【摘要】：目的:探討周圍型浸潤(rùn)性肺腺癌CT征象及病理特征與表皮生長(zhǎng)因子受體(EGFR)基因突變狀態(tài)的相關(guān)性。材料與方法:收集193例經(jīng)病理證實(shí)為周圍型浸潤(rùn)性肺腺癌患者的手術(shù)標(biāo)本,采用擴(kuò)增阻滯突變系統(tǒng)(ARMS)對(duì)所有標(biāo)本行EGFR基因突變檢測(cè),結(jié)合患者胸部CT征象及病理資料行回顧性分析。結(jié)果:193例患者中EGFR基因突變率為62.2%(120/193)。在CT征象方面:EGFR基因突變患者與野生型患者于橫軸位上腫瘤最大直徑(Dmax)分別為(2.52±1.01)cm和(3.11±1.34)cm,兩者差異有統(tǒng)計(jì)學(xué)意義,P0.05。ROC曲線提示Dmax=2.01cm為判斷EGFR基因突變狀態(tài)的最佳診斷閾值,敏感度與特異度分別為79%和64%。含磨玻璃密度影(GGO)的腫瘤突變率為78.0%(39/50),高于無(wú)GGO者(81/143,56.6%),P0.05。腫瘤不伴有囊腔樣改變者突變率為65.5%(110/168),高于伴有囊腔樣改變者(10/25,40.0%),P0.05。磨玻璃影/腫瘤直徑比(G/T)、分葉征、毛刺征、胸膜凹陷征、血管集束征、空氣支氣管征、空泡征與EGFR基因突變率無(wú)顯著相關(guān)性(P值均0.05)。在病理特征方面:組織學(xué)類型中以貼壁生長(zhǎng)為主型浸潤(rùn)性腺癌突變率為77.5%(31/40),高于其它亞型(89/153,58.2%),P0.05。以實(shí)體生長(zhǎng)為主型突變率為26.3%(5/19),低于其它亞型(115/174,66.1%),P0.05。無(wú)淋巴結(jié)轉(zhuǎn)移者突變率為66.9%(91/136),高于淋巴結(jié)轉(zhuǎn)移者(29/57,50.9%),P0.05。結(jié)論:在周圍型浸潤(rùn)性肺腺癌中,部分CT征象及病理特征對(duì)于輔助預(yù)測(cè)EGFR基因突變狀態(tài)具有一定價(jià)值,腫瘤于橫軸位最大直徑小于2.01cm、病灶內(nèi)有GGO成分及不伴有囊腔樣改變者突變率高,組織學(xué)分類上以貼壁生長(zhǎng)為主型、無(wú)淋巴結(jié)轉(zhuǎn)移患者中突變率高。
[Abstract]:Objective: to investigate the correlation between CT signs and pathological features of peripheral invasive lung adenocarcinoma and the mutation status of epidermal growth factor receptor (EGF) receptor (EGFR) gene. Materials and methods: 193 surgical specimens of peripheral invasive lung adenocarcinoma proved by pathology were collected. EGFR gene mutation was detected by amplification block mutation system (ARMS). Combined with chest CT signs and pathological data of the patients were retrospectively analyzed. Results: the mutation rate of EGFR gene was 62.2% (120 / 193) in 193 patients. In terms of CT signs, the maximum diameter (Dmax) of EGFR gene mutation patients and wild-type patients were (2.52 鹵1.01) cm and (3.11 鹵1.34) cm, respectively. P0.05.ROC curve indicated that Dmax=2.01cm was the best diagnostic threshold for EGFR gene mutation status. The sensitivity and specificity were 79% and 64%, respectively. The mutation rate of (GGO) with glass opacity was 78.0% (39 / 50), which was higher than that without GGO (81 / 143 / 56.6%). The mutation rate was 65.5% (110 / 168) in tumors without cystoid changes, higher than that in 10 / 25% (40.0%) patients with cystic changes (P0.05%). There was no significant correlation between G / T, lobulation sign, burr sign, pleural depression sign, vascular cluster sign, air bronchus sign, vacuole sign and mutation rate of EGFR gene (P < 0. 05). In pathological features, the mutation rate of adherent growth type invasive adenocarcinoma was 77.5% (31 / 40), which was higher than that of other subtypes (89 / 153 58.2%, P 0.05). The mutation rate of solid growth dominant type was 26.3% (5 / 19), which was lower than that of other subtypes (115 / 174 / 66.1%), P 0.05. The mutation rate in patients without lymph node metastasis was 66.9% (91 / 136), which was higher than that in patients with lymph node metastasis (29 / 57 / 50.9%) (P 0.05). Conclusion: in peripheral invasive lung adenocarcinoma, some CT signs and pathological features are useful in predicting the mutation status of EGFR gene. The maximum diameter of tumor in axial position was less than 2.01cm, and the mutation rate was high in the lesions with GGO components and no cystic cavity changes. The histopathological classification was mainly adherent growth type, and the mutation rate was high in the patients without lymph node metastasis.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R734.2

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本文編號(hào)：2264124