CT纹理特征对82例早期实性肺腺癌隐匿性淋巴结转移的预测价值  

Predictive value of CT texture features for occult lymph node metastasis in 82 cases of early solid lung adenocarcinoma

作　　者：张冉冉 张然 寻航 邢力刚[2] 孙晓蓉[1] ZHANG Ran-ran;ZHANG Ran;XUN Hang;XING Li-gang;SUN Xiao-rong(Shandong Cancer Hospital Affiliated to Shandong First Medical University,Jinan 250117,P.R.China;Department of Medical Imaging,Linyi Cancer Hospital,Linyi 276001,P.R.China;Department of Radiation Oncology,Shanghai Pulmonary Hospital Affiliated to Tongji University,Tongji University School of Medicine,Shanghai 200433,P.R.China)

机构地区：[1]山东第一医科大学附属山东省肿瘤医院核医学科,山东济南250117 [2]山东第一医科大学附属山东省肿瘤医院放疗科,山东济南250117 [3]临沂市肿瘤医院影像科,山东临沂276001 [4]同济大学医学院,同济大学附属上海市肺科医院放疗科,上海200433

出　　处：《中华肿瘤防治杂志》2020年第17期1387-1392,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的CT纹理是目前肿瘤异质性分析的重要方法,有无淋巴结转移对肺癌患者治疗方式的选择及预后评估均有重要意义。本研究旨在分析CT纹理特征在早期实性肺腺癌隐匿性淋巴结转移(occult lymph node metastasis,OLNM)中的预测价值。方法回顾性分析临沂市肿瘤医院2015-02-03-2018-12-23经手术病理确诊的T1-2N0M0期实性肺腺癌患者82例的病例资料,其中OLNM阴性61例,OLNM阳性21例。应用PyRadiomics分析软件测量术前静脉期CT图像7个纹理参数值,比较不同组间纹理参数值的差异,应用受试者工作特征(receiver operating characteristic,ROC)曲线评价诊断效能,分析不同纹理参数对OLNM的预测效能。结果OLNM阴性与阳性2组间肿瘤的病理T分期(T1a1例,T1b29例,T1c25例,T2a22例,T2b5例;P<0.001)、肿瘤于肺野的分布(肺野外2/3共58例,肺野内1/3共24例;χ^2=0.179,P=0.009)及病理分化程度(高分化6例,中分化46例,低分化30例;χ^2=19.415,P<0.001)在有无淋巴结转移组间差异均有统计学意义。有OLNM组静脉期CT图像的能量值和均值性均大于无OLNM组,差异有统计学意义,P<0.05;有OLNM组静脉期CT图像的熵值、偏度、峰度及平均值均小于无OLNM组,差异有统计学意义,P<0.05;而自相关参数在有无OLNM组间差异无统计学意义,P=0.795。能量值对有无OLNM具有最佳预测效能,假阳性率为14.29%,假阴性率为29.51%;平均值、峰度、偏度及均值性对有无OLNM具有一定的预测效能,其预测灵敏度假阳性率分别为38.1%、39.05%、19.05%和23.81%,假阴性率分别为18.75%、37.7%、36.07%和37.07%。结论术前CT纹理特征参数对早期实性肺腺癌患者有无OLNM具有一定的预测价值。OBJECTIVE CT texture is an important method for tumor heterogeneity analysis,and the status of lymph node metastasis has a significant impact on the choice of treatment modality and prognosis of lung cancer patients.The aim of this study was to investigate the predictive value of CT texture features in early solid lung adenocarcinoma with occult lymph node metastasis.METHODS Data for 82 patients were retrospectively reviewed who were diagnosed as clinical stage T1-2 N0 M0 NSCLC treated with radical surgery from February 3,2015 to December 23,2018.Seven texture features of venous-phase CT images were measured by PyRadiomics software.The inter-group difference between texture feature values was compared,and receiver operating characteristic curve was used to evaluate the diagnostic efficiency and the predicted efficiency for occult lymph node metastasis from patients.RESULTS The clinical T stage,distribution and differentiation degree of the tumor were statistically different between the groups with and without lymph node metastasis(P<0.001;χ^2=0.179,P=0.009;χ^2=19.415,P<0.001;respectively).The energy of the venous-phase images in positive group with occult lymph node metastasis were larger than those in negative group(P<0.05).The mean kurtosis skewness and entropy of the venous-phase images in positive group with occult lymph node metastasis were smaller than those in negative(P<0.05).There were no significant difference in correlation between the groups(P=0.795).Energy value was the best predictor for occult lymph node metastasis,with a false positive rate of 14.29%and a false negative rate of 29.51%.Mean,kurtosis,skewness and meanness had certain predictive efficacy for occult lymph node metastasis.The false positive rates of predictive sensitivity were 38.1%,39.05%,19.05%and 23.81%,and false negative rates were 18.75%,37.7%,36.07%and 37.07%,respectively.CONCLUSION Preoperative CT texture features may have a predictive value for the status of occult lymph node metastasis in patients with early solid lung adeno

关 键 词：肺肿瘤 腺癌 淋巴结 电子计算机断层扫描 纹理 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]