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中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (02) : 290 -292. doi: 10.3877/cma.j.issn.1674-6902.2023.02.039

综述

肺磨玻璃结节自然衍变规律与CT鉴别诊断研究现状及进展
熊廷伟1, 褚志刚1, 吕发金1,()   
  1. 1. 400016 重庆,重庆医科大学附属第一医院放射科
  • 收稿日期:2022-10-17 出版日期:2023-04-25
  • 通信作者: 吕发金
  • 基金资助:
    重庆市技术创新与应用发展专项重点项目(CSTC2021jscx-sbN0030); 重庆市科卫联合医学科研重点项目(2022ZDXM006)

Current status and progress in the study of natural evolution patterns and CT differential diagnosis of pulmonary ground glass nodules

Tingwei Xiong1, Zhigang Chu1, Fajin Lyu1()   

  • Received:2022-10-17 Published:2023-04-25
  • Corresponding author: Fajin Lyu
引用本文:

熊廷伟, 褚志刚, 吕发金. 肺磨玻璃结节自然衍变规律与CT鉴别诊断研究现状及进展[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 290-292.

Tingwei Xiong, Zhigang Chu, Fajin Lyu. Current status and progress in the study of natural evolution patterns and CT differential diagnosis of pulmonary ground glass nodules[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(02): 290-292.

肺磨玻璃结节(ground-glass nodule, GGN)定义为存在于肺内的局灶性密度增高影但不足以掩盖潜在的支气管及血管束的一类病变,按照GGN是否伴有实质成分,可分为纯磨玻璃结节(pure ground-glass nodule, pGGN)和部分实性结节(part-solid nodule, PSN)[1,2,3]。近年来,随着胸部低剂量CT(low-dose computed tomography, LDCT)的应用以及肺癌筛查普及率上升,GGN的检出率不断升高[4,5]。GGN性质多样,可以是非肿瘤性病变,也可是肿瘤性病变;病理上GGN表现为局灶纤维化、肺泡出血、炎症、肿瘤细胞贴壁式生长,而其内的实性成分常为肿瘤细胞浸润生长、肿瘤细胞堆积、间质纤维化、细胞塌陷所致。根据2021版WHO肺肿瘤分类[6],非典型腺瘤样增生(atypical adenomatous hyperplasia, AAH)和原位腺癌(adenocarcinoma in situ, AIS)归类为前驱腺体病变,微浸润腺癌(minimally invasive adenocarcinoma, MIA)和浸润性腺癌(invasive adenocarcinoma, IAC)归类为腺癌。AAH由非典型的Ⅱ型肺泡细胞或肺泡壁和呼吸细支气管细胞的增生形成;AIS一般没有间质或血管浸润,而当浸润范围<5 mm时称为MIA、当浸润范围>5 mm则为IAC[5,7]。GGN的生长衍变过程遵循由AAH、AIS、MIA到IAC的自然进展规律,GGN的生长衍变是一个动态过程,不会一直处于某个病理阶段,通过连续随访观察GGN的衍变模式了解GGN发展趋势较单一研究某一病理阶段的形态学改变的临床价值更大。本文对GGN的衍变模式进行综述,为肺GGN的个体化管理以及临床诊疗策略的制定提供参考依据。

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