肺部单发微小磨玻璃结节(<10mm)MSCT特征对肺腺癌病理亚型的诊断价值
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摘要
目的:探讨肺部单发微小磨玻璃结节(GGN,<10mm)的MSCT影像特征对于浸润前病变(不典型腺瘤样增生AAH+原位腺癌AIS)、微浸润腺癌(MIA)和浸润性腺癌(IAC)的诊断价值。方法:回顾性分析272例肺部单发微小GGN的MSCT图像特征,按照肺腺癌病理分类标准分为3组,包括AAH+AIS:95(31+64)例,MIA 153例和IAC 24例。对三组患者的临床资料及GGN的CT特征进行分析,包括患者性别、年龄、GGN最大径、CT值及MSCT图像的影像特征(边缘、瘤肺界面、内部结构及邻近结构)。采用受试者操作特征曲线(ROC)分析三组病变最大径及CT值的鉴别诊断价值。结果:病灶位置、密度、边缘分叶征、边缘毛刺征、边缘棘突征、瘤肺界面、血管集束征、支气管充气征、空泡征、血管穿入、病变最大径及CT值等特征指标在三组中的差异有统计学意义(P<0.05);而性别、年龄及胸膜凹陷征在三组中差异无统计学意义(P>0.05)。病变最大径诊断AAH+AIS和IAC、AAH+AIS和MIA及AAH+AIS和MIA+IAC的诊断阈值分别为7.70mm (敏感度91.7%,特异度30.5%),7.15mm (敏感度49.7%,特异度37.9%)及7.15mm (敏感度55.4%,特异度37.9%)。CT值诊断AAH+AIS和IAC、AAH+AIS和MIA及AAH+AIS和MIA+IAC的诊断阈值分别为-539.5HU (敏感度100%,特异度33.7%),-562.5 HU (敏感度77.8%,特异度45.3%)及-547.5HU(敏感度74.6%,特异度38.9%)。结论:MSCT的影像特征对表现为微小GGN(<10mm)的AAH+AIS、MIA及IAC具有重要的诊断价值。GGN的最大径及CT值对于AAH+AIS、MIA及IAC具有较好的诊断效能。
Objective:To investigate the diagnostic value of multi-slice computed tomography(MSCT)imaging features of solitary pulmonary ground-glass micro-nodules(dimension<10 mm;GGN)among pre-invasive atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC).Methods:A retrospective analysis of thin-slice thoracic MSCT examination was performed in a total of 272 pathological confirmed solitary pulmonary GGNs,including 95 AAH+ AIS(31+64),153 MIA and 24 IAC.The clinical data from these 3 groups of patients and the CT features of the GGNs were analyzed,including gender,age,GGN's maximum diameter,CT density value and imaging features of the MSCT images(edge,tumor-lung interface,internal structure and adjacent structure).The diagnostic value of maximal lesion diameter and CT density of GGN were analyzed by receiver operator characteristic curve(ROC).Results:Significant differences were found on the characteristics of lesion location,density,marginal lobulation sign,marginal burr,lung tumor interface,vascular bundle,bronchial aeration sign,vacuole sign,non-inflation sign and vacuole sign,and vascular penetration among the 3 groups(all P<0.05);whereas no difference was found on the gender,age and the characteristics of pleural sag(all P>0.05).The optimal cut-off value of maximal transverse diameter of lesions in diagnosis of AAH+AIS and IAC,AAH+AIS and MIA,and AAH+AIS and MIA+IAC was respectively 7.70 mm(Sensitivity:0.917,Specificity:0.305),7.15 mm(Sensitivity:0.497,Specificity:0.379)and 7.15 mm(Sensitivity:0.554,Specificity:0.305).The optimal cut-off value of CT density of lesions in diagnosis of AAH+AIS and IAC,pre-invasion AAH+AIS and MIA,and AAH+AIS and MIA+IAC was respectively-539.5 HU(Sensitivity:1.00,Specificity:0.337),-562.5 HU(Sensitivity:0.778,Specificity:0.453)and-547.5 HU(Sensitivity:0.746,Specificity:0.389).Conclusion:The MSCT imaging features of solitary pulmonary GGN(dimension<10 mm)has important diagnosis value among AAH+AIS,MIA and IAC.Simultaneously,the maximum diameter and CT density of GGN can be of good diagnosis efficacy among AAH+ AIS,MIA and IAC.
