肺部磨玻璃結(jié)節(jié)CT征象在微浸潤腺癌與浸潤腺癌病變的對比分析
發(fā)布時間：2018-08-19 06:26
【摘要】：目的:本文通過對術(shù)后病理證實為微浸潤腺癌與浸潤腺癌的肺部磨玻璃樣結(jié)節(jié)(Ground glass nodules,GGNs)進行薄層CT(High-resolution CT,HRCT)征象的對比并分析,探討肺磨玻璃結(jié)節(jié)在微浸潤腺癌(Micro invasive adenocarcinoma,MIA)與浸潤性腺癌(Invasive adenocarcinoma,IAC)之間CT征象的差異,以進一步認識兩組磨玻璃結(jié)節(jié)的相關(guān)特性,準確判斷兩者的區(qū)別,從而更好的輔助臨床鑒別診斷和指導治療。方法:收集自2016年1月至2016年12月期間,就診于大連醫(yī)科大學附屬第二醫(yī)院胸外二科,并于本院行薄層計算斷層掃描發(fā)現(xiàn)有肺部磨玻璃結(jié)節(jié)且經(jīng)術(shù)后病理證實為微浸潤腺癌和浸潤腺癌的患者。影像圖片均使用本院德國SOMATOM Definition AS 64型號機器,統(tǒng)一掃描范圍均為由肺尖部至膈肌頂部。CT檢查原始采集數(shù)據(jù)設(shè)定值:設(shè)備管電壓設(shè)定值為120KV,管電流設(shè)定值為150m A,設(shè)定層厚8mm,層距8mm或?qū)雍?0mm,層距10mm。薄層掃描CT的重建參數(shù)設(shè)置層厚為1mm,層距為1mm。肺窗數(shù)據(jù)設(shè)置:窗寬為1200HU,窗位為-600HU;縱隔窗數(shù)據(jù)設(shè)置:窗寬為400HU,窗位為40HU。結(jié)果由兩名高年資的影像科醫(yī)師對CT影像資料的特征進行分析。術(shù)后切除標本送病理。行10%福爾馬林(甲醛)以固定,給予石蠟行包埋并制作成載玻片標本,再行HE染色處理。必要時行免疫組化檢查以確定診斷。最終病理診斷由兩位病理科高年資醫(yī)師進行判定(病理的結(jié)果依據(jù)肺腺癌新分類標準予以分類)。最后使用SPSS 17.0版本軟件對所收集的數(shù)據(jù)進行分析。對所有病理結(jié)果診斷為微浸潤腺癌與浸潤性腺癌的CT征象:GGN性質(zhì)、病灶位置、病灶大小、實性成分(實性成大小及實性成分比例)、形態(tài)、邊界、分葉征、毛刺征、胸膜凹陷征、支氣管充氣征及空泡征進行統(tǒng)計學分析。相關(guān)計數(shù)資料運用χ2檢驗,期望值小于5則用Fisher檢驗,計量資料使用T檢驗。把有價值的影響因素行Logistic多因素分析,以尋找兩組間的差異因素。對病灶大小、實性成分使用受試者工作特征曲線,既ROC曲線(receiver operating characteristic curve),確定最佳分界值,并算出曲線下的面積以評估其診斷價值。以P值0.05則表示微浸潤腺癌與浸潤性腺癌之間的差異具有顯著的統(tǒng)計學意義。結(jié)果:73名患者中,共83例GGNs,病理結(jié)果為微浸潤腺癌37例,占比例為44.6%;浸潤腺癌46例,占比例為55.4%。單因素分析顯示病灶大小(p=0.00)、GGN性質(zhì)(p=0.003)、形態(tài)(p=0.037)、分葉征(p=0.049)、毛刺征(p=0.022)P值小于0.05,具有統(tǒng)計學意義。對兩組中有意義的因素行多因素分析,病灶大小(P=0.000)、GGN性質(zhì)(P=0.015)、毛刺征(P=0.022)具有統(tǒng)計學意義。對病灶大小進行ROC曲線分析:病灶大小曲線下面積0.823,病灶大小最佳截點11.50mm,敏感度78.3%,特異性73.0%。兩組中m GGNs病灶實性成分進行比較,微浸潤腺癌中平均實性成分大小(mm)2.50±1.008,實性成分比例(%)23.99±5.737,浸潤性腺癌平均實性成分大小(mm)4.90±1.412,實性成分比例(%)35.55±3.861。m GGNs實性成分大小(P=0.00)及比例(P=0.00)在兩組間有統(tǒng)計學意義。多因素分析實性成分大小(P=0.004)、實性成分比例(P=0.048)均具有統(tǒng)計學意義。對兩組間實性成分大小、比例行ROC曲線分析:實性成分大小曲線下面積0.925,最佳截點3.25mm,敏感度88.6%,特異性77.8%;實性成分比例曲線下面積0.912,最佳截點28.1%,敏感度90.9%,特異性85.2%。結(jié)論:本研究通過對微浸潤腺癌與浸潤腺癌的磨玻璃樣結(jié)節(jié)CT征象進行對比分析,分析結(jié)果示病灶大小、病灶性質(zhì)、毛刺征在兩組之間的差異顯著,并具有統(tǒng)計學意義,這對于微浸潤腺癌與浸潤腺癌兩者的鑒別診斷具有一定的價值所在,尤其對于病灶大小大于11.50mm,含實性成分,具有分葉征及毛刺征的病灶,更有可能為浸潤性腺癌。而實性成分大小和實性成分比例在兩組混合磨玻璃結(jié)節(jié)中的差異顯著,具有統(tǒng)計學意義。實性成分大小及實性成分比例對以混合磨玻璃結(jié)節(jié)為表現(xiàn)的微浸潤腺癌與浸潤腺癌兩者之間的相區(qū)別提供了參考,實性成分大小大于3.25mm,實性成分比例大于28.1%的病灶更傾向于浸潤性腺癌。因此,通過磨玻璃的薄層掃描,可以為臨床的鑒別診斷提供一定幫助及選擇合理的術(shù)式,使患者受益。
[Abstract]:Objective: To investigate the role of ground glass nodules (GNs) in microinvasive adenocarcinoma (MIA) and invasive adenocarcinoma (Invasive adenocarcinoma) by comparing and analyzing the high resolution CT (HRCT) findings of GNs confirmed by pathology after operation. Methods: From January 2016 to December 2016, we collected the data from the Department of Thoracic Surgery, Second Affiliated Hospital of Dalian Medical University, and treated them in our hospital. Thin-slice computed tomography (TLCT) revealed ground glass nodules in the lungs, which were confirmed by postoperative pathology as microinvasive adenocarcinoma and invasive adenocarcinoma. The images were taken by our German SOMATOM Definition AS 64 machine. The uniform scan ranged from the tip of the lungs to the top of the diaphragm. The reconstruction parameters of thin-slice CT were set to 1 mm in thickness and 1 mm in interval. The lung window data were set to 1200 HU in width and - 600 HU in