肺腺癌的能谱CT参数与肿瘤浸润性及 Ki-67表达的相关性研究

目的：探究能谱CT成像参数与肺腺癌病理上的浸润性及Ki-67表达的相关性。材料与方法：收集我院2016年3月至2017年 7月经手术病理证实为肺腺癌患者的资料，共计60例，免疫组化均包含Ki-67，术前均已行宝石能谱成像（Gemstone spectral imaging,GSI）扫描。其中纯磨玻璃结节（pGGN）15例、混合磨玻璃结节（mGGN）组15例、实性结节组30例，采用spearman相关分析分别比较三组结节动、静脉期IC和Ki-67抗原表达的相关性。其中30例磨玻璃结节（GGN）分为A组，包括浸润前病变（2例）和微浸润腺癌（14例），共计16例；B组为浸润性腺癌，共计14例。比较两组腺癌动、静脉期IC和Ki-67抗原表达的差异。结果：所有病例中，动、静脉期IC和Ki-67抗原表达呈负相关（r1=-0.749，P1=0.000；r2=-0.624，P2=0.000）；pGGN组动、静脉期IC和Ki-67抗原表达无相关性（P＞0.05）；mGGN组和实性结节组的动、静脉期IC和Ki-67抗原表达呈负相关（r1=-0.754、-0.617 ，P1＜0.05；r2=-6.09、-0.460，P2=＜0.05）。A组Ki-67抗原表达小于B组（P=0.001），两组动、静脉IC的差异无统计学意义。结论：肺腺癌能谱CT相关参数和KI-67抗原表达有显著的负相关性，在评估肿瘤增殖能力方面具有潜在的价值，但在诊断GGN浸润程度的作用还有待进一步研究论证。

Ki-67 expression and invasiveness of lung adenocarcinoma: Correlation with spectral CT parameters

Objective: To explore the correlation of the spectral CT imaging , Ki-67 and invasiveness of lung adenocarcinoma. Methods: A total of 60 cases of lung adenocarcinoma confirmed by pathology were collected from March 2016 to July 2017 in our hospital, and all cases have immunohistochemical indexes (Ki-67). Gemstone Spectral Imaging (GSI) enhanced scanning was performed on all patients . All the cases were divided into three groups: 15 cases of pGGN group, 15 cases of mGGN group, and 30 cases of solid nodules group. Spearman’s rank correlation analysis was used to estimate the correlation of Ki-67 and the iodine concentration in arterial and venous phases . Thirty glass-ground nodules were divided into two groups including：group A (16cases) included preinvasive lesions (2 cases) and minimally invasive adenocarcinoma (14 cases), group B (14cases) was invasive pulmonary adenocarcinoma. The difference between Ki-67 and IC in arterial and venous phases of the two groups were compared. Results：In all cases, there was a negative correlation between Ki-67 and iodine concentration in arterial and venous phases (r1=-0.749, P1=0.000; r2=-0.624, P2=0.000); Also, a negative correlation between the two was found in mGGN group and solid nodules group （r1=-0.754、-0.617 ，P1＜0.05；r2=-6.09、-0.460，P2=＜0.05），expect pGGN group. The expression of Ki-67 antigen in group was smaller than that of group B (P=0.001), but there was no significant difference of iodine concentration in arterial and venous phases between the two groups.Conclusion: There is a significant negative correlation between the multiple parameters of IC in spectral CT and Ki-67 in lung adenocarcinoma, which has a potential value to evaluate tumor proliferation capacity，but its role in diagnosing GGN infiltration level remains to be further exploited.