Hermelijn Sergei M, Mackenbach Maarten J, van Horik Cathy, Ciet Pierluigi, Wolf Janina L, von der Thüsen Jan H, Wijnen René M H, Tiddens Harm A W M, Schnater J Marco
Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Molewaterplein 40. 3015 GD Rotterdam, Mailing address: Postbus 2060, Rotterdam 3000 CB, the Netherlands.
Department of Pediatric Metabolic Diseases, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
J Pediatr Surg. 2022 Aug;57(8):1567-1572. doi: 10.1016/j.jpedsurg.2021.10.008. Epub 2021 Oct 14.
Risk for infection and potential malignant degeneration are the most common arguments for resecting asymptomatic Congenital Pulmonary Airway Malformations (CPAM). We aimed to investigate if CT- imaging characteristics can be used to predict histopathological features, by using an objective quantitative CT scoring method.
Archival CPAM tissue samples were histologically re-assessed and patients who had a pre-operative volumetric CT-scan were included. Lung disease was quantified using the newly-developed congenital lung abnormality quantification(CLAQ) scoring method and obtained percentages were used to predict histopathological signs of inflammation and presence of mucinous proliferation (MP). Because MP is presumed a precursor for mucinous adenocarcinoma in situ (AIS) this method was also used to compare CT-scans of patients with AIS to those with only CPAM.
Thirty-three CPAM patients were included of which 13(39%) had histological signs of inflammation and 8(24%) had a MP. Patients with inflammation had a significantly smaller lesion (14% vs 38%) while those with MP had more extensive disease (54%vs17%). Patients with AIS had a significantly smaller lesion compared to CPAM patients (5%vs29%). Significant predictors for inflammation were smaller lesion size and percentage hypodensity within lesions while a larger lesion size and percentage parenchymal hyperdensity (solid lung tissue components) were predictors for MP as well as AIS.
Smaller CPAM lesions may be more susceptible to inflammation while larger lesions may be associated with the presence of MP. Parenchymal hyperdensity is found as a predictor for MP as well as AIS and should therefore elicit more extensive gross sampling.
Level III.
感染风险和潜在恶性变是切除无症状先天性肺气道畸形（CPAM）最常见的理由。我们旨在通过使用一种客观的定量CT评分方法，研究CT成像特征是否可用于预测组织病理学特征。
对存档的CPAM组织样本进行组织学重新评估，并纳入术前进行容积CT扫描的患者。使用新开发的先天性肺异常量化（CLAQ）评分方法对肺部疾病进行量化，并将获得的百分比用于预测炎症的组织病理学征象和黏液性增殖（MP）的存在。由于MP被认为是原位黏液腺癌（AIS）的前体，该方法还用于比较AIS患者与仅患有CPAM患者的CT扫描结果。
纳入了33例CPAM患者，其中13例（39%）有炎症的组织学征象，8例（24%）有MP。有炎症的患者病变明显较小（14%对38%），而有MP的患者疾病范围更广（54%对17%）。与CPAM患者相比，AIS患者的病变明显较小（5%对29%）。炎症的显著预测因素是病变较小和病变内低密度百分比，而较大的病变大小和实质高密度百分比（实性肺组织成分）是MP以及AIS的预测因素。
较小的CPAM病变可能更容易发生炎症，而较大的病变可能与MP的存在有关。实质高密度被发现是MP以及AIS的预测因素，因此应进行更广泛的大体标本采集。
三级。
