亚实性肺结节在ⅠA期肺癌影像诊断中的价值

doi:10.3969/j.issn.1007-3969.2015.03.007

中国癌症杂志 ›› 2015, Vol. 25 ›› Issue (3): 199-204.doi: 10.3969/j.issn.1007-3969.2015.03.007

亚实性肺结节在ⅠA期肺癌影像诊断中的价值

黄浩哲¹，李国栋¹，许立超¹，李文涛¹，王升平²

1. 复旦大学附属肿瘤医院介入治疗科，复旦大学上海医学院肿瘤学系，上海 200032 ；
2. 复旦大学附属肿瘤医院放射诊断科，复旦大学上海医学院肿瘤学系，上海 200032

出版日期:2015-03-30 发布日期:2015-05-18
通信作者: 李文涛　E-mail:liwentao98@126.com
基金资助:
上海申康医院发展中心局级课题(SHDC12012112)；上海市科委课题(KW1231)。

The value of subsolid pulmonary nodules in imaging diagnosis of stage ⅠA lung cancer

HUANG Haozhe¹, LI Guodong¹, XU Lichao¹, LI Wentao¹, WANG Shengping²

1.Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 2.Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China

Published:2015-03-30 Online:2015-05-18
Contact: LI Wentao E-mail: liwentao98@126.com

摘要/Abstract

摘要： 背景与目的：亚实性肺结节(subsolid pulmonary nodule，SSPN)作为一种特征性而非特异性的肺部病灶与早期肺癌关系密切，为探讨其对ⅠA期肺癌的诊断价值，本研究将分析不同性质SSPNs的CT诊断及鉴别诊断要点。方法：收集2008年4月—2014年4月在复旦大学附属肿瘤医院行CT引导Hookwire定位下胸腔镜手术(video assisted thoracic surgery，VATS)治疗的405例孤立性肺结节(solitary pulmonary nodule，SPN)患者的临床及影像学资料。根据磨玻璃影(ground-glass opacity，GGO)成分含量将SPNs分为单纯型磨玻璃影(pure ground-glass opacity，pGGO)、混合型磨玻璃影(mixed ground-glass opacity，mGGO)和实性结节(solid nodule，SN)3组，并统计各组恶性率。根据术后病理结果，再将SSPNs分为ⅠA期肺癌组和良性组，分析对比影响SSPN良、恶性的影像学特征。结果：共纳入405例SPN患者，其中SSPNs有367例(包括124例pGGOs和243例mGGOs)，且在ⅠA期肺癌中的发生率明显高于良性组[95.9%(257/268) vs 80.3%(110/137)，P<0.001]。SSPN的总恶性率为70.0%(257/367)，且mGGO的恶性率(72.0%)要高于pGGO(66.1%)和SN(28.9%)。恶性SSPN多发生于中年女性肺上叶，且病灶边界不清、边缘毛刺、分叶和胸膜凹陷征的发生率高于良性组(P<0.05)。结论：SSPN是肺癌的重要征象，且以mGGO的恶性倾向最高。若中年女性伴有肺上叶的SSPN，且病灶边界不清、边缘出现毛刺、分叶或胸膜凹陷时，应高度怀疑恶性。

关键词: , 亚实性肺结节, 磨玻璃影, ⅠA期肺癌, 影像诊断

Abstract: Background and purpose: With characteristic but non-specific features, subsolid pulmonary nodules (SSPN) is closely associated with early lung cancer. This study aimed to estimate the imaging value of SSPN in stage ⅠA lung cancer, and summarized the radiological features of various SSPNs, retrospectively. Methods: The clinical data and imaging data of 405 patients with solitary pulmonary nodules (SPNs) from Apr. 2008 to Apr. 2014 at Fudan University Shanghai Cancer Center were collected. According to ground-glass opacity (GGO) proportion, SPNs were divided into 3 groups: pure ground-glass opacity (pGGO), mixed ground-glass opacity (mGGO) and solid nodule (SN). The malignant ratios were calculated based on the postoperatively pathological results. Besides, SSPNs were classified into stage ⅠA lung cancer group and benign lesions group aiming at identifying the differentiating computed tomography (CT) features. Results: Of the enrolled 405 SPN patients, there were 367 SSPNs (including 124 pGGOs and 243 mGGOs) whose incidence in stage ⅠA lung cancer group was significantly higher than those in benign group [95.9% (257/268) vs 80.3% (110/137), P<0.001]. The total malignant ratio of SSPN was 70.0% (257/367), mGGO had a higher malignant ratio (72.0%) than those of pGGO (66.1%) and SN (28.9%). The malignant SSPNs were frequently detected in upper lobe of middle-aged women with a higher incidence of irregular edge, spiculation, lobulation and pleural retraction than benign group (P<0.05). Conclusion: SSPN is one of the significantly malignant indicators, and mGGO has the highest malignant tendency. Senility, female, irregular edge, spiculation, lobulation, pleural retraction and pulmonary upper lobe distribution are demonstrated the significant discriminators from benign lesions.

Key words: Subsolid nodule, Ground-glass opacity, Stage ⅠA lung cancer, Imaging diagnosis

黄浩哲,李国栋,许立超,等. 亚实性肺结节在ⅠA期肺癌影像诊断中的价值[J]. 中国癌症杂志, 2015, 25(3): 199-204.

HUANG Haozhe, LI Guodong, XU Lichao, et al. The value of subsolid pulmonary nodules in imaging diagnosis of stage ⅠA lung cancer[J]. China Oncology, 2015, 25(3): 199-204.

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亚实性肺结节在ⅠA期肺癌影像诊断中的价值

The value of subsolid pulmonary nodules in imaging diagnosis of stage ⅠA lung cancer

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