低剂量螺旋CT对以亚实性肺结节为主要表现的早期肺腺癌的诊断意义

目的 评价低剂量螺旋CT对以亚实性肺结节为主要表现的早期肺腺癌的诊断意义.方法 回顾性选择上海市浦东新区周浦医院2018年1月至2019年6月46例CT表现为亚实性肺结节并经手术确诊为早期肺腺癌病人的临床资料,根据肺结节的密度类型分为有实性成分的混合性磨玻璃结节组和纯磨玻璃结节组.根据病理结果分为浸润前组(包括微浸润性...

Significance of low-dose spiral CT in the diagnosis of early stage adenocarcinoma of the lung mainly manifested by the solid pulmonary nodules

Objective To evaluate the diagnostic significance of low-dose spiral CT in early stage lung adenocarcinoma mainly manifested by ascitic pulmonary nodules.Methods The clinical data of 46 patients with subsolid lung nodules by CT manifestations whowere diagnosed as early lung adenocarcinoma by surgery in Shanghai Pudong New District Zhoupu Hospital from January 2018 to June2019 were retrospectively enrolled. According to the density type of lung nodules, they were assigned into mixed ground glass nodulesgroup and pure ground glass nodules group. According to the pathological results, they were assigned into pre-invasion group (includingmicroinvasive foci) and invasive lesion group. The differences in age, gender, lesion length, presence of glitches, CT value, proportion ofsolid components, presence of lobulation signs, presence of pleural signs, and presence of vacuoles were compared between the twogroups. The main points and accuracy of CT identification of the pre-invasion group and invasive lesion group were analyzed.Results There were 30 mixed ground glass nodules and 17 pure ground glass nodules in 46 patients. In the pure ground glass nodule group, thedifference in lesion length between the pre-invasion group and the invasive lesion group was statistically significant (10.8±4.1) mm vs. (16.8±5.9) mm, P<0.05]. There were no significant differences in age, gender, glitch sign, CT value, lobulation sign, pleural sign, andvacuole sign between the two groups (P>0.05). For the mixed ground glass nodule group, there were statistically significant differencesin the proportion of solid components (26.3±17.5)% vs. (50.7±19.6)%], lesion length (14.9±5.5) mm vs. (21.5±5.9) mm], defoliation sign, burr sign, and pleural pull sign between the pre-invasion group and invasive lesion group (all P<0.05). The length of the lesion in the pure ground glass nodules group was the only significant feature that distinguishes the pre-invasion group from the invasive lesion group (OR=1.31, P=0.013). The best cut-off value for the length of the lesion between the two groups was 14.6 mm. The proportion of solid components (OR=201.936, P=0.006) and lesion length (OR=1.165, P=0.041) in the mixed ground glass nodule group were independent risk factors for distinguishing the pre-invasion group from the invasive lesion group. The area under the receiver operating characteristic curves of the proportion of solid components combined with the length of the lesion was 0.862 (95%CI: 0.761-0.957). At this time, the sensitivity was 73.5% and the specificity was 83.9%, which was higher than the single distinction.Conclusions In the low-dose spiral CT image, the nodule lesion with pure ground glass<14.6 mm is a good distinguishing point between pre-invasion lesions (including microinvasive foci) and invasive foci. In the mixed ground glass nodular lesion, the ratio of solid components of the lesion combined with the length of the lesion is helpful to improve the diagnostic rate of differentiation.