| 摘要: |
| ［摘要］ 目的 探讨基于胸部薄层CT扫描（TSCT）的肺磨玻璃影（GGO）病变“四分型法”在临床中的应用价值。方法 回顾性分析2020年1月至2022年12月于首都医科大学宣武医院接受胸腔镜手术治疗的1 541例患者的临床资料，共包含肺GGO病变2 005例次。采用“四分型法”对肺GGO病变进行分型：Ⅰ型，无空泡征和（或）细支气管征的纯GGO（p-GGO）；Ⅱ型，有空泡征和（或）细支气管征的p-GGO；Ⅲ型，仅在肺窗可见实性成分的异质性磨玻璃影（h-GGO）；Ⅳ型，在肺窗和纵隔窗均可见实性成分的部分实性磨玻璃影（ps-GGO）。分析肺GGO病变影像学特征［最大径、病变类型、发生部位、分型、肿瘤实性成分占比（CTR）等］与术后病理检查结果的关联性。结果 1 541例患者自发现肺GGO至接受手术治疗的时间为0.10～156.00个月，平均11.23个月，其间肺GGO病变变化不明显1 255例次（62.59%），最大径增大536例次（26.73%），密度增高45例次（2.24%），最大径增大伴密度增高169例次（8.43%）。术前肺GGO最大径为（13.21±7.90）mm；主要为单发病变［1 098例次（54.76%）］；多分布于右肺上叶［757例次（37.76%）］。肺GGO类型：Ⅰ型248例次（12.37%），Ⅱ型682例次（34.01%），Ⅲ型862例次（42.99%），Ⅳ型213例次（10.62%）。CTR≤25%有950例次（47.38%），25%75%有125例次（6.23%）。肺GGO病变中，良性病变186例次（9.28%），恶性病变1 819例次（90.72%），其中包括腺体前驱病变744例次，浸润期病变1 075例次。分析结果显示，肺GGO病变术后病理检查结果与GGO最大径、病变类型、发生部位、分型、CTR及随访变化情况均存在关联性（P<0.05）。对应分析结果显示，与肺GGO病变CTR相比，肺GGO病变分型散点与术后病理恶性变［不典型腺瘤样增生（AAH）、原位腺癌（AIS）、微浸润腺癌（MIA）、浸润期腺癌（IA）］散点在二维分布图中更为接近，提示基于“四分型法”的肺GGO影像学特征与术后病理恶性变有更好的对应关系。结论 基于TSCT的肺GGO病变“四分型法”有助于临床医师更好地评估以GGO为主要影像学表现的早期肺癌的风险度。 |
| 关键词: 肺磨玻璃影病变 胸部薄层CT扫描 四分型法 术后病理 肺癌 |
| DOI：10.3969/j.issn.1674-3806.2024.10.08 |
| 分类号:R 655.3 |
| 基金项目:973国家科技计划项目（编号：2011CB510100） |
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| A study on the clinical application of “four taxonomies classification method” of pulmonary ground-glass opacity lesions based on thin-section CT scanning of the chest |
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SU Lei1, ZHANG Yi1, GAO Yan2, WANG Tengteng1, LI Yuanbo1, ZHANG Peilong1, WANG Leiming3, WEI Xiuqin4
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1.Department of Thoracic Surgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China; 2.Department of Radiology, Xuanwu Hospital Capital Medical University, Beijing 100053, China; 3.Department of Pathology, Xuanwu Hospital Capital Medical University, Beijing 100053, China; 4.Endoscopy Center, Plastic Surgery Hospital Chinese Academy of Medical Sciences, Beijing 100144, China
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| Abstract: |
| ［Abstract］ Objective To explore the clinical application value of “four taxonomies classification method” of pulmonary ground-glass opacity(GGO) lesions based on thin-section computed tomography(TSCT) scanning of the chest. Methods The clinical data of 1 541 patients who underwent thoracoscopic surgery in Xuanwu Hospital Capital Medical University from January 2020 to December 2022 were retrospectively analyzed, including 2 005 pulmonary GGO lesions. The pulmonary GGO lesions were classified by using “four taxonomies classification method”: type Ⅰ, pure GGO(p-GGO) without vacuolar sign and(or) bronchiole sign; type Ⅱ, p-GGO with vacuolar sign and(or) bronchiole sign; type Ⅲ, heterogeneous GGO(h-GGO) of solid components visible only in the lung window; type Ⅳ, part-solid GGO(ps-GGO) of solid components visible in both the lung window and the mediastinal window. The relationship between the imaging characteristics of pulmonary GGO lesions［maximum diameter, type of lesions, occurrence site, classification and consolidation-to-tumor ratio(CTR)］ and the results of postoperative pathological examination was analyzed. Results In the 1 541 patients, the time from the discovery of pulmonary GGO to receiving surgical treatment was 0.10-156.00 months, with an average of 11.23 months. During this period, there were no significant changes in 1 255 pulmonary GGO lesions(62.59%), and the maximum diameter increased in 536 pulmonary GGO lesions(26.73%), and the density increased in 45 pulmonary GGO lesions(2.24%), and the maximum diameter increased with increases in density in 169 pulmonary GGO lesions(8.43%). The maximum diameter of preoperative pulmonary GGO was (13.21±7.90)mm. The characteristics of the lesions were mainly single lesion, with a total of 1 098 lesions(54.76%), and the lesions were mostly distributed in the upper lobe of the right lung(757 lesions, 37.76%). Types of pulmonary GGO: 248 GGOs of type Ⅰ(12.37%), 682 GGOs of type Ⅱ(34.01%), 862 GGOs of type Ⅲ(42.99%) and 213 GGOs of type Ⅳ(10.62%), 950 GGOs with CTR≤25%(47.38%), 616 GGOs with 25%75%(6.23%). Among the pulmonary GGO lesions, there were 186 benign lesions(9.28%) and 1 819 malignant lesions(90.72%), including 744 glandular prodromal lesions and 1 075 infiltrative lesions. The analysis results showed that the results of postoperative pathological examination of the pulmonary GGO lesions were correlated with the maximum diameter of GGO, type of lesions, occurrence site, classification, CTR and the changes in GGO lesions during follow-up(P<0.05). The results of correspondence analysis showed that compared with the CTR of pulmonary GGO lesions, the scattered spots of pulmonary GGO lesions were more similar to the scattered spots of postoperative pathological malignant changes［atypical adenomatous hyperplasia(AAH), adenocarcinoma in situ(AIS), microinvasive adenocarcinoma(MIA) and invasive adenocarcinoma(IA)］ in the two-dimensional distribution map, suggesting that the imaging characteristics of pulmonary GGO lesions based on the “four taxonomies classification method” had good corresponding relations with postoperative pathological malignant changes. Conclusion The “four taxonomies classification method” based on TSCT is helpful for clinicians to better evaluate the risk degree of early-stage lung cancer with GGO as the main imaging manifestation. |
| Key words: Pulmonary ground-glass opacity(GGO) lesions Thin-section computed tomography(TSCT) scanning of the chest Four taxonomies classification method Postoperative pathology Lung cancer |
