MSCT Signs And Pathological Basis Analysis Of Lung Cancer Associated With Cystic Airspaces

Objective:To investigate the correlation between MSCT signs and pathological types of lung cancer associated with cystic airspaces and to improve the detection rate,diagnosis rate and pathological basis of lung cancer associated with cystic airspaces.Materials and Methods:Collecting 50 cases of lung cancer associated with cystic airspaces from January 2011 to July 2017 in our hospital,the pathology was adenocarcinoma.According to the pathological types of adenocarcinoma,we divided them into three groups: AIS(adenocarcinoma in situ)group,MIA(minimally invasive adenocarcinoma)group and IAC(invasive adenocarcinoma)group.Imaging according to whether there were solid components of the lesion would be divided into without solid component group and with solid component group.Retrospective analysis of lung cancer with cystic airspaces clinical data,pathological features and MSCT signs,measurement of indicators using ANOVA,Kruskal Wallis H test was used when the samples did not fit the normal distribution.Spearman rank correlation analysis and Pearson correlation analysis were used to analyze the correlation between MSCT signs and pathological types.The receiver operating characteristic(ROC)analyses were conducted for the risk index.The data were analyzed by χ2 test or Fisher exact test.The follow-up cases were used to evaluate the dynamic changes of CT.Results:1.Pathological features: 50 cases of lung cancer associated with cystic airspaces pathology were adenocarcinoma.13 cases of adenocarcinoma in situ,15 cases of minimally invasive adenocarcinoma,22 cases of invasive adenocarcinoma.Twenty-two pathological sections of the cysts were observed in the cysts.Twenty-two cysts were coated with tumor cells under light microscope.Three of them were alveolar expansion and fusion without interstitial infiltration.2 cases had no organization in the cystic airspaces,2 cases were honeycomb,4 cases of cystic airspaces separated into fibers,vascular tissue,7 cases of bronchial lumen narrowing,2 cases of bronchiectasis,1 case of bullae,1 case of nourishing the blood vessels.2.MSCT signs: 50 cases of lung cancer associated with cystic airspaces,imaging were peripheral lung cancer.(1)The proportion of MSCT signs was greater than 50%:42 cases(84%)with round/oval shape,32 cases(64%)with honeycomb sign and 29 cases(58%)with ground glass sign,30 cases(60%)with lobulation sign,44 cases(88%)with well defined and unsmooth interface,the cystic cavity in 36 cases(72%)is located in the center,29 cases(58%)with multiple cysts,41 cases(82%)with thin-walled cystic,25 cases(50%)with vascular convergence sign and 29 cases(58%)with morphological type.(2)ⅣIn 50 cases of lung cancer associated with cystic airspaces there were 23 cases without solid component group and 27 cases with solid component group.The ratio of lobulation,speculation,septum inside airspace,mural nodule,vascular convergence and bronchial truncation in solid component group were higher than in lesions without solid component group,there were statistical difference(P<0.05).The ratio of ground glass sigh and blood vessel passing in lesions without component group were higher than in solid component group,there were statistical difference(P<0.05).There was no statistical difference between the two groups in lesion morphology,honeycomb sign,tumor-lung interface,location of cysts,number of cysts,wall thickness,pleural indentation,bronchus passing through the airspace and morphological classification(P> 0.05).3.Correlation between MSCT signs and pathological types:(1)Correlation between pathological types of three groups and CT classification of two groups: there was statistical difference in the two groups of without solid component and with solid component between adenocarcinoma in situ group and invasive adenocarcinoma group(P <0.05).In adenocarcinoma in situ group without solid ingredients mostly,while in invasive adenocarcinoma group contain the most solid component.(2)The correlation between MSCT signs and pathological types of the three groups: there were statistical differences between pathological types of three groups in ground glass opacity,lobulation,spiculation,the number of cysts,septum inside airspace,mural nodules and blood vessel passing(P<0.05).Among them,in adenocarcinoma in situ group,there were 12 cases(92.31%)of ground-glass sign,9 cases(69.23%)of monocyst and 6 cases(46.15%)of blood vessel passing through the cyst.In invasive adenocarcinoma group,there were 20 cases(90.91%)with lobulation sign,13 cases(59.09%)with speculation sign,18 cases(81.82%)with multiple cysts,14 cases(63.64%)of septum inside airspace,14 cases(63.64%)of mural nodules,all the proportion were higher.There was no statistical difference in age,the size of cystic airspace,the size of lesion and different pathological types.The size of solid component was positively correlated with different pathological types.There was no statistical difference between the groups of adenocarcinoma in situ and minimally invasive adenocarcinoma(P = 0.169).There was statistical difference(P = 0.000,P = 0.001)between adenocarcinoma in situ group,minimally invasive adenocarcinoma group and invasive adenocarcinoma group.The ROC was plotted with an area under the curve of 0.867 and a 95% confidence interval of 0.757 ~ 0.977,P = 0.000,the critical value of the lesion size was 0.75,the sensitivity was 100% and the specificity was 75%.4.Follow-up characteristics: 8 cases of lung cancer associated with cystic airspaces follow-up MSCT signs have changed.Follow up,among them 1 case of ground glass nodules increased and the cystic cavity was changed,and saw septum inside airspace,1 case of the cystic cavity enlarged,the air space wall thickened irregularly and the solid component increased,6 cases of cystic cavity narrowed and the solid component increased.Conclusions:1.The pathological basis of lung cancer with cystic airspaces may have:(1)Secondary formation of lung cancer arising from the wall of the emphysema and pulmonary bulla;(2)Lung cancer arising from the thin-walled of a preexisting cystic airspace;(3)The mechanism of secondary thin-walled cystic cavity in lung cancer may be a one-way valve blocking effect caused by tumor invasion of airway narrowing.2.Lung cancer associated with cystic airspaces MSCT signs are special,in addition to have some special signs,such as thin-walled cystic cavity,honeycomb sign,unsmooth inner wall,septum inside airspace and ground glass opacity sign,but also the typical signs of lung cancer.Combined with the dynamic follow-up comprehensive analysis can be helpful for the diagnosis.3.The focus of the without solid component of the lung cancer associated with cystic airspaces is to observe the uniformity of the wall of the cyst,septum inside airspace,honeycomb sign,blood vessel passing in lesions and around the ground glass sign.With solid component of the lung cancer with cystic airspaces is relatively easy to diagnosis,with many typical signs of lung cancer,but also appears special signs such as honeycomb sign and septum inside airspace.4.Dynamic follow-up diagnosis of the disease have a very important value,follow-up of the cystic cavity can increase or decrease.It is very significative for the diagnosis of this disease and early surgical treatment when the follow-up of the air space wall thickened irregularly,mural nodules or solid mass formation,septum inside airspace or common signs of lung cancer.5.The MSCT signs of lung cancer associated with cystic airspaces have correlation with different pathological types,the ground glass sign,lobulation sign,spiculation,septum inside airspace,mural nodules and blood vessel passing in lesions are helpful to predict the invasive extent of the lesion.The size of the solid component was positively correlated with the degree of invasion.The age,the size of the cyst and the size of the lesion were no statistical difference in different pathological types.