月牙征预测纯磨玻璃结节肺腺癌浸润性的价值  

Crescent sign for predicting the invasiveness of lung adenocarcinoma with pure ground-glass opacity

作　　者：俞慧波 陈中港 李琼 傅钢泽[1] 项兰婷 黄定品 刘瑾瑾[1] 李鹏[3] 杨运俊[1] Yu Huibo;Chen Zhonggang;Li Qiong;Fu Gangze;Xiang Lanting;Huang Dingpin;Liu Jinjin;Li Peng;Yang Yunjun(Department of Radiology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of Radiology,Theorem Clinical School of Wenzhou Medical University,Wenzhou 325000,China;Department of Pathology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院放射科,325000 [2]温州医科大学定理临床学院放射科,325000 [3]温州医科大学附属第一医院病理科,325000

出　　处：《中华放射学杂志》2021年第4期403-408,共6页Chinese Journal of Radiology

基　　金：浙江省卫生创新人才项目(20161107);浙江省高校中青年学科带头人项目(20171011)。

摘　　要：目的探讨月牙征对纯磨玻璃结节(pGGN)肺腺癌浸润性的预测价值。方法回顾性分析温州医科大学附属第一医院2013年7月到2018年6月经手术病理证实为肺腺癌的316例患者(320个pGGN)的临床、病理及影像资料。依据病理结果将pGGN分为浸润前病变组148个和浸润性病变组172个。使用logistic回归分析确定pGGN浸润性的危险因素,并对各危险因素进行ROC曲线分析。结果浸润前病变组出现月牙征24个(16.2%),浸润性病变组出现月牙征49个(28.5%),差异具有统计学意义(χ^(2)=6.804,P=0.009);浸润前病变组和浸润性病变组患者年龄、病灶大小、形态、分叶征、血管牵拉征的差异具有统计学意义(P<0.05)。ROC曲线显示以病变大小10.5 mm为临界值,鉴别诊断浸润前病变和浸润性病变的灵敏度为65.7%,特异度为61.5%,曲线下面积为0.666。Logistic回归多因素分析显示,病灶最大径≥10.5 mm、不规则形态、月牙征、血管牵拉征是pGGN浸润性的独立危险因素,其OR值(95%CI)分别为3.192(1.981~5.144)、3.672(1.545~8.725)、1.972(1.104~3.521)、2.026(1.087~3.777)。根据上述4个独立危险因素建立logistic模型的曲线下面积为0.711(95%CI 0.655~0.768)。结论月牙征能有效地反映pGGN的浸润性。病灶最大径≥10.5 mm、不规则形态、月牙征、血管牵拉征均是预测pGGN浸润性的独立危险因素。Objective To evaluate the value of the crescent sign for predicting the invasiveness of lung adenocarcinoma presenting as pure ground-glass nodule(pGGN).Methods The clinical,pathological and imaging data of 316 patients(320 pGGNs)confirmed lung adenocarcinoma by surgery and pathology from July 2013 to June 2018 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed.All pGGNs were divided into preinvasive group(148 pGGNs)and invasive group(172 pGGNs)according to histopathology.Logistic regression analysis was used to determine the risk factors for invasiveness of pGGN,and the ROC curve analysis was performed on each risk factor.Results Crescent sign was found in 24 cases(16.2%)in the preinvasive group and 49(28.5%)in the invasive group,and the difference between the two groups was statistically significant(χ^(2)=6.804,P=0.009).There were statistically significant differences in patient′s age,lesion size,shape,lobulation sign,and vascular stretch sign between the two groups(P<0.05).The ROC curve showed that with the lesion size 10.5 mm as the optimal cut off value,the sensitivity for differential diagnosis of preinvasive and invasive lesions was 65.7%,the specificity was 61.5%,and the area under the curve was 0.666.Logistic regression analysis showed that maximum diameter of the lesion≥10.5 mm,irregular shape,crescent sign and vascular stretch were independent risk factors of invasiveness of pGGN,and the OR value(95%CI)were 3.192(1.981-5.144),3.672(1.545-8.725),1.972(1.104-3.521),and 2.026(1.087-3.777),respectively.A logistic model was established based on the above four independent risk factors,and the area under curve was 0.711(95%CI 0.655-0.768).Conclusion Crescent sign can effectively reflect the invasiveness of pGGN.Maximum diameter of the lesion≥10.5 mm,irregular shape,crescent sign and vascular stretch sign are independent risk factors of invasiveness of pGGN.

关 键 词：肺肿瘤 腺癌 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤]