张韡 汪鑫睿

摘要：目的：探讨周围型肺腺癌高分辨率CT表现与最新病理分型的相关性及其鉴别诊断的价值。方法：选取2018年3月-2020年3月期间在我院接受手术治疗或者是接受经皮穿刺活检被确诊的周围型肺腺癌患者78例，共检出病灶82个，其中低分化组病灶27个，中高分化组病灶55个。结果：低分化组以及中高分化组的周围型肺腺癌其病灶形态以及密度之间存在显著差异（P<0.05）;周围型肺腺癌疾病中分叶征、毛刺征以及胸膜凹陷征等CT征象发生的几率同腺癌不同组织分化程度之间存在显著差异（P<0.05），且空泡征、支气管气相以及血管集束征等CT征象的发生几率同组织分化程度之间不存在显著差异 （P>0.05）;不同分化程度的病灶在各肺叶处的发生位置之间不存在显著差异（P<0.05），且低分化组瘤体>3cm肿块明显多于中高分化组（P<0.05）。结论：周围型肺腺癌疾病患者的CT表现同病理分型之间具有一定程度的关联性，且肿瘤直径超过3cm并同时存在分叶征以及毛刺征等多种CT表现时，其疾病恶化程度相对更加严重。

关键词：周围型肺腺癌;高分辨率CT表现;最新病理分型;相关性;鉴别诊断

Abstract： Objective： To investigate the correlation between high-resolution CT findings and the latest pathological classification of peripheral lung adenocarcinoma and its value in differential diagnosis. Methods： 78 patients with peripheral lung adenocarcinoma diagnosed by surgery or percutaneous biopsy in our hospital from March 2018 to March 2020 were selected. A total of 82 lesions were detected， including 27 lesions in the poorly differentiated group and 55 lesions in the moderately well differentiated group. Results： There were significant differences in the morphology and density of peripheral lung adenocarcinoma between the low-differentiation group and the middle-differentiation group （P<0.05）. Points in peripheral lung adenocarcinoma disease Ye Zheng， burr）， and pleural indentation sign were adenocarcinoma with CT signs in such significant differences between different tissue differentiation degree （P<0.05）， and cavitation character， bronchial gas phase and vascular cluster character between CT signs of the risk and tissue differentiation degree there is no significant difference （P>0.05）; There was no significant difference in the location of lesions with different degrees of differentiation in each pulmonary lobe （P<0.05）， and the tumor >3cm mass in the poorly differentiated group was significantly more than that in the moderately well differentiated group （P<0.05）. Conclusion： The CT findings of patients with peripheral lung adenocarcinoma are correlated with the pathological types to a certain extent， and the aggravation degree of the disease is relatively more serious when the tumor diameter is more than 3cm and there are multiple CT manifestations such as lobules and burr.

Key Words： Peripheral Lung Adenocarcinoma; High Resolution CT Appearance; Latest Pathological Classification; Correlation; Differential Diagnosis;

肺癌属于临床上发生率较高的恶性肿瘤疾病类型，且此类疾病患病率以及致死率相对较高。肺腺癌疾病的相关影像学特征具有明显的多样性，且周围型要明显比中央型多，当前临床上已经将毛刺征、胸膜凹陷、血管集束征以及深分叶征等多种征象作为对周围型肺腺癌疾病进行科学诊断的一项关键手段[1]。相关研究表明，周围型肺腺癌具有比較复杂的形态，且征象表现相对丰富，在特异性诊断并不明显时需要共同联系相关临床资料以及CT征象等进行全面的总结分析。而高分辨率CT 的应用可以有效防止病灶以及征象漏扫，从而促进检查准确率得到进一步提升。本研究探讨周围型肺腺癌高分辨率CT表现与最新病理分型的相关性及其鉴别诊断的价值，报道如下。

1 资料与方法

1.1 一般资料

选取2018年3月-2020年3月在我院接受手术治疗或者是接受经皮穿刺活检被确诊的周围型肺腺癌患者78例，其中多发病灶9例，单发病灶69例。……