相关（OR = 1.005，P = 0.032）。MIA 多为较大的、分叶状或不规则的混合磨玻璃结节，实性成分大于 5mm，且衰减值较高。此外，MIA 常伴有肺静脉异常、空气支气管征和胸膜凹陷。
结论
HRCT 可以显示早期肺腺癌的形态学特征，并识别微创成分。
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