Objective:To investigate the diagnostic value of multi-slice computed tomography(MSCT)imaging features of solitary pulmonary ground-glass micro-nodules(dimension<10 mm;GGN)among pre-invasive atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC).Methods:A retrospective analysis of thin-slice thoracic MSCT examination was performed in a total of 272 pathological confirmed solitary pulmonary GGNs,including 95 AAH+ AIS(31+64),153 MIA and 24 IAC.The clinical data from these 3 groups of patients and the CT features of the GGNs were analyzed,including gender,age,GGN's maximum diameter,CT density value and imaging features of the MSCT images(edge,tumor-lung interface,internal structure and adjacent structure).The diagnostic value of maximal lesion diameter and CT density of GGN were analyzed by receiver operator characteristic curve(ROC).Results:Significant differences were found on the characteristics of lesion location,density,marginal lobulation sign,marginal burr,lung tumor interface,vascular bundle,bronchial aeration sign,vacuole sign,non-inflation sign and vacuole sign,and vascular penetration among the 3 groups(all P<0.05);whereas no difference was found on the gender,age and the characteristics of pleural sag(all P>0.05).The optimal cut-off value of maximal transverse diameter of lesions in diagnosis of AAH+AIS and IAC,AAH+AIS and MIA,and AAH+AIS and MIA+IAC was respectively 7.70 mm(Sensitivity:0.917,Specificity:0.305),7.15 mm(Sensitivity:0.497,Specificity:0.379)and 7.15 mm(Sensitivity:0.554,Specificity:0.305).The optimal cut-off value of CT density of lesions in diagnosis of AAH+AIS and IAC,pre-invasion AAH+AIS and MIA,and AAH+AIS and MIA+IAC was respectively-539.5 HU(Sensitivity:1.00,Specificity:0.337),-562.5 HU(Sensitivity:0.778,Specificity:0.453)and-547.5 HU(Sensitivity:0.746,Specificity:0.389).Conclusion:The MSCT imaging features of solitary pulmonary GGN(dimension<10 mm)has important diagnosis value among AAH+AIS,MIA and IAC.Simultaneously,the maximum diameter and CT density of GGN can be of good diagnosis efficacy among AAH+ AIS,MIA and IAC.
引文
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[18]赵娇,李建华,费佳,等.肺磨玻璃样结节:有助于预判肺腺癌浸润性的CT征象[J].放射学实践,2018,33(4):383-388.
[2]Naidich DP,Bankier AA,MacMahon H,et al.Recommendations for the management of subsolid pulmonary nodules detected at CT:A statement from the fleischner society[J].Radiology,2013,266(1):304-317.
[3]Aoki T,Tomoda Y,Watanabe H,et al.Peripheral lung adenocarcinoma:correlation of thin-section CT findings with histologic prognostic factors and survival[J].Radiology,2001,220(3):803-809.
[4]Godoy MC,Naidich DP.Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung:recommended interim guidelines for assessment and management[J].Radiology,2009,253(3):606-622.
[5]Henschke CI,Yankelevitz DF,Mirtcheva R,et al.CT screening for lung cancer:frequency and significance of part-solid and nonsolid nodules[J].AJR,2002,178(5):1053-1057.
[6]Lee HJ,Goo JM,Lee CH,et al.Predictive CT findings of malignancy in ground-glass nodules on thin-section chest CT:the effects on radiologist performance[J].Eur Radiol,2009,19(3):552-560.
[7]Oda S,Awai K,Liu D,et al.Ground-glass opacities on thin-section helical CT:differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia[J].AJR,2008,190(5):1363-1368.
[8]Siegel R,DeSantis C,Virgo K,et al.Cancer treatment and survivorship statistics,2012[J].CA,2012,62(4):220-241.
[9]Travis WD,Brambilla E,Noguchi M,et al.International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma[J].J Thorac Oncol,2011,6(2):244-285.
[10]Lee HJ,Lee CH,Jeong YJ,et al.Iaslc/ats/ers international multidisciplinary classification of lung adenocarcinoma:novel concepts and radiologic implications[J].J Thorac Imaging,2012,27(6):340-353.
[11]Si MJ,Tao XF,Du GY,et al.Thin-section computed tomography-histopathologic comparisons of pulmonary focal interstitial fibrosis,atypical adenomatous hyperplasia,adenocarcinoma in situ,and minimally invasive adenocarcinoma with pure groundglass opacity[J].Eur J Radiol,2016,85(10):1708-1715.
[12]高盼,何文杰,孙英丽,等.小细胞肺癌的CT表现分类及其价值[J].放射学实践,2018,33(8):847-851.
[13]Ikeda K,Awai K,Mori T,et al.Differential diagnosis of groundglass opacity nodules:CT number analysis by three-dimensional computerized quantification[J].Chest,2007,132(3):984-990.
[14]Kitami A,Kamio Y,Hayashi S,et al.One-dimensional mean computed tomography value evaluation of ground-glass opacity on high-resolution images[J].Gen Thorac Cardiovasc Surg,2012,60(7):425-430.
[15]Nomori H,Ohtsuka T,Naruke T,et al.Differentiating between atypical adenomatous hyperplasia and bronchioloalveolar carcinoma using the computed tomography number histogram[J].Ann Thorac Surg,2003,76(3):867-871.
[16]Yanagawa M,Kuriyama K,Kunitomi Y,et al.One-dimensional quantitative evaluation of peripheral lung adenocarcinoma with or without ground-glass opacity on thin-section CT images using profile curves[J].Br J Radiol,2009,82(979):532-540.
[17]李兆勇,朱刚明,梁俊生,等.周围型小肺癌的MSCT诊断及与局灶性机化性肺炎鉴别[J].放射学实践,2015,30(7):741-745.
[18]赵娇,李建华,费佳,等.肺磨玻璃样结节:有助于预判肺腺癌浸润性的CT征象[J].放射学实践,2018,33(4):383-388.