| Part ?Comparison analysis of tiny glass nodularlung adenocarcinoma HRCT sign and pathologic new classificationObjective Comparative analysis of lung nodules HRCT manifestations of tiny grinding glass with lung adenocarcinoma pathology,the relationship between the new classification of to improve the GGN diagnosis level.Methods A retrospective analysis of 127 cases confirmed by pathology of lung small GGN HRCT data were collected from January 2015 to December 2016 on Suzhou hospital affiliated to nanjing medical university,according to the pathology of lung adenocarcinoma new classification standard,it was divided into 3 groups: group a total of 35 cases,pre-invasive group including atypical adenomatous hyperplasia(AAH)21 cases,carcinoma in situ(AIS)14 cases;minimally invasive adenocarcinoma(MIA)group 45 cases,invasive adenocarcinoma(IAC)group 47 cases.To evaluate Age,Gender,lesions location,GGN size,density,tumor-lung interface(clear,blur),pleural retraction,umbilical concave,air-bronchogram,Bubble lucency,Lobulation,Spiculation,Tumor microvascular CT sign.Measurement data using one-way classification(ANOVA),when the sample is not in conformity with the normal distribution with Kruskal-Willis H testing,when comparing two group parameters,using the Bonferroni method to correcting the inspection level.The counting data is checked by chi-square.Pvalue<0.05 indicates statistical difference.Results There was no statistically significant difference between age,gender and lesion location in the three groups.pre-invasive group lesion size was 5.82 ±2.33 mm,MIA group lesion size was 7.95±2.43 mm,IAC group lesion size was 12.93 ± 4.34 mm,GGN size comparison shows differences between groups were statistically significant(P = 0.032,0.000,0.000);The GGN density of the pre-infiltration group was-540±95HU,and the GGN density of the MIA group was-521 ±128HU,and the GGN density of the IAC group was-484 ± 93 HU,and the difference of GGN density in the three groups was not statistically significant(P=0.063).tumor-lung interface compared between pre-invasive groups with MIA group,IAC group showed differences were statistically significant(P = 0.013,0.005),but there was no statistically significant difference MIA group and IAC group(P = 0.716);Pleural retraction compared between groups showed pre-invasive group,MIA group with IAC group differences were statistically significant(P = 0.000,0.000),but the differences between the groups with pre-invasive group and MIA group has no statistical significance(P = 0.119);lobulation compared between 3 groups showed differences were statistically significant(P = 0.000,0.000,0.001);the speculation compared between 3 groups showed differences were statistically significant(P = 0.008,0.000,0.001).Tumor microvascular CT sign compared between groups show that MIA group,IAC group were higher than pre-invasive group,difference was statistically significant(P = 0.000,0.000),the comparison between MIA group and IAC group,there was no statistically significant difference(P = 0.139).Bubble lucency,air-bronchogram,umbilical concave there was no statistically significant difference between the 3 groups.Conclusion Lesion size,lobulation,spiculation,pleural retraction,tumor-lung interface,tumor microvascular CT sign for tiny grinding glass can be improved nodular lung adenocarcinoma pathology classification of new knowledge,and it canbe evaluated in the early stage of small grinding glass lung adenocarcinoma,and provide the basis for the selection of clinical diagnosis and treatment plan.Part ?Tiny ground glass nodules-like lung adenocarcinoma of HRCT vascular sign researchObjective To classify the vascular sign of tiny ground glass nodules-like lung adenocarcinoma in HRCT,and explore its value to differentiate benign from malignant of the ground glass nodules(GGN).Methods 87 patients with tiny ground glass nodules-like lung adenocarcinoma examined on HRCT were retrospectively evaluated.According to the new pathological classification standard of lung adenocarcinoma,they were divided into three groups:(1)pre-invasive group(n=25),including 14 cases of atypical adenomatous hyperplasia(AAH)and 11 cases of carcinoma in situ(AIS);(2)minimally invasive adenocarcinoma(MIA)group(n=35);(3)invasive adenocarcinoma(IAC)group(n=27).The lesions were divided into three types according to the grinding of glass composition proportion: Type A,pure ground glass nodules(p GGN);Type B,mixed ground glass nodules(m GGN)which contain glass composition?50%;Type C,m GGN which contain glass composition<50%.The vascular sign of GGN were divided into four types.Type 1: Without vessels passing through the GGN,or vessels passing by GGN;Type 2: Intact vessels passing through GGN,but vascular morphology is normal;Type 3,Single vessels passing through GGN,and distorted,stiff vessels seen within GGN;Type 4,Two or more vesselspassing through GGN,and branches between vessels formed in GGN,the diameter of vessel is irregular,partial enlargement.The relationship among the size of the GGN,content of the grinding of glass proportion and the vascular sign of GGN were analyzed both in axial images and reconstruction images.Measurement data using one-way classification(ANOVA),when the sample is not in conformity with the normal distribution with Kruskal-Willis H testing,when comparing two group parameters,using the Bonferroni method to correcting the inspection level.The counting data is checked by chi-square.p value<0.05 indicates statistical difference.Results The GGN sizes in the pre-invasive group,MIA group and IACgroup were 5.82 ± 2.33 mm,7.95 ± 2.43 mm,12.93± 4.34 mm.The comparison of GGN size between groups showed statistical significance(P=0.032,0.000,0.000).According to the grinding of glass composition proportion,there were 45 cases of class A(p GGN),among which 24 cases(96%,24/25)were infiltrated before,and 15 cases(42.85%,15/35)in the MIA group,and 6 cases in the IAC group(22.22%,6/27).There were 11 cases of class B(m GGN),1 case(4%,1/25),8 cases(22.85%,8/35)and 3 cases(11.11%,3/27)in each group.There were 31 cases of class C(m GGN),among which 0 case,12 cases(34.28%,12/35),and 18 cases(66.66%,18/27).There were significant differences between content of the grinding of glass proportion and classification of vascular sign of GGN(c2 = 33.323,P = 33.323).In the relationship between different pathological types of GGN and blood vessels,the dominant position of type 1 and type 2 in the pre-invasive group was 24(96%).The incidence of type 3 and type 4 in the MIA group was low,only 4%.In the MIA group and the IAC group,the incidence rate was 60% and 74% respectively,which was significantly different from the pre-invasive group(P=0.000,0.000).Further analysis indicated that type 3 was more commonly seen in MIA.The 2+3 accounted for 71% of the MIA group.type 4 more likely seen in IAC,and the 2+4 was 74% of the IAC group.Statistical analysis showed that there was no significant difference between MIA group and IAC group on type 2,but there was a significant difference between type 3 and type 4(P= 0.043).Conclusions pre-invasive lesions were mainly manifested as type 1 and type 2 vascular signs,while MIA was mainly manifested as type 3 vascular signs,while invasive cancer was mainly manifested as type 4 vascular signs.To study HRCT vascular sign of tiny ground glass nodules-like lung adenocarcinoma can improve the ability of the GGN benign and malignant diagnosis,provide reliable basis for clinical diagnosis and treatment. |
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