HRCT影像学表现对浸润性肺腺癌病理亚型的预测价值

裴蕾 潘伟 纪清源 张敏鸽

[摘要] 目的 分析高分辨率CT（HRCT）影像学表现对浸润性肺腺癌（IAS）病理亚型的预测价值。 方法 选取2020年1月至2021年1月我院经手术切除的130例肺部磨玻璃结节患者为研究对象，以手术病理结果作为“金标准”，评估HRCT对浸润性肺腺癌病理亚型的预测价值。 结果 HRCT影像特征检测发现，微小浸润性腺癌、浸润性腺癌肺部磨玻璃结节下不规则病灶检出率较高，分叶检出率高于毛刺、胸膜牵拉，瘤肺界面清楚光整发生率高于毛糙发生率，内部结构空泡征发生率高于空气支气管征，胸膜凹陷征发生率高于血管集束征（P<0.05）。IAS不同病理亚型间相比，空泡征、空气支气管征、血管集束征存在显著性差异（P<0.05）。 结论 毛刺、胸膜凹陷征、空泡征等HRCT影像特征对浸润性肺腺癌病理亚型分型提供重要参考依据，对其病理亚型预测及手术治疗方案确定具有较高的临床应用价值。

[关键词] 高分辨率CT;影像学表现;浸润性肺腺癌;病理亚型;预测价值

[中图分类号] R734.2;R814.42          [文献标识码] B          [文章编号] 1673-9701（2021）31-0127-04

[Abstract] Objective To analyze the predictive value of high-resolution CT（HRCT） imaging performance on the pathological subtypes of invasive lung adenocarcinoma（IAS）. Methods A total of 130 patients with surgically resected pulmonary ground glass nodules in our hospital from January 2020 to January 2021 were selected as the research objects. The predictive value of HRCT on the pathological subtypes of invasive lung adenocarcinoma was evaluated by taking the surgical pathological findings as the gold standard. Results The detection rate of irregular lesions under the pulmonary ground glass nodules was relatively high in minimally invasive adenocarcinoma and invasive adenocarcinoma， and the detection rate of lobulation was higher than that of burr and pleural indentation. The incidence of clear and smooth tumor-lung interface was higher than that of roughness， the incidence of bronchus encapsulated air sign in internal structure was higher than that of air bronchogram sign， and the incidence of pleural indenlation sign was higher than that of vessel convergeence sign（P<0.05）. There were significant differences among different IAS pathological subtypes in bronchus encapsulated air sign， air bronchogram sign， and vessel convergeence sign（P<0.05）. Conclusion HRCT imaging features such as burr， pleural indenlation sign and bronchus encapsulated air sign provide important reference basis for pathological subtyping of invasive lung adenocarcinoma， and have high clinical application value for the prediction of its pathological subtype and the determination of surgical treatment plan.

[Key words] High-resolution CT; Imaging performance; Invasive lung adenocarcinoma; Pathological subtype; Predictive value

隨着影像学技术的发展及临床的广泛应用，肺纯磨玻璃结节病变临床检出率逐年升高[1]。根据肺腺癌病理新分类肺纯磨玻璃结节病理组织学分为微小浸润性腺癌（MIA）、浸润性腺癌（IAS）及浸润前病变，且预后效果存在显著差异[2]。低剂量高分辨率CT（HRCT）的影像学表现与肺腺癌病理学及生物学行为存在密切关联，为肺癌的早期诊断及预后提供重要参考依据[3-4]。但相关学者指出，腺癌的预后与肺纯磨玻璃结节的恶性程度存在直接关联，因此准确的评估肺纯磨玻璃结节具有重要意义[5-6]。……