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| 良、恶性肺磨玻璃结节CT特征及其鉴别诊断意义 |
| 赵家义1,韩一平1*,杨立信2,金海2,陈炜3,生晶3,左长京4,郑建明5 |
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(1. 第二军医大学长海医院呼吸与危重症医学科, 上海 200433;
2. 第二军医大学长海医院胸外科, 上海 200433;
3. 第二军医大学长海医院医学影像科, 上海 200433;
4. 第二军医大学长海医院核医学科, 上海 200433;
5. 第二军医大学长海医院病理科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 通过研究病理学确诊的肺磨玻璃结节（GGN）患者的临床特点、CT征象，探讨良、恶性肺GGN鉴别诊断的相关因素。方法 回顾性分析2013年10月至2016年10月第二军医大学长海医院经病理确诊的181例肺GGN患者的临床资料和影像学资料，用SPSS 19.0软件对良、恶性肺GGN的影响因素进行单因素分析、多因素logistic回归分析。良、恶性肺GGN病理诊断结果与胸部CT检查诊断结果符合率的分析采用Kappa一致性检验。结果 181例患者中恶性肺GGN 106例，良性肺GGN 75例。单因素分析结果显示，年龄、吸烟指数、GGN最大径、毛刺征、分叶征、胸膜凹陷征、空泡征、支气管充气征和CT值9项因素在良、恶性肺GGN比较中差异有统计学意义（P均<0.05）。多因素回归分析结果显示，年龄偏大、毛刺征、分叶征、胸膜凹陷征、支气管充气征、空泡征和CT值增高是恶性肺GGN的危险因素（P均<0.05）。Kappa一致性检验结果显示，相比良性肺GGN（CT检查诊断结果符合率为65.3%），胸部CT检查能更准确地识别恶性肺GGN（诊断符合率为80.3%），差异有统计学意义（χ2=5.698，Kappa=-0.122，P=0.017）。良性肺GGN中，炎性病变较结核病更容易被误诊（χ2=22.626，Kappa=0.593，P<0.01）。结论 对于年龄偏大的患者且胸部CT检查有分叶征、毛刺征、胸膜凹陷征、支气管充气征、空泡征和CT值增高等表现时，应高度怀疑恶性肺GGN的可能；而判别良性肺GGN需进一步结合患者一般情况、临床特征和影像学检查表现等综合判断。 |
| 关键词: 肺 磨玻璃结节 计算机体层摄影 危险因素 鉴别诊断 |
| DOI：10.16781/j.0258-879x.2018.02.0129 |
| 投稿时间：2017-06-13修订日期：2017-12-18 |
| 基金项目: |
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| CT signs and diagnostic significance in patients with benign or malignant pulmonary ground-glass nodules |
| ZHAO Jia-yi1,HAN Yi-ping1*,YANG Li-xin2,JIN Hai2,CHEN Wei3,SHENG Jing3,ZUO Chang-jing4,ZHENG Jian-ming5 |
(1. Department of Respiratory and Critical Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Thoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
3. Department of Medical Imaging, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
4. Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
5. Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the factors related to the identification of benign or malignant pulmonary ground-glass nodule (GGN) through studying the clinical features of patients with lung GGN diagnosed by pathology. Methods The clinical data and imaging data from 181 patients, who were pathologically confirmed to have lung GGN in Changhai Hospital of Second Military Medical University from Oct. 2013 to Oct. 2016, were retrospectively analyzed. Statistical software SPSS 19.0 was used to conduct univariate analysis and multivariate logistic regression analysis of influencing factors of benign or malignant lung GGN. The coincidence of chest CT diagnosing benign or malignant lung GGN and the pathology diagnosis was analyzed with Kappa consistency test. Results Of the 181 patients, 106 had malignant lung GGN and 75 had benign lung GGN. Univariate analysis showed that age, smoking index, maximum diameter of GGN, spiculation, lobulation, pleural indentation, vacuole sign, air bronchogram sign and CT value were the influencing factors for the differential diagnosis of benign and malignant lung GGN (all P<0.05). Multivariate regression analysis showed that aged, spiculation, lobulation, pleural indentation, air bronchogram sign, vacuole sign and increased CT value were independent risk factors of malignant lung GGN (all P<0.05). Compared with benign lung GGN, chest CT had a higher accuracy in diagnosing the malignant lung GGN (80.3% vs 65.3%, χ2=5.698, Kappa=-0.122, P=0.017). For the benign GGN, inflammatory lesions were more likely to be misdiagnosed versus tuberculosis (χ2=22.626, Kappa=0.593, P<0.001). Conclusion For older patients with chest CT signs including lobulation, spiculation, pleural indentation, air bronchogram sign, vacuole sign and increased CT value, malignant lung GGN should be highly suspected. When diagnosing benign lung GGN, the doctors should comprehensively analyze patient general situation, clinical features and imaging findings of the patients. |
| Key words: lung ground-glass nodule computed tomography risk factor differential diagnosis |
