Value of CT Features on Differential Diagnosis of Pulmonary Subsolid Nodules and Degree of invasion Prediction in Pulmonary Adenocarcinoma

: 【中文题目：亚实性肺结节CT征象在良恶性鉴别
及腺癌恶性侵袭程度评估中的价值】 【中文摘要：背景与目的 亚实性肺结节为肺原发腺癌的常见计算机体层成像（computed tomography, CT）表现，依据其CT影像特征预测病理分型对确定临床治疗策略具有临床价值。本研究根据病理分类，回顾性分析良性、不典型腺瘤样增生（atypical adenomatous hyperplasia, AAH）/原位腺癌（adenocarcinoma in situ, AIS）/微侵袭性腺癌（minimally invasive adenocarcinoma, MIA）、侵袭性腺癌三组亚实性肺结节的CT征象，评估其在良恶性鉴别及恶性侵袭程度判别中的价值。方法 回顾性分析106例经手术切除亚实性结节的CT征象。依据手术病理分为良性和恶性组，恶性组根据侵袭程度分为无/微侵袭组（AAH/AIS/MIA）、侵袭性腺癌组，测量结节大小、实性成分比例、瘤肺界面、形状、边缘、胸膜牵拉征、空气支气管征、结节内血管异常等CT征象。根据单因素分析（χ2检验、非参数检验Mann-Whitney U检验）结果筛选有统计学差异的变量，纳入Logistic回归多因素分析。结果 Logistic回归分析显示清晰的瘤肺界面、空气支气管征以及结节内血管异常是恶性结节的重要预测指标，风险比分别为38.1（95%CI: 5.0-287.7; P<0.01）、7.9（95%CI: 1.3-49.3; P=0.03）、7.2（95%CI: 1.4-37.0; P=0.02）。更大的实性成分所占比例是侵袭性腺癌与AAH/AIS/MIA组鉴别的重要指标，其风险比分别为1.04（95%CI: 1.01-1.06, P=0.01）。结论 亚实性结节中出现清晰的瘤肺界面、空气支气管征、结节内血管异常提示其恶性概率增加。恶性结节中实性成分所占比例越大预示着侵袭性更高。】 【中文关键词：肺肿瘤；亚实性结节；计算机体层成像；定量变量；定性变量；良性；恶性】. METHODS: The CT findings of 106 cases of resected sub-solid nodules were retrospectively analyzed. The nodules were firstly divided into benign and malignant groups and the malignant group was further divided into non/micro-invasive group (atypical adenomatous hyperplasia/adenocarcinoma in situ/minimally invasive adenocarcinoma) and invasive adenocarcinoma group. The nodule size, proportion of solid components, tumor-lung interface, shape, margin, pleural traction, air bronchus sign, vascular abnormalities inside the nodule were evaluated. The univariate analysis (χ2 test, non-parametric test Mann-Whitney U test) was performed to screen statistically significant variables and then enrolled in further multivariate Logistic regression analysis. RESULTS: Multivariate logistic regression analysis showed that a clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormalities were important indicators of malignant nodules with hazard ratios of 38.1 (95%CI: 5.0-287.7; P<0.01), 7.9 (95%CI: 1.3-49.3; P=0.03), 7.2 (95%CI: 1.4-37.0; P=0.02), respectively. The proportion of solid components was the only significant indicator for identifying invasive adenocarcinoma from AAH/AIS/MIA , with a risk ratio of 1.04 (95%CI: 1.01-1.06, P=0.01). CONCLUSIONS: SSNs with clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormality inside nodule are more likely to be malignant. A higher percentage of solid components indicates a higher likelihood to be an invasive lesion in malignant SPNs.