关键词: 肺部磨玻璃结节, 高分辨CT, 肺腺癌, 病理分型

Abstract:

Objective To explore the relationship between high-resolution CT signs of pulmonary ground glass nodules （GGN） and the pathological typing of lung adenocarcinoma. Methods A total of 104 patients with GGN confirmed by pathology from October 2021 to October 2025 were included in the study. Based on the World Health Organization （WHO） pathological classification criteria for lung adenocarcinoma， the patients were classified into the invasive adenocarcinoma （IAC） group， the minimally invasive adenocarcinoma （MIA） group， the adenocarcinoma in situ （AIS） group， and the atypical adenomatous hyperplasia （AAH） group. The baseline data， clinical indicators， high-resolution computed tomography （HRCT） sign features， and HRCT quantitative parameters of patients with different pathological types were compared. The HRCT sign features and quantitative parameters of IAC subtypes （wall-attached type， acinar type， and papillary type） were compared. Binary logistic regression analysis was employed to explore the influencing factors of IAC. The receiver operating characteristic （ROC） curve was utilized to analyze the diagnostic value of HRCT features for IAC. Results The proportions of lobulation sign， spiculation sign， clear and rough interfaces， vacuole sign， bronchial truncation sign， pleural indentation sign， and vessel convergence sign were significantly higher in the IAC group than those in the MIA， AIS， and AAH groups （P < 0.05）. The maximum nodule diameter， CT value， volume， and mass in the IAC group were significantly higher than those in the MIA， AIS， and AAH groups （P < 0.05）， whereas the relative CT value was significantly lower than that in the other three groups （P < 0.05）. There were no statistically significant differences in HRC qualitative features among the three IAC subtypes （P > 0.05）. The CT value， volume， and mass in the wall-attached type group were significantly lower than those in the acinar type and papillary type groups （P < 0.05）， while the relative CT value was significantly higher （P < 0.05）. Moreover， the CT value in the acinar type group was significantly lower than that in the papillary type group （P < 0.05）. The maximum nodule diameter， CT value， and volume were all influencing factors of IAC occurrence （P < 0.05）. The AUC values for predicting confirmed IAC using the lobulation sign， maximum nodule diameter， CT value， and volume were 0.668， 0.929， 0.827， and 0.909 respectively. Combined prediction yielded an AUC of 0.992， with a sensitivity of 97.01% and a specificity of 75.68%， indicating higher predictive value. Conclusions The high-resolution CT signs of pulmonary GGN are associated with the pathological typing of lung adenocarcinoma. In patients with IAC， the maximum nodule diameter， CT value， and volume are relatively large， and the lobulation sign is prominent. There are significant differences in CT signs between patients with IAC and those without IAC. Moreover， CT quantitative parameters and signs can also offer references for the clinical identification of IAC pathological subtypes.

Key words: pulmonary ground glass nodules, high-resolution CT, lung adenocarcinoma, pathological typing