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  • Title: [Value of CT Features on Differential Diagnosis of Pulmonary Subsolid Nodules and Degree of invasion Prediction in Pulmonary Adenocarcinoma].
    Author: Guo F, Li X, Wang X, Zheng W, Wang Q, Song W, Yu T, Fan Y, Wang Y.
    Journal: Zhongguo Fei Ai Za Zhi; 2018 Jun 20; 21(6):451-457. PubMed ID: 29945703.
    Abstract:
    BACKGROUND: Subsolid pulmonary nodules are common computed tomography (CT) findings of primary lung adenocarcinoma. It is of clinical value to determine the clinical treatment strategies based on CT features. The aim of this study is to find the valuable CT characteristics on differential diagnosis and the degree of invasion prediction by a retrospectively analysis of three groups subsolid nodules, including benign, and invasive adenocarcinoma. METHODS: The CT findings of 106 cases of resected sub-solid nodules were retrospectively analyzed. The nodules were firstly divided into benign and malignant groups and the malignant group was further divided into non/micro-invasive group (atypical adenomatous hyperplasia/adenocarcinoma in situ/minimally invasive adenocarcinoma) and invasive adenocarcinoma group. The nodule size, proportion of solid components, tumor-lung interface, shape, margin, pleural traction, air bronchus sign, vascular abnormalities inside the nodule were evaluated. The univariate analysis (χ2 test, non-parametric test Mann-Whitney U test) was performed to screen statistically significant variables and then enrolled in further multivariate Logistic regression analysis. RESULTS: Multivariate logistic regression analysis showed that a clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormalities were important indicators of malignant nodules with hazard ratios of 38.1 (95%CI: 5.0-287.7; P<0.01), 7.9 (95%CI: 1.3-49.3; P=0.03), 7.2 (95%CI: 1.4-37.0; P=0.02), respectively. The proportion of solid components was the only significant indicator for identifying invasive adenocarcinoma from AAH/AIS/MIA , with a risk ratio of 1.04 (95%CI: 1.01-1.06, P=0.01). CONCLUSIONS: SSNs with clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormality inside nodule are more likely to be malignant. A higher percentage of solid components indicates a higher likelihood to be an invasive lesion in malignant SPNs. 【中文题目：亚实性肺结节CT征象在良恶性鉴别
及腺癌恶性侵袭程度评估中的价值】 【中文摘要：背景与目的 亚实性肺结节为肺原发腺癌的常见计算机体层成像（computed tomography, CT）表现，依据其CT影像特征预测病理分型对确定临床治疗策略具有临床价值。本研究根据病理分类，回顾性分析良性、不典型腺瘤样增生（atypical adenomatous hyperplasia, AAH）/原位腺癌（adenocarcinoma in situ, AIS）/微侵袭性腺癌（minimally invasive adenocarcinoma, MIA）、侵袭性腺癌三组亚实性肺结节的CT征象，评估其在良恶性鉴别及恶性侵袭程度判别中的价值。方法 回顾性分析106例经手术切除亚实性结节的CT征象。依据手术病理分为良性和恶性组，恶性组根据侵袭程度分为无/微侵袭组（AAH/AIS/MIA）、侵袭性腺癌组，测量结节大小、实性成分比例、瘤肺界面、形状、边缘、胸膜牵拉征、空气支气管征、结节内血管异常等CT征象。根据单因素分析（χ2检验、非参数检验Mann-Whitney U检验）结果筛选有统计学差异的变量，纳入Logistic回归多因素分析。结果 Logistic回归分析显示清晰的瘤肺界面、空气支气管征以及结节内血管异常是恶性结节的重要预测指标，风险比分别为38.1（95%CI: 5.0-287.7; P<0.01）、7.9（95%CI: 1.3-49.3; P=0.03）、7.2（95%CI: 1.4-37.0; P=0.02）。更大的实性成分所占比例是侵袭性腺癌与AAH/AIS/MIA组鉴别的重要指标，其风险比分别为1.04（95%CI: 1.01-1.06, P=0.01）。结论 亚实性结节中出现清晰的瘤肺界面、空气支气管征、结节内血管异常提示其恶性概率增加。恶性结节中实性成分所占比例越大预示着侵袭性更高。】 【中文关键词：肺肿瘤；亚实性结节；计算机体层成像；定量变量；定性变量；良性；恶性】.
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