| Objective: To explore the clinical application value of CT-based vascular and bronchial typing and combined quantitative analysis in the prediction and differential diagnosis of different infiltration degrees of pGGN-like lung adenocarcinoma,in order to further improve the preoperative prediction accuracy and differential diagnosis level of pGGN-like lung adenocarcinoma with different infiltration degrees.Methods:The clinical and CT data of 147 pGGN patients(180 pGGN lesions)in our hospital were retrospectively analyzed.All pGGN lesions were confirmed by surgical pathology.The cases were divided into 3groups according to the infiltrated degree of pGGN lesions: preinvasive lesion group(n=79);microinvasive adenocarcinoma group(n=51);invasive adenocarcinoma group(n=50).The maximum diameter of the lesion was 3.0cm.Main collection and analysis indicators include: the general clinical data,lesion location,size,and pGGN relationship with blood vessels were divided into the following 3 types and quantificated according to the related literature:?,vessels passing by pGGN,gived one point;?,intact vessels passing through pGGN,gived two point;?,the lesion vessels were wider,distorted or tortuous compare to other vessels at the same image,gived three point.The relationship between bronchus and pGGN were divided into the following 3 types and quantificated :?,bronchus passing by pGGN,gived one point;?,intact bronchus passing through pGGN,gived two point;?,the lesion bronchus were wider,distorted or tortuous compare to other bronchus at the same image,gived three point.The relationship of bronchial and blood vessels with pGGN were divided into 5 types and quantificated: ?,"non-duct sign",blood vessels and bronchus are no relationship with pGGN or moves from it,gived two points;?,"normal single duct sign",either intact blood vessels or intact bronchus passing through pGGN,gived three points;?,"abnormal single duct sign",either the lesion vessels or bronchus were wider,distorted or tortuous compare to other vessels or bronchus at the same image,gived four points;?,"normal double duct sign",not only intact blood vessels but also bronchus passing through pGGN,gived four points;?,"abnormal double duct sign",not only blood vessels but also bronchus passing through pGGN,if only blood vessels or bronchus were wider,distorted or tortuous compare to other vessels or bronchus at the same image,gived five points,if blood vessels and bronchus were wider,distorted or tortuous compare to other vessels or bronchus at the same image,gived six points.SPSS 20.0 was used for statistical analysis,and p<0.05 was considered statistically significant.The age and lesion size of pGGN in the three groups were determined by t test with multiple independent samples,and the differences of vascular and bronchial typing and combined typing were compared by chi-square test.Spearman test was adopted to analyze the correlation between pGGN vascular and bronchial typing and combined typing of the three groups with different pathological subtypes.ROC curve was used to analyze the diagnostic efficacy of vascular and bronchial typing quantitative indicators and combined quantitative indicators for the infiltration degree of different types of lung adenocarcinoma.Results: 1.In this study,there was no statistical significance in pGGN among the three groups in terms of gender,single or multiple lesions,and location of occurrence,with P values of 0.364,0.114,and 0.871,respectively,and the difference was statistically significant in terms of age.The age of the invasive adenocarcinoma group was larger than that of the microinvasive adenocarcinoma group(P<0.05).The mean values of pGGN size in the three groups were respectively the preinvasive lesion group(0.87cm±0.29cm),the microinvasive adenocarcinoma group(1.03cm±0.53cm)and the invasive adenocarcinoma group(1.33cm±0.54cm),with statistically significant differences(P<0.001).There were statistically significant differences between the preinvasive lesion group and the invasive adenocarcinoma group,and between the microinvasive adenocarcinoma group and the invasive adenocarcinoma group(all P values were less than 0.05).As the lesion diameter increased,the degree of infiltration increased.There was no significant difference between the preinvasive lesion group and the microinvasive adenocarcinoma group(P=0.166).2.Blood vessels and bronchial classification comparison:(1)blood vessels classification: pGGN lesion adjacent vessels classification difference between three groups with statistical significance(P<0.001),preinvasive lesion group was given priority to with ?,? type(100%);With the increase of infiltrated degree,invasive adenocarcinoma group was given priority to with ?,? type(100%).(2)bronchial classification: pGGN lesion adjacent bronchial classification difference between three groups had statistical significance(P<0.001),preinvasive lesion group and microinvasive adenocarcinoma group are ? type(94.9%,60.8%);And invasive adenocarcinoma group was given priority to with ?,? type(up 78.0%).(3)combined classification: pGGN between the three groups of blood vessels and bronchi type joint points difference have statistical significance(P<0.001),the preinvasive lesion group was ?,? type(98.7%);As the infiltrated degree of malignancy increased,the ? above proportion increase gradually,including microinvasive adenocarcinoma group(53.0%),invasive adenocarcinoma group(94.0%).3.The quantitative analysis of pGGN bronchus,blood vessels,bronchus and blood vessels in the three groups showed statistically significant differences(P<0.001).The higher the classification of bronchus and blood vessels and the combined evaluation score of the two groups,the higher the degree of infiltration.4.Spearman correlation test results showed that combined typing was more correlated with different pathological types of pGGN than bronchial typing and vascular typing.The results of ROC curve analysis showed that the diagnostic efficiency of pGGN with different degrees of infiltration by the combination of bronchi and vessels was higher than that of bronchi or vessels alone.Conclusion:1.The size of pGGN lesion is conducive to the differential diagnosis of different infiltration degrees.The larger the lesion is,the higher infiltration degree was.However,reasonable classification of vascular and bronchial types with pGGN lesions is also helpful to determine the degree of infiltration.2.The CT vascular and bronchial typing of pGGN and the quantitative index of pGGN's combined typing are helpful for the differential diagnosis of pGGN's infiltration degree,among which the diagnostic efficacy of the combined bronchial and vascular typing for pGGN's infiltration degree is higher than that of the bronchial or vascular type alone. |
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