肺磨玻璃结节与邻近血管及支气管的关系与分型对其良恶性鉴别诊断的价值

摘要

目的 研究肺磨玻璃结节(GGN)与邻近血管及支气管的关系及分型,探讨其对GGN良恶性鉴别诊断及评估恶性程度的应用价值.方法 收集经大连大学附属中山医院手术病理和临床证实的172例共计187个GGN病灶,其中浸润性腺癌组88个、浸润前病变组70个、良性结节组29个.应用CT图像横轴位并结合MPR及VR等后处理图像进行多维度分析,比较不同组间GGN与血管及支气管的关系、类型分布及相关性,评价不同分型的诊断敏感度、特异度及准确率.在CT上对GGN的磨玻璃成分进行量化,分析不同组间磨玻璃成分的分布及相关性.结果 GGN的血管及支气管关系分型在3组不同性质GGN中所占比例差异有统计学意义(P＜0.01).良恶性GGN中血管与支气管分型关系存在负相关(r=-0.569,P＜0.01).浸润性腺癌组GGN的血管分型以Ⅲ、Ⅳ型为主,支气管分型以Ⅱ、Ⅲ型多见;浸润前病变组GGN的血管分型以Ⅱ型、支气管分型以Ⅳ型多见;良性病变组GGN中血管分型以Ⅰ、Ⅱ型多见,支气管分型以Ⅳ、Ⅴ型为主.血管与支气管征象同时存在对GGN良恶性鉴别尤其是对恶性诊断的准确率明显高于单独出现.CT图像上GGN的磨玻璃成分比例与血管、支气管分型间存在相关性(r=0.550,P＜0.01;r=-0.571,P＜0.01).结论 GGN与邻近血管与支气管的关系及其分型对鉴别良恶性诊断具有重要作用,联合两种征象及分型并结合GGN内磨玻璃成分量化分析,可进一步提高鉴别诊断准确率.%Objective To study the relationship between ground-glass nodule (GGN) and adjacent blood vessels and bronchus,and to discuss its value in differentiating benign and malignant GGN.Methods The 187 GGNs were divided into the following three groups:the invasive adenocarcinoma group (n =88),the pre-invasive lesion group (n =70) and the benign nodule group (n =29).CT images were combined with MPR and VR Images for multi-dimensional analysis to fully demonstrate the relationship between GGN and blood vessels and bronchus and compare among different groups.Based on the relationship between GGN and blood vessels and bronchus,the GGNs were classified into 4 types and 5 types respectively.GGNs were quantitatively analyzed on CT images to compare the glass composition of GGN among different groups.Results (1) The GGN types classified according to the relationship between GGN and blood vessels and bronchus were significantly different among the three groups (P ＜ 0.01).There was a significant correlation between blood vessels and bronchial types inGGN (r =-0.569,P ＜ 0.01).(2) The GGNs in the invasive adenocarcinoma group were mainly vascular type Ⅲ and Ⅳ,and more commonly bronchial type Ⅱ and Ⅲ.In the pre-invasive lesion group,vascular type Ⅱ and bronchial type Ⅳ GGNs were more common.The GGNs in the benign group were more commonly vascular type Ⅰ and Ⅱ and bronchial type Ⅳ and Ⅴ.(3) The accuracy for benign and malignant GGN differentiation,especially for malignant GGN diagnosis,is significantly higher when both vascular and bronchial types are present compared to a single type.(4) There was a correlation between the GGN composition and the GGN classification of blood vessels and bronchus (r =0.550,P ＜ 0.01;r =-0.571,P ＜ 0.01).Conclusion The relationship between GGN and adjacent blood vessels and bronchus and its application in GGN classification plays an important role in the differential diagnosis of benign and malignant GGN.The presence of two kinds of signs and types combining with GGN internal friction analysis can further improve the accuracy of differential diagnosis.