Brock模型与肺结节影像分级报告系统对亚实性肺结节良恶性鉴别能力的比较  

Comparison of the Brock model and LU-RADS in differentiating malignant subsolid pulmonary nodules from benign nodules

作　　者：曹伟云[1] 刘海芬 谭俊 伍世葵[1] 刘浩雷 CAO Wei-yun;LIU Hai-fen;TAN Jun;WU Shi-kui;LIU Hao-lei(Department of Respiratory and Critical Care Medicine,The First Affilated Hospital of Hunan Traditional Chinese Medicine College,Zhuzhou 412000,Hunan,China;Department of Radiology,The First Affilated Hospital of Hunan Traditional Chinese Medicine College,Zhuzhou 412000,Hunan,China)

机构地区：[1]湖南中医药高等专科学校附属第一医院呼吸与危重症医学科,株洲412000 [2]湖南中医药高等专科学校附属第一医院放射科,株洲412000

出　　处：《东南国防医药》2022年第6期573-577,共5页Military Medical Journal of Southeast China

基　　金：湖南省中医药科研计划项目(2021112)。

摘　　要：目的比较Brock模型和肺结节影像分级报告系统(LU-RADS)在亚实性肺结节(SPN)良恶性鉴别能力。方法回顾性分析2018年1月至2021年12月期间在湖南中医药高等专科学校附属第一医院行手术切除且病理证实的133例SPN患者临床资料,根据病理结果分为良性SPN组41例和恶性SPN组92例,并对其临床资料进行统计分析,通过Brock模型预测公式计算SPN的恶性概率,由2位放射科医师分别独立阅片并确定SPN的LU-RADS分类。分别绘制Brock模型和LU-RADS的ROC,得到AUC并进行比较。结果恶性SPN组患者的年龄、最大直径明显大于良性SPN组患者(P<0.01),恶性SPN组中的毛刺征(P<0.01)、分叶征(P=0.02)和胸膜牵拉征(P<0.01)明显多于良性SPN组,且恶性SPN多以混合性磨玻璃结节(mGGN)为主(77.17%)。恶性SPN组的LU-RADS 4A和4B类明显多于良性SPN组(56 vs 4,P<0.05),恶性SPN组的Brock模型的恶性概率明显大于良性SPN组(0.21 vs 0.06,P<0.05)。Brock模型与LU-RADS具有较好的相关性(r=0.75,P<0.01),两者鉴别SPN良恶性的能力均较高且差异无统计学意义(AUC:0.83 vs 0.78,P=0.16),亚组分析显示Brock模型对混合性磨玻璃结节的良恶性鉴别能力明显高于LU-RADS(AUC:0.92 vs 0.85,P=0.03),但两者对纯磨玻璃结节的良恶性鉴别能力均较差(AUC:0.59 vs 0.55,P=0.66)。结论Brock模型对混合性磨玻璃结节良恶性鉴别能力优于LU-RADS。Objective To compare Brock model and Lung imaging reporting and data system(LU-RADS)in differentiating malignant subsolid pulmonary nodules(SPN)from benign nodules.Methods The clinical data of 133 patients with SPN who underwent surgical resected and were pathologically confirmed from Jan 2018 to Dec 2021 were retrospectively analyzed.According to the pathological results,the patients were divided into two groups:benign SPN group(41 patients)and malignant SPN group(92 patients),and their clinical data were statistically analyzed.The malignant probability of SPN was calculated by Brock model.LU-RADS category of SPN was determined by two radiologists independently.The Receiver operating characteristic(ROC)curves of Brock model and LU-RADS were drawn respectively,and the area under curve(AUC)was comparable.Results Patients with malignant SPN were significantly older than patients with benign(P<0.01).The maximum diameter of malignant SPN was significantly larger than that of the benign SPN(P<0.01).Margin characteristics of nodule included speculation(P<0.01),lobulation(P=0.02),and pleural indentation(P<0.01)were found more frequently in malignant SPN than in benign SPN.Nodule type in malignant SPN group was dominated by mGGN(77.17%).LU-RADS category 4A and 4B of the malignant SPN group were more than the benign SPN group(56 vs 4,P<0.05),the malignant probability of malignant SPN group was significantly higher than that of benign SPN group(0.21 vs 0.06,P<0.05).Brock model has a good correlation with LU-RADS(r=0.75,P<0.01),and had a comparable performance in diagnosing lung cancer for the SPN(AUC:0.83 vs 0.78,P=0.16).Subgroup analysis showed that Brock model had a higher performance in diagnosing malignancy for the mixed ground glass nodules than LU-RADS(AUC:0.92 vs 0.85,P=0.03),but both had a similar lower performance in the detection of malignancy from the pure ground glass nodules(AUC:0.59 vs 0.55,P=0.66).Conclusion Brock model was superior malignant nodule.

关 键 词：亚实性肺结节 预测模型 LU-RADS 恶性结节 

分 类 号：R734.2[医药卫生—肿瘤]