高分辨CT、胸部平片及病理学诊断肺磨玻璃结节临床分析

目的分析高分辨CT与胸部平片联合用于肺磨玻璃结节鉴别诊断的价值，以提高肺磨玻璃结节早期检出率，为临床合理治疗提供影像学依据。 方法选择2018年1月至2019年12月经手术病理结果或穿刺活检证实860例肺磨玻璃结节患者作为分析对象，全部患者在术前均接受胸部平片检查与高分辨CT检查，且均经高分辨率CT与胸部平片发现有肺部结节征象；记录手术病理及穿刺活检结果；观察患者胸部平片与高分辨CT检查主要征象，分析各检查方法单独及联合用于肺磨玻璃结节鉴别诊断的价值。 结果860例患者中经证实恶性385例，其中289例经手术病理确诊，96例经穿刺活检明确，包括原位腺癌135例，微浸润腺癌155例，浸润性腺癌72例，其他23例，恶性率为44.8%；860例肺磨玻璃结节患者经胸部平片检查结果显示，肺结节直径范围为1.0～3.0 cm；肺结节的分布：326例左肺，534例右肺；经高分辨CT检查结果显示，良恶性病变肺磨玻璃结节病灶大小比较，差异无统计学意义(P>0.05)，恶性结节表现出不规则形、毛刺征、分叶征、界面清楚光整、空泡征、支气管征等征象占比均高于良性组(P<0.05)；胸部平片、高分辨CT单独及联合诊断肺磨玻璃结节的曲线下面积分别为0.847、0.876、0.940，均>0.8，诊断价值好，且联合诊断的曲线下面积最大。 结论胸部平片与高分辨CT联合检测，并结合病理学对提高肺磨玻璃结节早期良性病变及恶性肿瘤进行鉴别诊断的正确率有重要价值。

Clinical analysis of high-resolution CT,chest plain film and pathological examination in diagnosis of pulmonary ground-glass nodules

ObjectiveTo analyze the clinical value of high-resolution CT combined with chest plain film in the differential diagnosis of pulmonary ground-glass nodules for increasing the early detection rate of pulmonary ground-glass nodules and providing imaging bases for clinical reasonable treatment. MethodsA total of 860 patients with pulmonary ground-glass nodules which were confirmed by surgical pathological results or puncture biopsy from January 2018 to December 2019 were selected as the research objects. All the patients underwent chest plain film and high-resolution CT examination before surgery, and both the high-resolution CT and the chest plain film showed the signs of pulmonary nodules. The results of surgical pathology and puncture biopsy were recorded. The main signs of chest plain film and high-resolution CT of the patients were observed, too. The values of single and combined examination methods in the differential diagnosis of pulmonary ground-glass nodules were analyzed. ResultsA total of 385 cases were diagnosed as malignant lesions out of the 860 patients, of which 289 cases were confirmed by surgical pathology and 96 cases were confirmed by puncture biopsy, including 135 cases of adenocarcinoma in situ, 155 cases of minimally invasive adenocarcinoma, 72 cases of invasive adenocarcinoma and 23 other cases, with a malignant rate of 44.8%. The results of chest plain film of the 860 cases of pulmonary ground-glass nodules showed that the range of the pulmonary nodules′diameter was 1.0-3.0 cm. The distribution of the pulmonary nodules was described as follows: 326 cases located in the left lungs and 534 cases located in the right lungs. The results of high-resolution CT showed that there was no statistical difference in the size of focus between the benign and malignant pulmonary ground-glass nodules (P>0.05). The proportions of irregular shape, spicule sign, lobulation sign, clear and smooth interface, vocule sign, and bronchus sign in the malignant nodules were higher than those of the benign group (P<0.05). The areas under the curves of chest plain film, high-resolution CT alone and combined diagnosis of pulmonary ground-glass nodules were 0.847, 0.876, and 0.940, respectively, all of which were greater than 0.8, indicating good diagnostic values. And the area under the curve of combined diagnosis was the largest. ConclusionChest plain film combined with high-resolution CT and pathological examination are of great value in improving the accuracy of differential diagnosis of early benign lesions and malignant pulmonary ground-glass nodules.