肿瘤直径及平扫CT值在肾上腺占位良恶性判定中的价值评估  

The diagnostic significance of tumor diameter and unenhanced CT attenuation value in distinguishing benign from malignant adrenal masses

作　　者：李梦莲 张子为[2] 刘梦思 曾阳杰 田朝阳 杨帆[2] 李平[1] Li Menglian;Zhang Ziwei;Liu Mengsi;Zeng Yangjie;Tian Zhaoyang;Yang Fan;Li Ping(Department of Endocrinology,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine,Nanjing 210008,China;Department of Endocrinology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Branch of National Clinical Research Centre for Metabolic Diseases,Nanjing 210008,China)

机构地区：[1]南京中医药大学鼓楼临床医学院内分泌科,南京210008 [2]南京大学医学院附属鼓楼医院内分泌科,国家代谢性疾病临床医学研究中心分中心,南京210008

出　　处：《中华内分泌代谢杂志》2023年第12期1016-1022,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：国家重点研发计划(2022YFC2505300,2022YFC2505306,2021YFC2501600,2021YFC2501603)。

摘　　要：目的探讨不同肿瘤直径和平扫计算机断层扫描(CT)值肾上腺占位的病理特征分布,并分析肿瘤直径及平扫CT值在肾上腺占位肿瘤良恶性中的评估价值。方法回顾性收集2017年1月至2022年10月至南京鼓楼医院就诊并行肾上腺占位切除术的1367例患者资料。根据肿瘤直径与平扫CT值将占位分为4组,分别比较4组患者的临床及病理特征。Logistic回归分析肿瘤直径和平扫CT值与恶性肾上腺占位的相关性,采用受试者工作特征(ROC)曲线评估两者在肾上腺占位肿瘤良恶性中的诊断价值。结果肾上腺皮质腺癌和其他恶性肿瘤所占比例随着肿瘤直径或平扫CT值的增加而升高。校正年龄、性别后,肿瘤直径(OR=1.624,95%CI 1.464~1.803,P<0.001)和平扫CT值(OR=1.108,95%CI 1.079~1.138,P<0.001)是恶性肾上腺占位的预测因素。肿瘤直径和平扫CT值诊断肾上腺恶性占位的ROC曲线下面积(AUC)分别为0.838和0.892,最佳切点分别为>3.4 cm和>30 HU时,灵敏度分别为75.5%和83.7%,特异度分别为80.5%和84.4%。肿瘤直径(>3.4 cm)联合平扫CT值(>20 HU)诊断恶性肾上腺占位的AUC为0.927,灵敏度为71.4%,特异度为90.1%。结论肿瘤直径及平扫CT值在肾上腺良恶性占位的评估中有重要价值。肿瘤直径(>3.4 cm)联合平扫CT值(>20 HU)具有最佳的诊断效率,该联合指标的临床应用在有效诊断恶性肾上腺占位的同时避免患者接受不必要的进一步检查或手术。Objective To explore the pathological characteristics of adrenal masses based on various tumor diameter and unenhanced computed tomography(CT)attenuation value,and evaluate the value of the two parameters in the assessment of the benign and malignant nature of adrenal masses.Methods The data of 1367 patients who underwent adrenalectomy in Nanjing Drum Tower Hospital from January 2017 to October 2022 were retrospectively collected.The adrenal masses were divided into four groups according to tumor diameter and unenhanced CT attenuation value,and the clinical and histopathological characteristics of the four groups were compared respectively.Logistic regression was used to analyze the correlation between tumor diameter,non-contrast CT attenuation value and malignant adrenal masses,and receiver operating characteristic(ROC)curve was used to assess the diagnostic value of both in benign and malignant adrenal masses.Results The proportion of adrenocortical carcinoma and other malignant tumors increased with the rise of tumor diameter or unenhanced CT attenuation value.After adjusting for age and gender,tumor diameter(OR=1.624,95%CI 1.464-1.803,P<0.001)and unenhanced CT attenuation value(OR=1.108,95%CI 1.079-1.138,P<0.001)were predictors of malignant adrenal masses.The tumor diameter and unenhanced CT attenuation value in diagnosing malignant adrenal masses had area under the ROC curve(AUC)of 0.838 and 0.892,respectively.With the optimal cut-off values of>3.4 cm and>30 HU,the sensitivity was 75.5%and 83.7%,and the specificity was 80.5%and 84.4%,respectively.The combination of tumor diameter>3.4 cm and unenhanced CT attenuation value>20 HU had an AUC of 0.927,with a sensitivity of 71.4%and a specificity of 90.1%in diagnosing malignant adrenal masses.Conclusions Tumor diameter and unenhanced CT attenuation value has important significance in the differential diagnosis of benign and malignant adrenal masses.A combination of tumor diameter(>3.4 cm)and unenhanced CT attenuation value(>20 HU)demonstrates best diagnostic effi

关 键 词：肾上腺占位 肾上腺意外瘤 肿瘤直径 平扫CT值 

分 类 号：R736.6[医药卫生—肿瘤]