[Study on solitary pulmonary nodules: correlation between diameter and clinical manifestation and pathological features]

Evaluation of dynamic image progression of minimally invasive and preinvasive lung adenocarcinomas

Background

The target of our study was to investigate if the size (greater than and less than 1 cm) of ground-glass opacities (GGOs) of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) of the lung influences the rate of their evolution.

Methods

We retrospectively analyzed patients with AIS and MIA who underwent surgery at Shanghai Chest Hospital, Shanghai Jiao Tong University between January 2018 and July 2019, focusing on histopathology, surgical procedure, epidermal growth factor receptor (EGFR) mutations, and computed tomography (CT) images.

Results

A total of 224 AIS (n=117) and MIA (n=107) tumors were analyzed. The patients with a tumor diameter <1 cm were distinctly younger than those with tumors >1 cm in size (P<0.001). Pure ground-glass opacities (pGGO) occurred significantly more in patients with nodules <1 cm, while part-solid/mixed ground-glass opacities (mGGO) predominated in patients with nodules >1 cm (P=0.047). There was no significant difference in GGO evolution for GGOs of different sizes. Mutations of EGFR were more common in patients with MIA than in those with AIS (P<0.001).

Conclusions

We found that GGO size and variation (pGGO or mGGO) did not correlate to tumor stability, therefore larger GGOs can undergo standard follow-up protocols to evaluate their evolution over time.

Differential diagnostic value of 64-slice spiral computed tomography in solitary pulmonary nodule

The present study aimed to evaluate the diagnostic value of 64-slice spiral multivariate computed tomography (CT) combined with dynamic contrast-enhanced scanning for benign and malignant solitary pulmonary nodules (SPNs). A total of 93 patients with SPN as diagnosed by CT were included. All these patients were subjected to routine and dynamic enhancement CT scanning. After reconstruction, the morphological characteristics following dynamic enhancement were analyzed, and compared for the benign and malignant SPN cases. The incidences of lobulation, spicular sign, pleural indentation and vacuole sign in the malignant SPN group were significantly higher compared with the benign SPN group. During the dynamic enhancement scanning, the CT values at all the time points for the inflammatory and malignant SPN groups were significantly higher than the benign SPN group. No significant differences were observed in the dynamic enhancement CT values at 30, 60, 90 and 120 sec between the inflammatory, and malignant SPN groups. However, in the inflammatory SPN group, the dynamic enhancement CT values at 300 and 540 sec were significantly lower than the malignant SPN group. Notably, the diagnostic accordance rate for the morphological signs combined with dynamic enhancement diagnosis was significantly higher than the morphological signs alone. The 64-slice spiral CT morphological signs combined with dynamic enhancement detection can be more effective for the differential diagnosis of benign and malignant SPN, which may provide potent evidence for the early clinical treatment.

[Applications of video-assisted thoracic surgery for the diagnosis and treatment of patients with small pulmonary nodules]

背景与目的

随着胸部CT的应用推广，孤立性肺结节的出现逐渐增多，尤其是胸部薄层高分辨CT的检查，检出直径10 mm以下的微小结节的概率增高，临床上对于如何诊治这类微小结节仍存在较大争议。本研究旨在探讨胸腔镜手术在肺部微小结节的诊断和治疗中的价值。

方法

2009年11月-2012年5月，对64例肺微结节应用电视胸腔镜手术先行肺结节楔形切除，术前均无明确病理诊断，术中送快速冰冻病理检查，根据病理结果 < 综合考虑后决定手术方式。

结果

原发性肺癌行全胸腔镜肺叶切除+淋巴结清扫20例; 行肺楔形切除44例，其中良性肿瘤21例、癌前病变18例、转移癌3例、不适合肺叶切除的原发性肺癌2例。所有患者均明确病理诊断，确诊率100%。全组患者手术顺利，无严重手术并发症和围手术期死亡。

结论

肺部微小结节影像学诊断有一定难度; 胸腔镜手术诊治肺部微小结节创伤小、诊断准确，具有重要的诊断意义。术前CT引导的hook-wire定位可帮助手术中探查病变部位。