Correlation Study Between Pathological Subtypes And High-Resolution CT Signs Of Invasive Lung Adenocarcinoma

Background and Objective:With the widespread development of lung cancer screening,the detection rate of small lung nodules has increased,and surgery is still the first choice for early lung cancer.At present,the main surgical methods are lobectomy and sublobectomy.For the adherent type with relatively good prognosis,sublobectomy shows the same therapeutic effect and can retain more lung function;but the solid type and micro The prognosis of the papillary type is poor and requires lobectomy+systemic lymph node dissection.How to use a simple and effective method to predict the pathological subtype of lung nodules before surgery has become a clinical problem that needs to be solved urgently.There have been studies using CT signs to identify pre-invasive lung nodule lesions,micro-invasive adenocarcinoma,and invasive adenocarcinoma,but for the adherent,acinar,papillary,solid,and micropapillary types,and other different pathological subtypes of CT Few studies on the identification of signs.This study aims to explore the diagnostic value of CT signs for pathological subtypes of lung adenocarcinoma,and to provide certain clinical value for preoperative planning of early lung cancer.Methods:We retrospectively analyzed the clinical data and CT images of 349 patients with invasive lung adenocarcinoma who were admitted to the Yunnan Cancer Hospital from January 2018 to December 2019.Record the patient’s age,gender,and location,interpret the patient’s CT images and analyze the nodule burr sign,lobular sign,air bronchus sign,pleural depression sign,vacuole sign,and vascular cluster sign,and measure the maximum diameter and solidity of the nodule The maximum diameter of the component calculates the actual component ratio.According to the 2015 version of the WHO lung tumor classification criteria,pathological diagnosis is made.According to the prognostic differences of different pathological subtypes,tumors are divided into low-risk,intermediate-risk and high-risk groups for subgroup analysis:adherent-based type without micropapillary subtypes and solids Tumors with subtype components are in the low-risk group.Tumors with papillary or acinar-based components without micropapillary subtypes and solid subtypes are classified as intermediate-risk groups.Tumors with micropapillary-based and solid-based components are classified as medium-risk groups.For the high-risk group.In this study,patients were divided into two categories for analysis.One was to analyze all patients;the other was to select patients ≤2cm for subgroup analysis.Chi-square test was used to analyze categorical data,one-way analysis of variance was used to analyze continuous variables,and multiple logistic regression was used to analyze variables that were statistically different in one-way analysis.P<0.05 was statistically significant.Results:Overall analysis results1.In the general data of patients,gender(P=0.008)has a statistically significant difference between the three groups;the patient’s age of onset(P=0.520)and lesion location(P=0.058)are in the three groups The difference between them is not statistically significant;2.In the imaging data of patients,the low-risk,intermediate-risk and high-risk groups are compared,size,burr sign,lobular sign,air bronchus sign,pleural depression sign,solid component ratio There are statistical differences(P<0.05);vacuole sign(P=0.154),vascular clustering sign(P=0.579)are not statistically different;3.Taking the above-mentioned statistically different independent variables,the intermediate-risk group and the high-risk group as the dependent variables,and the low-risk group as the reference group,multivariate logistic regression analysis shows that the intermediate-risk group(the glitch sign positive OR 2.067 95%CI 1.038～4.113,P=0.039;lobular sign positive OR 2.312 95%CI 1.124～4.755,P=0.023;solid component ratio>50%OR 3.668 95%CI 1.736～7.749,P=0.001),high-risk group(2-3cm,OR 2.200 95%CI 1.021～4.743,P=0.044;glitch sign positive OR 5.071 95%CI 1.197～21.490,P=0.028;leaf sign positive OR 10.028 95%CI 3.054～32.923,P<0.001;The proportion of solid components>50%OR 9.661 95%CI 2.189～42.638,P=0.003)the correlation with the dependent variable is statistically significant,and the correlation between the remaining independent variable and the dependent variable is not statistically significant(P>0.05).Results of subgroup analysis of<2cm1.In the general data of patients<2cm,the difference in gender(P=0.004)between the three groups is statistically significant;the age of onset of patients(P=0.622),the location of the lesion(P=0.067)The difference between the three groups was not statistically significant;2.In the imaging data of patients<2cm,the low-risk,intermediate-risk and high-risk groups were compared,and the burr sign,lobular sign,pleural depression sign,and actual There is a statistical difference in the proportion of sexual components(P<0.05);there is no statistical difference in the vacuole sign(P=0.119),the air bronchial sign(P=0.14),and the vascular cluster sign(P=0.392);3.As the independent variables of statistical difference,the intermediate-risk group and the high-risk group were used as the dependent variables,and the low-risk group was used as the reference group.Multivariate logistic regression analysis showed that the intermediate-risk group(solid component ratio>50%,OR 2.582 95%CI 1.201～5.552,P=0.015);high-risk group(female,OR4.134 95%CI 1.343～12.724,P=0.013;glitch sign positive,OR 10.383 95%CI 1.116～92.436,P=0.036;leaf leaf sign positive,OR 12.241 95%CI 2.885～51.938,P=0.001;the proportion of solid components>50%,OR 5.839 95%CI 1.021～33.394,P=0.047)The association with the dependent variable is statistically significant.The association was not statistically significant(P>0.05).Conclusion:1.Gender,size,burr sign,lobular sign,air bronchus sign,pleural depression sign,and solid component ratio are relative to the low-risk group(adherent type),intermediate-risk group(acinar type/papillary type),and high-risk group(The differential diagnosis of solid type/micropapillary type)has certain value.2.When the size of the nodule>2cm,the burr sign is positive,the lobular sign is positive,and the proportion of solid components>50%,it indicates that the nodule belongs to the high-risk group pathological type.For this type of patient,lobectomy+systematic lymph node dissection It is a more reasonable surgical method.3.In patients with a nodule size ≤2cm,when the patient is female,the burr sign is positive,the lobular sign is positive,and the proportion of solid components is more than 50%,it is likely that the nodule belongs to the high-risk group.Patients should carefully choose sublobectomy.