Department of Computed Tomography and Magnetic Resonance, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei Province, China; Department of Radiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China.
Departments of Urology, Hebei Medical University No2 Hospital: Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
Diagn Interv Radiol. 2022 May;28(3):230-238. doi: 10.5152/dir.2022.211100.
PURPOSE We aimed to evaluate and compare the growth patterns among pathological types of inde- terminate subsolid nodules in patients without a history of cancer as observed on computed tomography (CT). METHODS This retrospective study included 77 consecutive patients with 80 indeterminate subsolid nod- ules on unenhanced thin-section CT. Subsolid nodules were classified into 2 growth pattern groups based on volume: growth (n = 35) and non-growth (n = 42). According to the pathologi- cal diagnosis, subsolid nodules were further subdivided into 3 groups: adenocarcinoma in situ (growth, n = 8 vs. non-growth, n = 22), minimally invasive adenocarcinoma (n = 14 vs. n = 15), and invasive adenocarcinoma (n=13 vs. n=5). Kaplan-Meier and Cox proportional hazards regres- sion analyses were performed to identify the risk factors for subsolid nodules growth. The CT findings of the 35 subsolid nodules in the growth group were compared among the 3 pathologi- cal groups. RESULTS In the growth group, the overall mean volume doubling time and mass doubling time (MDT) were 811.5 days and 616.5 days, respectively. Patient's age (odds ratio=1.041, P=.045) and CT subtype of non-solid nodule and part-solid nodule (odds ratio=3.430, P=.002) could predict subsolid nodule growth. The baseline volume, mass, and mean CT value were larger in the inva- sive adenocarcinoma group than in the adenocarcinoma in situ group (all P < .01). The shortest volume doubling time was observed in the invasive adenocarcinoma group, followed by the minimally invasive adenocarcinoma group and the adenocarcinoma in situ group. A shorter mass doubling time was observed in the minimally invasive adenocarcinoma group than in the adenocarcinoma in situ group (all P < .02). CONCLUSION As age increases, the risk of pulmonary subsolid nodule growth increases by 4% each year, and part-solid nodules have a 3 times higher risk of growth compared to non-solid nodules in patients with no history of cancer. Subsolid nodules with more aggressive pathological charac- teristics grow at a faster rate.
本研究旨在评估并比较无癌症病史患者 CT 观察到的不同类型不定型亚实性结节的生长模式。
本回顾性研究纳入了 77 例 80 个不定型亚实性结节患者，所有患者均行平扫 CT。根据体积，将亚实性结节分为生长组（n=35）和非生长组（n=42）。根据病理诊断，亚实性结节进一步分为 3 组：原位腺癌（生长组 n=8，非生长组 n=22）、微浸润性腺癌（n=14，n=15）和浸润性腺癌（n=13，n=5）。采用 Kaplan-Meier 和 Cox 比例风险回归分析确定亚实性结节生长的危险因素。比较生长组 35 个亚实性结节在 3 种病理类型中的 CT 表现。
生长组的总体平均体积倍增时间和质量倍增时间分别为 811.5 天和 616.5 天。患者年龄（优势比=1.041，P=.045）和 CT 表现为非实性结节和部分实性结节（优势比=3.430，P=.002）是亚实性结节生长的预测因素。与原位腺癌组相比，浸润性腺癌组的基线体积、质量和平均 CT 值更大（均 P<.01）。在所有组中，浸润性腺癌组的体积倍增时间最短，其次是微浸润性腺癌组和原位腺癌组。与原位腺癌组相比，微浸润性腺癌组的质量倍增时间更短（均 P<.02）。
随着年龄的增长，无癌症病史患者肺部亚实性结节生长的风险每年增加 4%，与非实性结节相比，部分实性结节的生长风险高 3 倍。具有侵袭性病理特征的亚实性结节生长速度更快。
