孤立性肺实性结节和混杂磨玻璃结节对比研究
Comparative study of solid and subsolid solitary pulmonary nodules
目的 探讨孤立性实性和混杂磨玻璃结节的病理特征，找出它们之间的影像学特征差异。 方法 回顾性分析804例孤立性肺结节（SPNs）患者手术切除治疗后的病理特征。根据胸部高分辨CT扫描结果是否存在磨玻璃样病变，将SPN分为实性和混杂磨玻璃结节。比较和评估实性和混杂磨玻璃结节组之间的病理特征。获得人口统计学（性别和年龄）和临床数据（吸烟，癌症史，糖尿病史，慢性阻塞性肺气肿或肺纤维化病史，肺结节的最大直径和位置），分析实性和混杂磨玻璃结节之间的差异。 结果 804例SPN患者中，48.9%（393例）为良性SPNs，51.1%（ 411例）为恶性；67.7%（544例）为实性结节，32.3%（260例）为混杂磨玻璃结节。在实性结节组中，61.2%（333例）被诊断为良性，38.8%（ 211例）为恶性。在混杂磨玻璃结节组中，23.1%（60例）为良性，76.9%（200例）为恶性。实性结节中良性病变的比例显著高于混杂磨玻璃结节中的比例（P<0.001）。此外，实性和混杂磨玻璃结节之间腺癌的亚型有显著差异（P<0.001）。混杂磨玻璃结节组中女性患者，慢性阻塞性肺气肿或肺纤维化病史患者，非吸烟者和上叶位置的比例远高于实性结节组。 结论 CT表现为实性和混杂磨玻璃结节恶性病变中，腺癌是最常见组织学类型，在腺癌亚型的构成上两者之间存在明显的差异。与男性和吸烟者相比，女性和非吸烟者（被动吸烟者）更倾向于发展为与肺腺癌相关的混杂磨玻璃结节，在大多数情况下，混杂磨玻璃结节位于肺的上叶。
Objective To explore pathological features of solid and subsolid nodules and identify the radiological characteristic differences between them. Methods A total of 804 patients with solitary pulmonary nodules (SPNs) were studied retrospectively following surgical resection treatment with a definite postoperative pathology. The SPNs were classified as either solid or subsolid nodules depending on the presence of ground-glass lesion based on thoracic CT scan results. Pathological causes of SPNs were also evaluated and compared between solid and subsolid nodule groups. Demographic (gender and age) and clinical data (smoking and cancer history, the maximum diameter and location of lung nodule) were retrieved to determine difference between solid and subsolid nodules. Results Of the 804 SPN patients, 393 (48.9%) cases were identified as benign SPNs and 411 (51.1%) as malignant, while 544 (67.7%) cases were solid nodules and 260 (32.3%) subsolid nodules. In solid nodules group, 333 (61.2%) cases were diagnosed as benign and 211 (38.8%) cases as malignant. In the subsolid nodules group, 60 (23.1%) cases were benign and 200 (76.9%) cases malignant. The proportion of benign lesions in solid nodules was significantly higher than those in subsolid nodules (P<0.001). In addition, there were significant differences in the subtypes of adenocarcinoma between solid and subsolid nodules (P<0.001). The ratios of female patients, nonsmokers and upper lobe locations were much higher in subsolid nodules than solid nodules. Conclusion Lung adenocarcinoma related subsolid nodules but not the solid nodules are more inclined to be developed in female and non-smokers (passive smoker) than male and smokers. In most cases, the nodules are found to be presented in upper lobe of the human lungs.
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甘肃省自然科学基金项目（1506RJZA258）
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