临床ⅠA期周围型肺腺癌病理性脉管浸润与其薄层CT征象的相关性研究

摘要

目的 探讨临床ⅠA期周围型肺腺癌薄层CT形态学征象与病理性脉管浸润的相关性.方法 回顾性分析98例ⅠA期周围型肺腺癌患者共计102个肺结节的临床、病理及术前影像表现,按照有无病理性脉管浸润进行分组.对肺结节直径、混杂磨玻璃结节内部实性成分直径与肿瘤直径的比值(C/T)、结节形态、病理分类等变量进行分析.分别采用两独立样本Mann-Whitney U检验、t检验、x2检验及行×列表资料的Fisher确切概率检验,在单变量分析的基础上筛选出肺结节CT形态学征象中与病理性脉管浸润相关的变量,再采用多变量Logistic回归进行分析,明确病理性脉管浸润的独立危险因素.同时采用ROC曲线分析肺结节直径、混杂磨玻璃结节内部实性成分直径及C/T值对判断病理性脉管浸润的敏感度和特异度.结果 102个肺结节中36个有病理性脉管浸润,66个无病理性脉管浸润.病理性脉管浸润组和无病理性脉管浸润组毛刺征、支气管充气征、异常静脉、血管集束征、胸膜凹陷征的结节个数和病灶中位直径分别是30、30,26、26,35、3,35、39,32、39个,2.1(1.0～3.0)、1.2(0.5～ 3.0)cm,两组间差异有统计学意义(x2=13.80、10.04、85.59、17.01、9.78,Z=-4.91;P值均＜0.01).多变量Logistic回归显示毛刺征及异常静脉为病理性脉管浸润的独立危险因素(优势比分别为33.867、8 161.063,P值均＜0.05).ROC曲线分析显示肺结节直径、混杂磨玻璃结节中实性成分直径及C/T值鉴别病理性脉管浸润的曲线下面积、截断点、敏感度、特异度分别是0.784、2.05 cm、66.7％、78.8％,0.886、1.08 cm、82.4％、90.0％,0.861、0.65、79.4％、85.0％.结论 临床ⅠA期周围型肺腺癌薄层CT征象中毛刺征及异常静脉是病理性脉管浸润的独立危险因素.%Objective To evaluate the correlation between thin-section CT morphologic features and pathological vascular invasion in the clinical stage ⅠA peripheral lung adenocarcinoma.Methods The preoperative thin-section CT images,clinical and pathological characteristics of 102 nodules in 98 patients were retrospectively analyzed and divided into two groups according to pathological vascular invasion.Variables including the diameter of tumor(T) and consolidation part (C) in the mix ground glass nodule (mGGN),C/T ratio,morphology and pathological classification were analyzed by two-independent samples Mann-Whitney U test or t test and x2 test or Fisher exact probability test.Variables with significant difference in the univariate analyses were entered into multivariate analysis to explore predictors for vascular invasion.The correlation between these measurements and vascular invasion was evaluated by a ROC analysis.Results All of 102 nodules,36 had pathological vascular invasion and 66 without.The numbers of two groups with speculation,air bronchogram,abnormal vein,vascular convergence,pleural indentation were 30,30;26,26;35,3;35,39;32,39 and the mediandiameter of tumors were 2.1(1.0-3.0),1.2(0.5-3.0) cm respectively.By univariateanalysis,spiculation,air bronchogram,abnormal vein,vascular convergence,pleural indentation,and diameter of tumor were significantly associated with pathological vascularinvasion (P＜0.01).By multivariate logistic analysis,the statistically significant difference were found in speculation and abnormal vein (OR=33.867,8 161.063,P＜0.05).The ROC analysis showed the area under curve,cut-off value,sensitivity and specificity ofthe diameter of tumor and consolidation part of mGGN and C/T ratio were 0.784,2.05 cm,66.7％,78.8％;0.886,1.08 cm,82.4％,90.0％ and 0.861,0.65,79.4％,85.0％ respectively in differentiating tumors with pathological vascular invasion.Conclusion The spiculation sign and abnormal vein are independent predictors for vascular invasion in stage ⅠA peripheral lung adenocarcinoma.