Youguo Zhang, Chengye Wang, Xiaofei Cheng, Xuefei Zhang, Changhong Liu
Department of Thoracic Surgery 1, The Second Hospital of Dalian Medical University, Dalian, China.
Turk Gogus Kalp Damar Cerrahisi Derg. 2023 Jan 30;31(1):95-104. doi: 10.5606/tgkdc.dergisi.2023.22239. eCollection 2023 Jan.
In this study, we aimed to analyze the relevance between computed tomography characterization and pathology of pulmonary ground-glass nodules with different pathology types.
Between January 2017 and December 2018, a total of 657 patients (191 males, 466 females; mean age: 60.9±8.1 years; range, 34 to 80 years) with pathologically diagnosed ground-glass nodules were retrospectively analyzed. The clinicopathological characteristics and computed tomography characterizations of patients with ground-glass nodules who received surgical resection were analyzed. The clinical data including age, sex, smoking status and medical history were recorded. Computed tomography characterizations included the location and size of the tumor, the size of the consolidation components, density uniformity, shape, margin, tumor-lung interface, internal signs and surrounding signs.
Based on the computed tomography imaging characteristics, a mean computed tomography value of ≥444.5 HU was more likely to indicate malignant lesions, while ≤444.5 HU indicated benign lesions. A malignant ground-glass nodules" maximum diameter of <6.78 mm, a diameter of the consolidation component of <3.88 mm, and a mean computed tomography value of <-536.5 HU were more likely to indicate atypical adenomatous hyperplasia and adenocarcinoma in situ. A maximum diameter of malignant ground-glass nodules of >11.52 mm, a diameter of the consolidation component of >6.20 mm, and a mean computed tomography value of ≥493.5 HU were more likely to indicate invasive adenocarcinomas. The focus between these parameters indicated minimally invasive adenocarcinomas.
Ill-defined tumor-lung interface, irregular in shape, and smooth nodule margins suggest benign lesions while round or oval, clear tumor-lung interface, spiculation signs, lobulation signs, bubble signs, air bronchograms, pleural indentations, and vessel convergences are helpful in the diagnosis of malignant lesions. A clear tumor-lung interface, the spiculation signs, lobulation signs, and bubble signs indicate the invasion of the lesions.
在本研究中，我们旨在分析不同病理类型的肺磨玻璃结节的计算机断层扫描特征与病理学之间的相关性。
回顾性分析2017年1月至2018年12月期间共657例经病理诊断为磨玻璃结节的患者（男性191例，女性466例；平均年龄：60.9±8.1岁；范围34至80岁）。分析接受手术切除的磨玻璃结节患者的临床病理特征和计算机断层扫描特征。记录包括年龄、性别、吸烟状况和病史在内的临床数据。计算机断层扫描特征包括肿瘤的位置和大小、实变成分的大小、密度均匀性、形状、边缘、肿瘤-肺界面、内部征象和周围征象。
基于计算机断层扫描成像特征，平均计算机断层扫描值≥444.5 HU更有可能提示恶性病变，而≤444.5 HU提示良性病变。恶性磨玻璃结节最大直径<6.78 mm、实变成分直径<3.88 mm且平均计算机断层扫描值<-536.5 HU更有可能提示非典型腺瘤样增生和原位腺癌。恶性磨玻璃结节最大直径>11.52 mm、实变成分直径>6.20 mm且平均计算机断层扫描值≥493.5 HU更有可能提示浸润性腺癌。这些参数之间的焦点提示微浸润性腺癌。
肿瘤-肺界面不清、形状不规则且结节边缘光滑提示良性病变，而圆形或椭圆形、清晰的肿瘤-肺界面、毛刺征、分叶征、空泡征、空气支气管征、胸膜凹陷和血管集束有助于恶性病变的诊断。清晰的肿瘤-肺界面、毛刺征、分叶征和空泡征提示病变有浸润。
