胸膜下纯磨玻璃结节的位置及相关分型在诊断浸 润性腺癌的临床价值

科研成果详情

题名	胸膜下纯磨玻璃结节的位置及相关分型在诊断浸润性腺癌的临床价值
其他题名	Clinical value of location and related classification of pureground glass nodules under pleura in diagnosis of invasiveadenocarcinoma
作者	陈中港
学位类型	硕士
导师	杨运俊
答辩日期	2021-11-19
学位授予单位	温州医科大学
学位专业	影像医学与核医学
关键词	肺肿物腺癌体层摄影术，X 线计算机
摘要	背景和目的近年来随着肺部低剂量 CT 筛查普遍展开、CT 成像技术的进展、人工智能检测肺结节软件的应用，纯磨玻璃结节（Subpleural ground glass nodules，pGGN）的检出率逐年增加。胸膜下 pGGN 属于手术的优势部位，对于早期肿瘤通常采用楔形切除或局部切除就能达到根治目的，如果病理等级比较高，外科医生需要根据实际情况扩大手术范围，甚至行肺叶切除。已有研究证实 CT 形态学特征与周围肺腺癌的病理分类相关。因此胸膜下 pGGN 的影像学评估能一定程度上为结节随访计划的制定或手术方式的选择提供重要参考价值。本研究探讨胸膜下纯磨玻璃结节与胸膜的位置关系，并且通过分析影像学特点提高对胸膜下 pGGN 为肺腺癌的浸润性鉴别能力。方法回顾性分析温州医科大学附属第一医院 2014 年 1 月至 2018 年 6 月经手术切除病理证实为肺腺癌或其浸润前病变外周胸膜下 2 厘米之内的 pGGN 共 195 个（192 例患者）。根据病理结果将其分为浸润前病变或微浸润腺癌组（PIL、MIA 组）、浸润性腺癌组（IAC 组）。搜集患者临床资料及影像学资料，由两名 CT 胸组高年资主治医师分别对图像进行分析评估，意见不同时通过协商取得一致。主要评估内容包括：结节长径与短径、结节平均密度、边缘是否清晰、形态是否规则、有无空泡征、分叶征、支气管充气征、毛刺征及血管集束征，并根据结节与胸膜位置关系分为三型：I 型：与胸膜无关系；Ⅱ型：结节与胸膜相贴；Ⅲ型：结节与胸膜线状牵拉。计量资料采用独立样本 t-检验或秩和检验；计数资料采用卡方检验进行统计分析。单因素分析中 P＜0.01 的变量将被纳入多因素 Logistic 回归模型分析 IAC 的独立预测因子。探讨预测 IAC 的危险因素，分析胸膜凹陷在各型位置关系中产生的原因及诊断意义。P＜0.05 为差异有统计学意义。结果共包括 PIL、MIA 组 163 个、IAC 组 32 个。单因素分析显示结节长径、结节短径、毛刺征、结节与胸膜的位置关系在两组患者之间具有显著统计学差异（P 温州医科大学硕士学位论文＜0.05）；多因素 Logistic 回归模型，结果显示结节与胸膜关系Ⅲ型在两组间存在统计学意义（OR=3.952，95%CI=0.794~5.674），为胸膜下 IAC 的独立预测因子；年龄（OR=1.038;95%CI：1.000~1.076，P=0.048）、病灶的平均密度（OR =1.004;95%CI：1.001~1.007，P=0.018）、病灶边缘与胸膜距离（OR=0.684;95% CI：0.562~0.833，P＜0.001）和肿瘤的胸膜牵连发生有关。结论结节与胸膜关系Ⅲ型是胸膜下 pGGN 浸润程度的独立风险因子，结节与胸膜关系分型有助于结节浸润程度的判断，可以指导随访计划和选择性手术治疗。关键词肺肿物；腺癌；体层摄影术，X 线计算机
其他摘要	Abstract Background and Objective Subpleural ground glass nodules (pGGN) have been increasingly detected in recent years with the widespread development of low-dose CT screening, the development of CT imaging technology and the application of artificial intelligence software for detecting pulmonary nodules. Subpleural pGGN is the preferred location for surgery, because wedge resection or local resection can generally achieve radical treatment for early-stage tumors. If the pathological grade is relatively high, surgeons need to expand the surgical scope according to the actual situation, or even perform lobectomy. It has been confirmed that CT morphological signs are associated with the pathological classification of peripheral lung adenocarcinoma. Therefore, imaging evaluation of subpleural pGGN can, to a certain extent, is valuable for making follow-up plans for nodules or selecting optimal surgical methods. In this study, we aimed to investigate the relationship between subpleural pGGN and pleura location, and improve the distinguish ability of invasiveness of subpleural pGGN from lung adenocarcinoma by analyzing the imaging characteristics. Methods We retrospectively reviewed 192 patients with 195 pGGN less than 2 cm which were pathologically confirmed to be lung adenocarcinoma or its preinvasive lesion in the First Affiliated Hospital of Wenzhou Medical University from January 2014 to June 2018. All pGGN were divided into preinvasive lesion (PIL), microinvasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) groups according to pathological results. Clinical and image data of the patients were collected. The images were analyzed and evaluated by two senior attending physicians, and consensus was reached when opinions were different. We evaluated the following morphological characteristics of pGGN: long diameter and short diameter of nodules, 6温州医科大学硕士学位论文 average density of nodules, clear edge, regular shape, vacuolar sign, lobulation sign, bronchial inflation sign, burr sign and vascular cluster sign. The position relationship between nodules and pleura were divided into three types: no relationship with pleura (type 1); nodules attached to pleura (type 2); and linear traction of nodules with pleura (type 3). Continuous variables were evaluated using independent sample T-test or rank sum test. Categorical data were analyzed by Chi-square test. Variables with P < 0.01 in univariate analysis were incorporated into the multivariate logistic regression model for obtaining independent predictors of IAC. P < 0.05 was considered statistically significant. Results A total of 163 pGGN were found in PIL, MIA group and 32 in IAC group. Univariate analysis showed that there were significant differences in the long diameter of nodules, short diameter of nodules, burr sign and the position relationship between nodules and pleura between 2 groups (P < 0.05). Multivariate Logistic regression model demonstrated that nodule pleural relationship type III was statistically significant between the two groups (odds ratio = 3.952, 95% confidence interval = [0.794, 5.674], which was an independent predictor of subpleural IAC. Age (OR = 1.038; 95% CI: 1.000-1.076, P=0.048) and mean density of lesions (OR=1.004; 95% CI: 1.001-1.007, P=0.018) and the distance between the lesion edge and pleura (OR=0.684; 95% CI: 0.562~0.833, P < 0.001) were associated with pleural involvement of tumors. Conclusion Type III of the position relationship between nodules and pleura is an independent risk factor for the degree of subpleural pGGN invasion. The classification of the relationship between nodules and pleura is helpful for the judgment of the degree of nodular invasion and can guide follow-up planning and select surgical treatment. Keywords lung tumor; adenocarcinoma; tomography，X-ray compute
学号	169001048
发布年限	2021-12-17
毕业论文分类号	R4
原始专题	温州医科大学第一临床学院
学位论文研究方向	胸膜下纯磨玻璃结节
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全文文件名	169001048陈中港2021影像医学与核医学.pdf
文献类型	学位论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/175636
专题	温州医科大学
作者单位	溫州医科大学温州医科大学第一临床学院
第一作者单位	温州医科大学
推荐引用方式 GB/T 7714	陈中港. 胸膜下纯磨玻璃结节的位置及相关分型在诊断浸润性腺癌的临床价值[D]. 温州医科大学,2021.