周围型浸润性肺腺癌MSCT表现与其病理亚型的相关性研究

发布时间：2018-02-28 15:45

本文关键词： 肺肿瘤腺癌体层摄影术 X线计算机病理　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:按照2015版WHO肺肿瘤组织学分类标准,探讨浸润性周围型肺腺癌的MSCT征象与五种主要病理亚型的相关性,对临床治疗提供一定的参考。方法:收集青岛大学附属医院2015年10至2016年10月间手术切除且病理证实的352例周围型浸润肺腺癌患者的临床及病理资料。依据最新的WHO(2015)肺肿瘤组织学分类标准,将浸润性肺腺癌病理亚型分为五组:实性组、微乳头组、乳头组、腺泡组、附壁组。按肺腺癌预后差异,将浸润性肺腺癌主要组织学亚型进行分级,1级为附壁型,2级为乳头和腺泡型,3级为实性和微乳头型。使用秩和检验和卡方检验对微乳头型,实性型,乳头型,腺泡型,附壁型5种病理亚型在年龄、性别、病变位置、病变大小(横轴位最大径)、毛刺征、分叶征、空泡征、病变密度、空气支气管征、空洞、囊腔样改变、胸膜凹陷征、血管集束征、病灶强化程度等是否存在差异进行统计分析。部分资料采用Spearman秩相关法、Kruskal-Wallis检验、Bonferroni检验、Fisher确切概率法对相关资料进行统计学分析。结果:352例患者,其中男150例(42.6%),女202例(57.4%),年龄范围40-81岁,平均年龄60.6±8.7岁。其中附壁型组53例(15%),腺泡型组196例(56%),乳头型组41例(12%),实性型30例组(8%),微乳头型组32例(9%)。病变大小、分叶征和空气支气管征在5组周围型浸润性肺腺癌病理亚型中差异可见统计学意义(P0.05);附壁型在病变大小方面与其它四型病例亚型存在统计学差异(P0.01),附壁型病变较小,病灶大小显著小于其它四型;分叶征在附壁型与其它四型病理亚型之间可见统计学差异(P0.05),附壁型肺腺癌其分叶征出现机率小于其它四型腺癌;腺泡型与其它四种病理亚型在空气支气管征方面可见统计学差异(P0.05),腺泡型肺腺癌其空气支气管征出现机率大于其它四型腺癌,其它四型之间在空气支气管征方面差异未见显著统计学差异。病灶中的实性成分比例在浸润性腺癌1级组,2级组及3级组中差异具有统计学意义(P0.01);动态增强扫描,浸润性腺癌的1级组、2级组及3级组平扫与增强后CT值比较差异具有统计学意义(P0.05);性别、病变部位、毛刺征、空洞、胸膜凹陷征、血管集束征、病变的囊腔样改变在微乳头型组、实性型组、乳头型组、附壁型组及腺泡型组等5组周围型浸润性肺腺癌病理亚型之间未见显著统计学差异(P0.05)。结论:周围型浸润性肺腺癌不同病理亚型的MSCT表现有一定差异,附壁型腺癌组的病变大小小于其余四种浸润性肺腺癌病理亚型,MSCT图像中其分叶征的出现率低于其它病理亚型;腺泡型肺腺癌组的空气支气管征出现率高于其余4种浸润性肺腺癌病理亚型;病变中的实性成分比例越高,浸润性肺腺癌的组织学级别越高。
[Abstract]:Objective: to investigate the correlation between the MSCT signs of invasive peripheral lung adenocarcinoma and five major pathological subtypes according to the 2015 WHO criteria for lung tumor histological classification. Methods: to collect the clinical and pathological data of 352 patients with peripheral invasive lung adenocarcinoma surgically resected from 2015 to October 2016 in Qingdao University affiliated Hospital. Lung neoplasms histological classification criteria, The pathological subtypes of invasive lung adenocarcinoma were divided into five groups: solid group, micronipple group, papilla group, acinar group, wall attached group. The main histological subtypes of invasive lung adenocarcinoma were classified as mural type, grade 2, papilla and acinar type, grade 3, solid and micropapillary type. Rank sum test and chi-square test were used to study micropapillary type, solid type, papillary type, acinar type, and acinar type. The age, sex, location, size of lesion (axial maximum diameter, burr sign, lobulation sign, vacuole sign, lesion density, air bronchus sign, cavity, cystic cavity change, pleural depression sign, etc. Statistical analysis was carried out on whether there were differences in vascular cluster sign, enhancement degree of lesion and so on. Some of the data were statistically analyzed by Spearman rank correlation method and Kruskal-Wallis test and Fisher exact probability test. There were 150 males and 202 females with a mean age range of 60.6 卤8.7 years, ranging from 40 to 81 years old, including 53 cases in the wall-attached type group, 196 cases in the acinar type group, 41 cases in the papillary type group and 82 cases in the solid type group, 32 cases in the micropapillary type group and 32 cases in the micropapillary type group. The difference of lobulation sign and air bronchus sign in the pathological subtypes of peripheral invasive lung adenocarcinoma was statistically significant (P 0.05), and there was a statistical difference between the wall type and the other four types in the size of the lesion (P 0.01), but the lesion of the wall type was small. The lesion size was significantly smaller than that of the other four types, and the lobulation sign was significantly different from the other four types of pathological subtypes (P 0.05), and the incidence of lobulation sign in the parietal lung adenocarcinoma was lower than that in the other four types of adenocarcinoma. There was significant difference in air bronchus sign between acinar type and other four pathological subtypes (P 0.05). The incidence of air bronchi sign in acinar type lung adenocarcinoma was higher than that in other four types of adenocarcinoma. There was no significant difference in air bronchial sign between the other four types. The proportion of solid components in the lesion was significantly different in grade 1, grade 1, grade 2 and grade 3 of invasive adenocarcinomas (grade 1, grade 2 and grade 3, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01). The difference of CT value between grade 1, grade 2 and grade 3 of invasive adenocarcinoma was statistically significant (P 0.05), sex, lesion site, burr sign, cavity, pleural depression sign, vascular cluster sign, and so on. The cystic changes of the lesions were found in the micropapillary, solid, papillary, papillary type groups. There was no significant difference between the pathological subtypes of peripheral invasive lung adenocarcinoma and acinar type. Conclusion: the MSCT findings of different pathological subtypes of peripheral invasive lung adenocarcinoma are different to some extent. The lesion size of the adjoining type adenocarcinoma group was smaller than that of the other four invasive lung adenocarcinoma subtypes (MSCT), and the occurrence rate of lobulation sign was lower than that of other pathological subtypes. The incidence of air bronchus sign in acinar lung adenocarcinoma group was higher than that in the other four invasive lung adenocarcinoma subtypes, and the higher the proportion of solid components in the lesion was, the higher the histological grade of invasive lung adenocarcinoma was.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R730.44

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