The Study Of The Relationship Between MSCT Features Of Lung Adenocarainomas And Its Pathological Basis And The Enlarged Intrathoracic Lymph Nodes

Objective:The aim of this study was to explore the relationship between MSCT features of lung adenocarcinoma and enlarged intrathoracic lymph nodes. we also wanted to find the basis mechanism of pathology of MSCT signs and enlarged intrathoracic lymph nodes,supplying reference values for clinical staging of lung adenocarcinoma and the selection of surgery program.Methods:56 patients with lung adenocarcinoma who had underwent MSCT scanning and CT-guided biopsy were enrolled into this retrospective study.Recorded MSCT features of lung adenocarcinoma(including tumor location,tumor sizes,enhancement degrees,spiking sign,spiculation lobulation,vacuole sign,blood vessel convergency sign,pleural indentation sign) and enlarged intrathoracic lymph nodes and its packets,The datas were put into computer and analyzed by SPSS13.0 statistical software.Results:1.The relationship between pulmonary primary tumor locations and enlarged intrathoracic lymph nodes:Lung adenocarcinoma occurs most frequently on the upper and lower lobe. The tumors locate on the upper lobe mostly correspond to the superior mediastinal enlarged lymph nodes,only the group of 7 enlarged lymph nodes are seen on the inferior mediastinum;The tumors locate on the inferior lobe mostly correspond to the inferior mediastinum enlarged lymph nodes,the enlarged lymph nodes in the superior mediastinal only are found in the group of 4,5,6;The tumors locate on the right middle correspond to the group of 4,7; hilar tumors correspond to the group of 4,5,7 of enlarged lymph nodes.The regression analysis between tumor location and enlarged intrathoracic lymph nodes have no relevance(P＞0.05). 2.The relationship between pulmonary primary sizes and enlarged thoracic lymph nodes:With 3cm as a standard,the tumor sizes are divided into two groups,the group of≤3cm and＞3cm,respectively.The group of≤3cm has 18 cases,the enlarged intrathoracic lymph nodes accounts for 33.3%(6 / 16);The group of≥3 cm has 38 cases,the enlarged intrathoracic lymph nodes accounts for 89.5%(34/38);the sizes of tumors which are impossible to estimate have two cases,both of them have enlarged intrathoracic lymph nodes.To compare the the different occurrences rate of two groups with the enlarged intrathoracic lymph nodes,the difference is statistically significant,P＜0.05,indicates the group of≥3 cm has higher incidence of enlargd lymph nodes than the≤3cm group.The regression analysis between primary tumor sizes and enlarged intrathoracic lymph nodes is statistically significant(P＜0.05),regression coefficient of 2.021,is positively correlated,suggesting that the bigger the mass,the probability occurrence of enlarged intrathoracic lymph nodes increases.3.The relationship between pathological types of lung adenocarcinoma and enlarged thoracic lymph nodes:The analysis between pathological types of lung adenocarcinoma and the enhancement degrees of enlarged intrathoracic lymph nodes is no statistical significance,P＞0.05,suggesting pathological types of lung adenocarcinoma have not the effect on the enhancement degrees of enlarged intrathoracic lymph nodes.The regression analysis between pathological types of lung adenocarcinoma and enlarged intrathoracic lymph nodes is statistically significant,P＜0.05,regression coefficient of -2.213,is nagative correlation,suggesting the lower malignant degrees of the pathological types of lung adenocarcinoma,the probability occurrence of enlarged intrathoracic lymph nodes decreases.4.The relationship between pulmonary primary morphological characteristics and enlarged thoracic lymph nodes:Spinous process sign and spiking sign accounts for 30.7%(34/56),and enlarged intrathoracic lymph nodes accounts for 79.4%(27/34),to compare whether tumors have these signs or not with the effect to intrathoracic enlargd lymph nodes have no statistical significance,P＞0.05.The regression analysis between spinous process sign and spiking sign and enlarged intrathoracic lymph nodes is statistically significant(P＜0.05),regression coefficient of 1.202,is positive correlation,suggesting tumor has spinous process sign and spiking sign,the probability occurrence of enlarged intrathoracic lymph nodes increases;Spiculation lobulation who accounted for 64.3%(36/56),and have enlarged intrathoracic lymph nodes accounts for 86.1%(31/36),to compare whether tumors have this sign or not with the effect to intrathoracic enlargd lymph nodes have no statistical significance,P＞0.05.The regression analysis between spiculation lobulation and enlarged intrathoracic lymph nodes have no significance(P＞0.05);Three cases of vacuole sign which are all in less than 3cm lesions are not associated with enlarged intrathoracic lymph nodes, to compare whether tumors have this sign or not and tumor locations with the effect to intrathoracic enlargd lymph nodes have no statistical significance, P＞0.05.The regression analysis between vacuole sign and enlarged intrathoracic lymph nodes has no significance(P＞0.05).Vascular convergence sign accounts for 30.7%(34/56),have enlarged intrathoracic lymph nodes accounted for 79.4%(27/34),and the symptoms is more common in lesions larger than 2cm,to compare whether tumors have this sign or not with the effect to intrathoracic enlargd lymph nodes have no statistical significance,P＞0.05;To compare whether tumors have this sign or not and tumor locations with the effect on enlargd intrathoracic lymph nodes have no statistical significance,P＞0.05.The regression analysis between vascular convergence sign,pleural indentation and enlarged intrathoracic lymph nodes have no significance(P＞0.05);Pleural indentation sign accounts for 69.4%(39/56), has enlarged intrathoracic lymph nodes accounts for 82.0%(32/39),to compare whether tumors have this sign or not with the effect to intrathoracic enlargd lymph nodes have no statistical significance,P＞0.05;The regression analysis between pteural indentation sign and enlarged intrathoracic lymph nodes have no significance(P＞0.05).5.The relationship between degrees of enhancemence of primary tumor and enlarged thoracic lymph nodes:The group of mild enhancement accounts for 8.9%(5/56),and enlarged intrathoracic lymph nodes accounts for 20.0%(1/5);The group of moderate enhancemence accounts for 39.2%(22/56),and enlarged intrathoracic lymph nodes accounts for 59.1%(13/22);The group of higher enhancemence accounts for 51.7%(29/56),and enlarged intrathoracic lymph nodes accounts for 96.5% (28/29),the group of mild enhancement and the group of moderate enhancemence are compared with the higher enhancemence,respectively,they have statistical differences,P＜0.05,the group of mild enhancemence and the group of moderate enhancemence has no significant difference.Conclusion:1.Lung adenocarcinoma occurs most frequently on the upper and lower lobe,intrathoracic lymph node metastasizing followed the raws by the near to distant metastasis and jump metastasis;2.Enlarged intrathoracic lymph nodes has relevance with MSCT findings of tumor sizes,enhanced degrees,spinous process and spiking sign and pathological types of lung adenocarcinoma.