基于HRCT形态学特征对肺腺体前驱病变及炎性结节的鉴别诊断  

HRCT-based morphological features for differential diagnosis in pulmonary precursor glandular lesions and inflammatory nodules

作　　者：叶威 陈艺 叶碧云 张志艳 钟荣翠 蓝博文[1] Ye Wei;Chen Yi;Ye Biyun;Zhang Zhiyan;Zhong Rongcui;Lan Bowen(Department of Radiology,Huizhou Central People's Hospital,Huizhou 516001,China;Department of Neurosurgery,Huizhou First Hospital,Huizhou 516003,China;Guangzhou Pingan Haoyi Medical Imaging Diagnosis Center,Guangzhou 510030,China)

机构地区：[1]惠州市中心人民医院放射科,惠州516001 [2]惠州市第一人民医院神经外科,惠州516003 [3]广州平安好医医学影像诊断中心,广州510030

出　　处：《国际呼吸杂志》2022年第21期1635-1640,共6页International Journal of Respiration

摘　　要：目的基于高分辨率CT对肺腺体前驱病变及炎性结节的形态学特征进行分析以提高影像诊断的准确性。方法本研究为病例对照研究,采用非随机抽样的方法选择惠州市中心人民医院2020年1月至2022年6月经手术病理证实肺腺体前驱病变[包括不典型腺瘤样增生及原位腺癌]及炎性结节患者各50例,分别比较其临床数据及肺结节影像形态学特征,筛选出具有统计学差异的变量。纳入二元logistic回归分析筛选出独立危险因素建立联合鉴别诊断模型,运用受试者工作特征曲线评估诊断效能。结果腺体前驱病变组的结节较炎性结节组直径小,病变位置在双上肺较多,形态上规则的占比较多,结节类型多为亚实性(P值均<0.05)。logistic回归分析结果显示结节直径及结节类型是肺腺体前驱病变的独立危险因素,结节直径最佳截断值为7mm时,受试者工作特征曲线分析诊断效能良好,曲线下面积为0.946(95%CI:0.882~0.981),敏感度为92%,特异度为84%。结论基于高分辨率CT形态学特征的差异有助于对肺腺体前驱病变及炎性结节进行鉴别诊断。亚实性结节及直径<7mm更倾向腺体前驱病变,为临床治疗方式的选择提供依据。Objective To explore the morphological features of precursor glandular lesions and inflammatory nodules based on high resolution computed tomography(HRCT)to improve the accuracy of imaging diagnosis.Methods This study is a case-control study.The non-random sampling method was used.Patients with precursor glandular lesions(n=50)including atypical adenomatous hyperplasia and adenocarcinoma in situ and inflammatory nodules(n=50),which were confirmed by operation pathology in Huizhou Central People′s Hospital from January 2020 to June 2022,were enrolled for analysis.The clinical data and morphological features of pulmonary nodules were compared to screen out variables with statistical differences.According to the binary logistic regression analysis,independent risk factors were screened out to establish a joint model for differential diagnosis,and receiver operating characteristic(ROC)curve was used to evaluate the diagnostic performance.Results The precursor glandular lesions group had smaller nodule diameter,mostly located in the upper lungs,with regular morphology and mostly subsolid nodules as compared with the inflammatory nodules group(all P<0.05).The logistic regression analysis showed that nodule size and nodule type were independent risk factors for precursor glandular lesions.ROC curve analysis showed that when the optimal cut-off value of nodule diameter was 7 mm,the area under the curve(AUC)was 0.946(95%CI:0.882-0.981),the sensitivity for 92%,and the specificity for 84%.Conclusions HRCT-based morphological differences contribute to differential diagnosis for precursor glandular lesions and inflammatory nodules.Subsolid nodules and size<7 mm are more prone to glandular precursor lesions,which provides a reference for the selection of clinical treatment methods.

关 键 词：腺瘤 原位腺癌 孤立性肺结节 诊断 鉴别 回归分析 

分 类 号：R734.2[医药卫生—肿瘤]