position. The mediastinal window data were set to 400 HU in width and 40 HU in position. The CT features were analyzed. The specimens were removed and sent to pathology. The specimens were fixed with 10% formaldehyde, embedded with paraffin and stained with HE. Immunohistochemistry was performed if necessary to confirm the diagnosis. The final pathological diagnosis was determined by two senior pathologists. Results were classified according to the new classification criteria of lung adenocarcinoma. The data were analyzed using SPSS 17.0 software. All pathological findings were diagnosed as micro-invasive adenocarcinoma and invasive adenocarcinoma on CT: GGN nature, location, size of the lesion, solid component (solid to solid ratio), shape, boundary, lobulation sign. _2 test was used for the related counting data, Fisher test was used for the expectation value less than 5, and T test was used for the measurement data. The ROC curve, the receiver operating characteristic curve, was used to determine the best boundary value and calculate the area under the curve to evaluate the diagnostic value. Univariate analysis showed lesion size (p = 0.00), GGN property (p = 0.003), morphology (p = 0.037), lobulation sign (p = 0.049), burr sign (p = 0.022) P value was less than 0.05, with statistical significance. The ROC curve analysis showed that the area under the curve of lesion size was 0.823, the best cut-off point of lesion size was 11.50m m, the sensitivity was 78.3%, and the specificity was 73.0%. The sex component ratio (%) was 23.99 (%) and the average solid component size (m m) was 4.90 (%) and the solid component ratio (%) was 35.55 (%) 3.861.m GGNs (P = 0.00) and the ratio (P = 0.00) were statistically significant between the two groups. ROC curve analysis showed that the area under the solid component size curve was 0.925, the best cut-off point was 3.25 mm, the sensitivity was 88.6%, and the specificity was 77.8%; the area under the solid component size curve was 0.912, the best cut-off point was 28.1%, the sensitivity was 90.9%, and the specificity was 85.2%. CT findings of nodules were compared and analyzed. The results showed that the size, nature and burr sign of the nodules were significantly different between the two groups, and the difference was statistically significant. The difference in the size and proportion of solid components between the two groups of mixed ground-glass nodules was statistically significant. For reference, lesions with solid components larger than 3.25 mm and solid components larger than 28.1% are more likely to be invasive adenocarcinoma. Therefore, thin-layer scanning with ground-glass can provide some help for clinical differential diagnosis and choose a reasonable surgical method to benefit patients.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R734.2
本文編號：2190928
[Abstract]:Objective: To investigate the role of ground glass nodules (GNs) in microinvasive adenocarcinoma (MIA) and invasive adenocarcinoma (Invasive adenocarcinoma) by comparing and analyzing the high resolution CT (HRCT) findings of GNs confirmed by pathology after operation. Methods: From January 2016 to December 2016, we collected the data from the Department of Thoracic Surgery, Second Affiliated Hospital of Dalian Medical University, and treated them in our hospital. Thin-slice computed tomography (TLCT) revealed ground glass nodules in the lungs, which were confirmed by postoperative pathology as microinvasive adenocarcinoma and invasive adenocarcinoma. The images were taken by our German SOMATOM Definition AS 64 machine. The uniform scan ranged from the tip of the lungs to the top of the diaphragm. The reconstruction parameters of thin-slice CT were set to 1 mm in thickness and 1 mm in interval. The lung window data were set to 1200 HU in width and - 600 HU in position. The mediastinal window data were set to 400 HU in width and 40 HU in position. The CT features were analyzed. The specimens were removed and sent to pathology. The specimens were fixed with 10% formaldehyde, embedded with paraffin and stained with HE. Immunohistochemistry was performed if necessary to confirm the diagnosis. The final pathological diagnosis was determined by two senior pathologists. Results were classified according to the new classification criteria of lung adenocarcinoma. The data were analyzed using SPSS 17.0 software. All pathological findings were diagnosed as micro-invasive adenocarcinoma and invasive adenocarcinoma on CT: GGN nature, location, size of the lesion, solid component (solid to solid ratio), shape, boundary, lobulation sign. _2 test was used for the related counting data, Fisher test was used for the expectation value less than 5, and T test was used for the measurement data. The ROC curve, the receiver operating characteristic curve, was used to determine the best boundary value and calculate the area under the curve to evaluate the diagnostic value. Univariate analysis showed lesion size (p = 0.00), GGN property (p = 0.003), morphology (p = 0.037), lobulation sign (p = 0.049), burr sign (p = 0.022) P value was less than 0.05, with statistical significance. The ROC curve analysis showed that the area under the curve of lesion size was 0.823, the best cut-off point of lesion size was 11.50m m, the sensitivity was 78.3%, and the specificity was 73.0%. The sex component ratio (%) was 23.99 (%) and the average solid component size (m m) was 4.90 (%) and the solid component ratio (%) was 35.55 (%) 3.861.m GGNs (P = 0.00) and the ratio (P = 0.00) were statistically significant between the two groups. ROC curve analysis showed that the area under the solid component size curve was 0.925, the best cut-off point was 3.25 mm, the sensitivity was 88.6%, and the specificity was 77.8%; the area under the solid component size curve was 0.912, the best cut-off point was 28.1%, the sensitivity was 90.9%, and the specificity was 85.2%. CT findings of nodules were compared and analyzed. The results showed that the size, nature and burr sign of the nodules were significantly different between the two groups, and the difference was statistically significant. The difference in the size and proportion of solid components between the two groups of mixed ground-glass nodules was statistically significant. For reference, lesions with solid components larger than 3.25 mm and solid components larger than 28.1% are more likely to be invasive adenocarcinoma. Therefore, thin-layer scanning with ground-glass can provide some help for clinical differential diagnosis and choose a reasonable surgical method to benefit patients.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R734.2
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