基于HRCT影像学表现对磨玻璃肺结节腺癌浸润程度的鉴别诊断  

High-resolution Computed Tomography Features of Pulmonary Ground Glass Nodules for Distinguishing Degree of Adenocarcinomas

作　　者：陈相猛[1] 张嘉瑜 段晓蓓[2] 孙丽霞[3] 李荣岗[3] 谭国强[1] 张朝桐[1] 龙晚生[1] CHEN Xiang-meng;ZHANG Jia-yu;DUAN Xiao-bei;SUN Li-xia;LI Rong-gang;TAN Guo-qiang;ZHANG Chao-tong;LONG Wan-sheng(Department of Radiology,Jiangmen Central Hospital,Jiangmen 529070,Guangdong Province,China;Department of Nuclear Medicine,Jiangmen Central Hospital,Jiangmen 529070,Guangdong Province,China;Department of Pathology,Jiangmen Central Hospital,Jiangmen 529070,Guangdong Province,China)

机构地区：[1]江门市中心医院放射科,广东江门529070 [2]江门市中心医院核医学科,广东江门529070 [3]江门市中心医院病理科,广东江门529070

出　　处：《中国CT和MRI杂志》2021年第6期71-74,共4页Chinese Journal of CT and MRI

摘　　要：目的分析HRCT影像学特征对磨玻璃肺结节(GGN)微小浸润性腺癌(MIA)与浸润性腺癌(IA)的鉴别诊断价值。方法回顾性收集和分析2017年2月至2019年9月经病理组织证实和术前HRCT表现为GGN的患者共152例,其中男50例,女102例;年龄范围19~81岁,平均年龄(53.5±12.3)岁。将患者临床资料和影像学表现分别进行单因素分析;筛选有统计学差异的变量,纳入二元Logistic回归分析并建立诊断模型,使用ROC曲线确定最佳诊断阈值。结果 MIA组75例,其中男18例,女57例,平均年龄(49.7±12.4)岁;IA组77例,其中男32例,女45例,平均年龄(57.2±11.1)岁。MIA组与IA组在患者性别、年龄、结节径线、形态、分叶征、毛刺征、空泡征、空气支气管征、胸膜牵拉征之间的差异有统计学意义(P<0.05)。二元Logistic回归分析结果径线为IA组的独立危险预测因素,OR值为1.404(95%CI:1.199~1.645;P<0.001)。ROC曲线分析显示径线10.0mm时为最佳诊断阈值,曲线下面积为0.857,灵敏度、特异度和准确度分别为72.7%、82.7%和77.6%。结论 HRCT影像学表现有助于GGN腺癌浸润程度的诊断。结节径线是预测肺腺癌为IA的独立危险因素,径线大于10.0mm更倾向于IA,有助于临床诊疗策略的制定。Objective To explore the application of high-resolution computed tomography(HRCT)features to differentiate minimally invasive adenocarcinoma(MIA)from invasive adenocarcinoma(IA)lesions appearing as pulmonary ground-glass nodules(GGNs).Methods From February 2017 to September2019,a total of 152 patients(50 males and 102 females;age ra nge:19-81 years;mean age 53.5112.3)years with surgical and pathological confirmed lung adenocarcinomas appearing as GGNs in HRCT images were analyzed retrospectively.Patient clinical cha racteristics and HRCT features were recorded and compared using univariate analysis between MIA and IA groups.Logistic regression analysis was used to establish a predictive model between HRCT features and nodule invasiveness.Receiver operating characteristic(ROC)analysis was performed to assess the diagnostic performance and determined the cutoff values.Results There were 75 patients(18 males and 57 females;mean age:49.7±12.4)years in the MIA group and 77 cases(32 males and 45 females;mean age:57.2±11.1)years in the IA group.There were significant statistical differences in gender,age,nodule size,sharp,lobulated sign,spiculated sign,bubble lucency,air bronchogram sign,and pleural traction sign between MIA and IA group(all P<0.05).Nodule size was an independent risk factor for IA in multivariation logistic regression analysis(OR value:1.404;95%CI:1.199~1.645;P<0.001).The optimum cut-off value size for IA was greater than 10.0 mm in the ROC curve analysis and the area under the curve(AUC),sensitivity,specificity,and accuracy were 0.857,72.7%,82.7%and 77.6%,respectively.Conclusion The HRCT features may be helpful in distinguishing pulmonary MIA from IA lesions that manifested as GGN.Nodule size was an independent risk factor,and greater than 10.0 mm were more likely to be IA,which will be helpful fo r surgical pattern selection.

关 键 词：磨玻璃结节 肺肿瘤 腺癌 浸润 计算机体层成像 

分 类 号：R734.2[医药卫生—肿瘤] R445.3[医药卫生—临床医学]