Zhang Yu, Ding Bo-Wen, Wang Lu-Na, Ma Wei-Ling, Zhu Li, Chen Qun-Hui, Yu Hong
Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Quant Imaging Med Surg. 2024 Oct 1;14(10):7265-7278. doi: 10.21037/qims-24-912. Epub 2024 Sep 26.
Lung adenocarcinoma associated with cystic airspace (LACA) was once considered an uncommon manifestation of lung adenocarcinoma (LUAD), and understandings of it are limited; however, it is being observed more frequently in clinical practice. This study sought to assess the prevalence of LACA, and compare the high-resolution computed tomography (HRCT) features of LACA in patients with varying degrees of invasiveness.
This study retrospectively reviewed the HRCT scans of 1,525 patients with LUAD ≤3 cm in diameter at the Shanghai Chest Hospital between January 2016 and May 2016. Each nodule was examined to detect the presence of cystic airspace. Additionally, we analyzed the qualitative HRCT findings of the cystic airspaces, including the pattern, number, wall component density, distribution, inner surface, mural nodules, septa, and vessels passing through the cystic airspace using the Pearson χ test or Fisher's exact test as appropriate. We also analyzed the quantitative measurements, such as the cystic airspace diameter, wall thickness, and thin-wall proportion, using a one-way analysis of variance or the Kruskal-Wallis rank-sum test as appropriate.
LACAs were observed on HRCT in 11.5% (176/1,525) of the patients, of whom 7.1% (36/505) had pure ground-glass nodules, 13.5% (112/830) had mixed ground-glass nodules, and 14.7% (28/190) had solid nodules (P=0.001). The surgical procedures for LACAs varied (P=0.012). The incidence of LACAs increased as nodule diameter and invasiveness increased (both P<0.001). Statistically significant differences were observed in the wall component density, distribution, septa, vessels passing through the cystic airspace, cystic airspace diameter, wall thickness, and thin-wall proportion among the preinvasive lesion (PL), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC) groups (P<0.001, P=0.024, P=0.001, P=0.025, P=0.001, P<0.001, and P<0.001, respectively). Wall component density increased as invasiveness increased (P<0.001). Unlike those in the MIAs and IACs, cystic airspaces in PLs typically lacked septa (P=0.001, and P<0.001, respectively). The IACs had larger cystic airspace diameters than the PLs (6.5 3.7 mm) (P<0.001). The IACs also had thicker wall thickness (11.8 6.8 mm, 11.8 8.3 mm) (P<0.001, and P<0.001, respectively) and smaller thin-wall proportions (181.5° 264.8°, 181.5° 223.8°) (P<0.001, and P=0.039, respectively) than the PLs and MIAs.
The prevalence and characteristics of cystic airspaces on HRCT can be used to predict invasiveness in patients with LUADs ≤3 cm in diameter.
肺腺癌合并含气囊腔（LACA）曾被认为是肺腺癌（LUAD）的一种罕见表现，人们对其了解有限；然而，在临床实践中其观察到的频率越来越高。本研究旨在评估LACA的患病率，并比较不同侵袭程度患者的LACA的高分辨率计算机断层扫描（HRCT）特征。
本研究回顾性分析了2016年1月至2016年5月在上海胸科医院就诊的1525例直径≤3 cm的LUAD患者的HRCT扫描结果。检查每个结节以检测含气囊腔的存在。此外，我们使用Pearson χ检验或Fisher精确检验（视情况而定）分析了含气囊腔的定性HRCT表现，包括模式、数量、壁成分密度、分布、内表面、壁结节、间隔和穿过含气囊腔的血管。我们还使用单因素方差分析或Kruskal-Wallis秩和检验（视情况而定）分析了定量测量结果，如含气囊腔直径、壁厚度和薄壁比例。
11.5%（176/1525）的患者在HRCT上观察到LACA，其中7.1%（36/505）为纯磨玻璃结节，13.5%（112/830）为混合磨玻璃结节，14.7%（28/190）为实性结节（P = 0.001）。LACA的手术方式各不相同（P = 0.012）。LACA的发生率随结节直径和侵袭性的增加而增加（均P < 0.001）。在原位病变（PL）、微浸润腺癌（MIA）和浸润性腺癌（IAC）组之间，在壁成分密度、分布、间隔、穿过含气囊腔的血管、含气囊腔直径、壁厚度和薄壁比例方面观察到统计学显著差异（分别为P < 0.001、P = 0.024、P = 0.001、P = 0.025、P = 0.001、P < 0.00 和P < 0.001）。壁成分密度随侵袭性增加而增加（P < 0.001）。与MIA和IAC不同，PL中的含气囊腔通常没有间隔（分别为P = 0.001和P < 0.001）。IAC的含气囊腔直径大于PL（6.5 3.7 mm）（P < 0.001）。IAC的壁厚度也比PL和MIA厚（11.8 6.8 mm, 11.8 8.3 mm）（分别为P < 0.001和P < 0.001），薄壁比例比PL和MIA小（181.5° 264.8°, 181.5° 223.8°）（分别为P < 0.001和P = 0.039）。
HRCT上含气囊腔的患病率和特征可用于预测直径≤3 cm的LUAD患者的侵袭性。
