Guo Fangfang, Li Xinling, Wang Xinyue, Zheng Wensong, Wang Qing, Song Wenjing, Yu Tielian, Fan Yaguang, Wang Ying
Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China.
Department of Radiology, Shijiazhuang First Hospital, Shijiazhuang 050011, China.
Zhongguo Fei Ai Za Zhi. 2018 Jun 20;21(6):451-457. doi: 10.3779/j.issn.1009-3419.2018.06.05.
Subsolid pulmonary nodules are common computed tomography (CT) findings of primary lung adenocarcinoma. It is of clinical value to determine the clinical treatment strategies based on CT features. The aim of this study is to find the valuable CT characteristics on differential diagnosis and the degree of invasion prediction by a retrospectively analysis of three groups subsolid nodules, including benign, and invasive adenocarcinoma.
The CT findings of 106 cases of resected sub-solid nodules were retrospectively analyzed. The nodules were firstly divided into benign and malignant groups and the malignant group was further divided into non/micro-invasive group (atypical adenomatous hyperplasia/adenocarcinoma in situ/minimally invasive adenocarcinoma) and invasive adenocarcinoma group. The nodule size, proportion of solid components, tumor-lung interface, shape, margin, pleural traction, air bronchus sign, vascular abnormalities inside the nodule were evaluated. The univariate analysis (χ2 test, non-parametric test Mann-Whitney U test) was performed to screen statistically significant variables and then enrolled in further multivariate Logistic regression analysis.
Multivariate logistic regression analysis showed that a clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormalities were important indicators of malignant nodules with hazard ratios of 38.1 (95%CI: 5.0-287.7; P<0.01), 7.9 (95%CI: 1.3-49.3; P=0.03), 7.2 (95%CI: 1.4-37.0; P=0.02), respectively. The proportion of solid components was the only significant indicator for identifying invasive adenocarcinoma from AAH/AIS/MIA , with a risk ratio of 1.04 (95%CI: 1.01-1.06, P=0.01).
SSNs with clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormality inside nodule are more likely to be malignant. A higher percentage of solid components indicates a higher likelihood to be an invasive lesion in malignant SPNs.
亚实性肺结节是原发性肺腺癌常见的计算机断层扫描（CT）表现。根据CT特征确定临床治疗策略具有临床价值。本研究旨在通过回顾性分析三组亚实性结节（包括良性、非浸润性腺癌和浸润性腺癌），寻找在鉴别诊断和侵袭程度预测方面有价值的CT特征。
回顾性分析106例切除的亚实性结节的CT表现。结节首先分为良性和恶性组，恶性组进一步分为非/微浸润组（非典型腺瘤样增生/原位腺癌/微浸润腺癌）和浸润性腺癌组。评估结节大小、实性成分比例、肿瘤-肺界面、形状、边缘、胸膜牵拉、空气支气管征、结节内血管异常情况。进行单因素分析（χ²检验、非参数检验曼-惠特尼U检验）以筛选具有统计学意义的变量，然后纳入进一步的多因素Logistic回归分析。
多因素Logistic回归分析显示，清晰的肿瘤-肺界面、空气支气管征和肺血管异常是恶性结节的重要指标，风险比分别为38.1（95%CI：5.0-287.7；P<0.01）、7.9（95%CI：1.3-49.3；P=0.03）、7.2（95%CI：1.4-37.0；P=0.02）。实性成分比例是从非典型腺瘤样增生/原位腺癌/微浸润腺癌中鉴别浸润性腺癌的唯一显著指标，风险比为1.04（95%CI：1.01-1.06，P=0.01）。
具有清晰肿瘤-肺界面、空气支气管征和结节内肺血管异常的亚实性结节更可能是恶性的。实性成分比例越高，恶性亚实性结节为浸润性病变的可能性越大。
