Objective: To explore the value of CT and autoantibody panel to diagnosis the subtype in early clinical stage lung cancer,especially lepidic predominant adenocarcinoma (LPA),and to provide the correct information for the clinical and the prognosis evaluation. Methods: A retrospective study was conducted of 60 patients (total 63 subsolid nodules,which included 39 PSN and 24 pGGN) who underwent surgical resection or needle biopsy for stage Ⅰa or Ⅰb lung adenocarcinoma at Affiliated Tumor Hospital of Zhengzhou University between June 2017 and April 2018,age from 28 to 82 years old,and the average age was (52±7) years. All patients underwent a pretreatment chest LDCT and the peripheral blood of all patients were used to detect the tumor related antibody (including p53, GAGE7, PGP9.5, CAGE, MAGEA1, SOX2, GBU4-5) through enzyme linked immunosorbent assay. All the patients were divided into LPA group (43 subsolid nodules, which included AIS 10 subsolid nodules, MIA 11 subsolid nodules, LPA 22 subsolid nodules) and invasive predominant adenocarcinoma (IPA) group (20 subsolid nodules). The information of CT scanning was measured and assessed in lung and mediastinal windows with double blind method. The mean computed tomography (m-CT) value and the solid component/tumor ratio in three-dimensional (3D) and two-dimensional (2D) planes were measured and analyzed using computer-aided diagnosis (CAD) system. Results: There were 20 partial solid nodules in IPA group, 19 partial solid nodules in LPA group and 24 ground-glass nodules (χ(2)=19.278,P=0.000). There were 4 circular nodules, 16 irregular nodules in the IPA group, 21 circular nodules, 5 oval nodules and 7 irregular nodules in the LPA group χ(2)=8.587,P=0.003). The incidence of burr, vascular aggregation and bronchial truncation in IPA group was higher than that in LPA group (40.0% vs 16.3%, 70.0% vs 18.6%, 30.0% vs 2.3%, χ(2)=4.234,15.860,10.580, P=0.040,0.000, 0.001). The incidence of clear tumor lung interface in patients in LPA group was significantly higher than that in patients in IPA group (97.7% vs 65.0%, χ(2)=13.146,P=0.00). Of all the quantitative analysis of nodules,the m-CT value, the solid component/tumor ratios in three-dimensional (3D) and two-dimensional (2D) planes in IPA group were higher than those of LPA group ((-180±156) vs (-410±213) HU, 0.44±0.32 vs 0.14±0.26, 0.54±0.26 vs 0.18±0.26, t=-4.208, -3.951、-5.166, P=0.000, 0.000, 0.000). Among the 60 patients with lung cancer, there were 33 cases with positive antibody in peripheral blood, with a positive rate of 55.0%. The positive rate of 7-AABs was 70.0% in IPA group and 44.2% in LPA group, which had no statistical difference (χ(2)=3.647, P=0.056), the positive expression of tumor-associated antibodies was independent of the patient's age, CT value and nodular solid components and lung nodular volume ratio and area ratio, P>0.05, only in correlation with pleural traction (χ(2)=3.866, P=0.049). Conclusion: Compared with IPA, the imaging features of LDCT about the mGGN and PGGN appearance, clear tumor-lung interface, low m-CT and the solid component/tumor ratio in two-dimensional or three-dimensional (3D) planes are benefit for the diagnosis of the LPA; the expression of tumor-associated antibody group is independent of the age of the patient and the number of nodular solid components, and is only related to pleural depression, which is not conducive to the identification of LPA and IPA.
目的： 探讨肿瘤相关抗体（AABs）谱结合CT征象鉴别诊断以附壁生长方式为主的早期肺腺癌亚型的应用研究，为术前正确诊断及预后评估提供依据。 方法： 回顾分析河南省肿瘤医院自2017年6月至2018年4月手术或穿刺病理证实的T1a或T1b期肺腺癌患者60例，男26例、女34例，年龄28~82岁，平均年龄（52±7）岁，共63个结节，部分实性39个，毛玻璃24个。所有患者术前均行至少一次胸部低剂量CT检查及采用酶联免疫吸附试验法检测外周血7-AABs水平（包括p53，GAGE7，PGP9.5，CAGE，MAGEA1，SOX2，GBU4-5）。根据病理类型分为附壁生长为主（LPA）组43个（原位癌10个，微浸润腺癌11个，附壁为主腺癌22个）；浸润型（IPA）组20个。采用双盲法观察并记录病灶的CT征象，采用计算机辅助诊断系统测量结节的CT值、结节实性成分的最大面积及体积比，采用χ(2)检验或t检验比较两组患者的影像学特征及肿瘤相关抗体组相关性分析。 结果： IPA组患者部分实性结节20个，LPA组部分实性结节19个，毛玻璃结节24个（χ(2)=19.278，P=0.000）；IPA组患者圆形结节4个，不规则形结节16个，LPA组患者圆形结节21个，椭圆形结节5个，不规则结节7个（χ(2)=8.587，P=0.003）；IPA组患者毛刺、血管聚集征及支气管截断的出现率高于LPA组患者（40.0%比16.3%、70.0%比18.6%、30.0%比2.3%，χ(2)=4.234、15.860、10.580，P=0.040，0.000，0.001）；LPA组患者的瘤肺界面清晰的出现率明显高于IPA组患者（97.7%比65.0%，χ(2)=13.146，P=0.00）。结节定量分析指标中，IPA组患者结节的CT值、结节的实性成分/结节体积比及面积比均明显高于LPA组[（-180±156）比（-410±213）HU、0.44±0.32比0.14±0.26、0.54±0.26比0.18±0.26，t=-4.208、-3.951、-5.166，P=0.000、0.000、0.000]；60例肺癌患者中，7-AABs阳性例数33例，阳性率55.0%，IPA组阳性表达率70.0%，LPA组阳性表达率44.2%（χ(2)=3.647，P=0.056）；7-AABs阳性表达与患者年龄、CT值及结节实性成分占比无关（P>0.05），仅与胸膜牵拉具有相关性（χ(2)=3.866，P=0.049）。 结论： 与IPA比较，mGGN及PGGN主要CT表现、瘤肺界面清晰、CT值较低、结节的实性成分占结节的面积及体积比较低者，均有助于LPA的诊断；7-AABs阳性表达与患者年龄及结节实性成分多少无关，仅与胸膜凹陷相关，无助于LPA与IPA的鉴别。.
Keywords: Adenocarcinoma; Antibodies, neoplasm; Cicatrix, hypertrophic; Lung neoplasms.