广西医学

目的探讨肺部磨玻璃结节（GGN）的高分辨CT（HRCT）征象及其评估肿瘤恶性侵袭程度的价值。方法回顾性分析110例GGN患者的临床资料，患者均行HRCT检查，根据病理学检查结果将患者分为良性组（n=36）和恶性组（n=74），再根据恶性侵袭程度将恶性组分为原位腺癌（AIS）组（n=24）、微浸润性腺癌（MIA）组（n=30）及浸润性腺癌（IAC）组（n=20）。以病理学检查结果为金标准，分析HRCT鉴别GGN良恶性的效能；比较不同恶性侵袭程度GGN患者的HRCT征象，分析实性成分及病灶大小对GGN患者肿瘤恶性侵袭程度的评估价值。结果 HRCT鉴别GGN良恶性的准确度、特异度、敏感度、阴性预测值、阳性预测值分别为95.45%（105/110）、97.22%（35/36）、94.59%（70/74）、89.74%（35/39）、98.59%（70/71），其与病理学检查结果的Kappa值为0.899。不同恶性侵袭程度GGN患者的病灶形态、分叶征、毛刺征、血管集束征、胸膜凹陷征、空泡征、空气支气管征比较，差异有统计学意义（P<0.05），其中，IAC组的病灶形态不规则、分叶征、毛刺征、血管集束征、胸膜凹陷征、空泡征、空气支气管征占比高于MIA组及AIS组（P<0.05），IAC组、MIA组及AIS组的实性成分、病灶大小依次降低（P<0.05）。受试者工作特征曲线结果提示，实性成分和病灶大小联合评估GGN患者肿瘤恶性侵袭程度的曲线下面积为0.937，高于两者单独评估的曲线下面积（P<0.05）。结论 HRCT鉴别诊断良恶性GGN的效能较好，结合HRCT的实性成分与病灶大小结果有助于评估GGN的恶性侵袭程度。

Objective To explore the high⁃resolution CT (HRCT) signs of pulmonary ground⁃glass nodule (GGN) and their values for evaluating malignant invasion degree of tumor. Methods The clinical data of 110 GGN patients were retrospectively analyzed, and all of the patients underwent HRCT examination. According to pathological results, patients were divided into benign group (n=36) or malignant group (n=74), and then according to malignant invasion degree, the malignant group was further assigned to adenocarcinoma in situ (AIS) group (n=24), microinvasive adenocarcinoma (MIA) group (n=30), or invasive adenocarcinoma (IAC) group (n=20). Taking the results of pathological examination as the golden standard, the efficiency of HRCT for distinguishing benign or malignant GGN was analyzed; moreover, HRCT signs were compared between GGN patients with different malignant invasion degree, and evaluation values of solid component and lesion size on malignant invasion degree of GGN patients were analyzed. Results The accuracy, specificity, sensitivity, negative predictive value, and positive predictive value of HRCT for distinguishing benign or malignant GGN were 95.45% (105/110), 97.22% (35/36), 94.59% (70/74), 89.74% (35/39), and 98.59% (70/71), respectively, and Kappa value of it with the pathological results was 0.899. There were statistically significant differences in lesion morphology, lobulation sign, spicule sign, vessel convergence sign, pleural indentation sign, vocule sign, and air bronchogram sign between GGN patients with different malignant invasion degrees (P<0.05), therein the IAC group exhibited higher proportions of irregular lesion morphology, lobulation sign, spicule sign, vessel convergence sign, pleural indentation sign, vocule sign, and air bronchogram sign as compared with the MIA and AIS groups (P<0.05), and the solid components, lesion sizes were decreased successively in the IAC, MIA, and AIS groups (P<0.05). The results of receiver operating characteristic curve indicated that area under the curve of solid component and lesion size for jointly evaluating malignant invasion degree of tumor in GGN patients was 0.937, which was higher than that of the two as above for single evaluation (P<0.05). Conclusion HRCT in the differential diagnosis of benign or malignant GGN exerts favorable efficiency. Combing HRCT solid component and lesion size is helpful to evaluate malignant invasion degree of GGN.