[HRCT features differentiate synchronous multiple primary lung adenocarcinomas from intrapulmonary metastases].

• L N Zhou
• N Wu
• S J Zhao
• L Yang
• Y L Wang
• R B Wang
• S X Yang

抄録

To investigate the high resolution CT (HRCT) features of lung adenocarcinoma for differentiating synchronous multiple lung adenocarcinoma from lung adenocarcinoma with intrapulmonary metastasis. The clinical and imaging features of 131 lesions from 62 patients of synchronous multiple primary lung adenocarcinoma (primary group) and 67 lesions from 31 patients of lung adenocarcinoma with intrapulmonary metastases (metastasis group) were retrospectively analyzed. According to the types of lesion, including pure ground glass nodule (pGGN), mixed ground glass nodule (mGGN) and solid nodule (SN), the image feature matching types of patients were divided into 7 types. The differences of image feature matching types between the primary group and the metastasis group were compared. Multiple lesions in the lung of patients were classified into the main lesion and the concomitant lesions according to their size. The differences including the size of the main lesion and the concomitant lesion (long diameter of nodule, long diameter of solid component in nodule), whether it contains ground glass components in nodule, shape, lobulation, margin, spiculation, bubble-like lucency, pleural retraction and pleural attachment were recorded and analyzed. The differences of image features of main lesion and the concomitant lesion in the primary group and the metastasis group were compared. The image feature matching types of pGGN + mGGN and mGGN + mGGN were more common in the primary group, and the ground glass component contained pGGN or mGGN was accounted for 62.9%(39/62). At least one lesion containing the ground glass component was accounted for 96.8% (60/62). There were two types in metastatic groups, mGGN+ SN and SN+ SN accounting for 6.5% (2/31) and 93.5% (29/31), respectively. There were significant differences in image feature matching types between the primary group and metastatic group (<0.01). Univariate analysis of the main lesions between the two groups showed that the gender, smoking history, long diameter of the main lesion, long diameter of the solid component, the ground glass component and pleural attachment were statistically different (<0.05). Further analysis by multivariate logistic regression showed that the male (=5.742, =0.010), SN (=41.291, <0.01) and pleural attachment (=9.288, =0.001) were the three significant risk factors associated with the main lesions in metastasis group.The most common concomitant lesions in primary group were pGGN, containing the ground glass component. However, all of the concomitant lesions in the metastatic group were SN (<0.01), showing round lesions with well-defined margin, attaching the pleura (<0.05). The HRCT features of lung adenocarcinoma can differentiate synchronous multiple lung adenocarcinoma from lung adenocarcinoma with intrapulmonary metastasis. At least one lesion contains ground glass components (pGGN or mGGN) in synchronous multiple primary lung adenocarcinoma, while SN is more common in lung adenocarcinoma with lung metastasis. Lung cancer with intrapulmonary metastasis can be considered when the main lesion is SN with pleural attachment and the intrapulmonary accompanying lesion is also solid nodules without lobular, speculation and bubble-like lucency.

探讨高分辨率CT(HRCT)特征对于同时多原发肺腺癌与肺腺癌伴肺内转移的鉴别诊断价值。 回顾性分析经手术病理证实的62例(131个病灶)同时多原发肺腺癌和31例(67个病灶)肺腺癌伴肺内转移患者的临床和影像学特征。按照病灶类型，纯磨玻璃结节(pGGN)、混合磨玻璃结节(mGGN)和实性结节(SN)，将患者分为7种影像配对类型，比较同时多原发肺癌(原发组)与肺癌伴肺内转移(转移组)的影像配对类型差异。将肺内多发病灶按照大小分为主病灶和伴随病灶。分析主病灶和伴随病灶的大小(总体长径，实性成分长径)、磨玻璃成分、形态、分叶、边界、毛刺、空泡征、胸膜牵拉及胸膜贴邻，比较原发组和转移组主病灶与伴随病灶间的影像学特征差异。 原发组影像学类型以pGGN＋mGGN和mGGN＋mGGN多见，病灶中均含磨玻璃成分(pGGN或mGGN)者占62.9%(39/62)，至少有1个病灶内含磨玻璃成分者占96.8%(60/62)；转移组仅有2种类型，其中大部分为SN＋SN(93.5%，29/31)，少数为mGGN＋SN(6.5%，2/31)。两组间影像配对类型的差异有统计学意义(<0.01)。单因素分析显示，原发组和转移组性别、吸烟史、主病灶长径、实性成分长径、磨玻璃成分及贴邻胸膜的差异均有统计学意义(均<0.05)。多因素分析显示，男性、无磨玻璃成分(实性病灶)及病灶贴邻胸膜是主病灶伴发肺内转移的危险因素(均<0.05)。原发组伴随病灶以pGGN多见，而转移组伴随病灶均为SN(<0.01)。转移组的伴随病灶多表现为圆形或类圆形，边界清楚，贴邻胸膜(<0.05)。 HRCT的影像学特征可以很好地鉴别同时多原发肺腺癌和肺腺癌伴肺内转移。同时多原发肺腺癌以含磨玻璃成分的病灶(pGGN或mGGN)多见，而肺腺癌伴肺转移以SN占绝大多数。当主病灶为SN并贴邻胸膜时，肺内伴随病灶亦是SN，且无分叶、毛刺和空泡征，可提示肺癌伴肺内转移的诊断。.