实变肿瘤体积比鉴别诊断早期肺腺癌亚型的价值  

The value of volume percentage of solid component differentiate and diagnose early stage lung adenocarcinoma subtypes

作　　者：屈晓艳 李刚锋 杨洋 安攀 侯星亦 高雅 朱元博 杨露 马质莹 崔光彬 QU Xiaoyan;LI Gangfeng;YANG Yang;AN Pan;HOU Xingyi;GAO Ya;ZHU Yuanbo;YANG Lu;MA Zhiying;CUI Guangbin(Department of Radiology,Tangdu Hospital,the Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院放射科,陕西西安710038

出　　处：《实用放射学杂志》2024年第5期709-712,720,共5页Journal of Practical Radiology

摘　　要：目的探讨实变肿瘤体积比鉴别诊断Ⅰ期肺腺癌亚型的价值,并预测实性成分最佳临界CT值。方法回顾性分析经手术病理证实为原位腺癌(AIS)和肺腺癌,且薄层CT表现为亚实性结节的962个肺结节,将病变分为:(1)AIS组(350例)与肺腺癌组(612例);(2)微浸润腺癌(MIA)组(213例)与浸润性腺癌(IAC)组(399例)。利用CT密度直方图测量不同阈值下结节内实变肿瘤体积比,分析不同阈值的诊断效能,并寻找实性成分最佳临界CT值。结果在AIS组与肺腺癌组中,年龄、质量、实变肿瘤体积比差异有统计学意义(P<0.001);CT阈值为-350HU诊断效能最高[曲线下面积(AUC)0.859,准确度81.69%,敏感度85.60%,特异度74.86%],该阈值下确定的实变肿瘤体积比临界值为8.3%。在MIA组与IAC组中,年龄(P=0.017)、质量(P<0.001)、实变肿瘤体积比(P<0.001)差异有统计学意义;CT阈值为-350HU诊断效能最高(AUC0.857,准确度78.27%,敏感度82.91%,特异度69.48%),该阈值下确定的实变肿瘤体积比临界值为16.9%。结论基于CT密度直方图测量的实变肿瘤体积比可有效鉴别诊断早期肺腺癌亚型。Objective To investigate the value of the volume percentage of solid component in differential diagnosis of stage I lung adenocarcinoma subtypes,and to predict the optimal critical CT value of solid component.Methods A total of 962 nodules with surgical pathological findings confirmed as adenocarcinoma in situ(AIS)or pulmonary adenocarcinoma and manifested as subsolid nodules on thin-section CT were analyzed retrospectively,and divided the lesions into:(1)AIS(n=35o)or pulmonary adenocarcinoma(n=612)groups;and(2)minimally invasive adenocarcinoma(MIA)(n=213)or invasive adenocarcinoma(IAC)(n=399)groups based on pathological findings.The volume percentage of solid components within pulmonary nodules was measured via CT density histogram analysis at different thresholds,the diagnostic efficacy of different thresholds was analyzed and the optimal critical CT values of solid component was found.Results In the AIS versus pulmonary adenocarcinoma groups,age,mass,and volume percentage of solid component were statistically significant(P<0.001);the CT threshold of-350 HU had the highest diagnostic efficacy[area under the curve(AUC)0.859,accuracy 81.69%,sensitivity 85.60%,and specificity 74.86%,respetivelyl,and the critical value of volume percentage of solid component determined under this threshold was 8.3%.In the MIA versus IAC groups,age(P=0.017),mass(P<0.001),and volume percentage of solid component(P<0.001)were statistically significant;the CT threshold of-350 HU had the highest diagnostic efficacy(AUC 0.857,accuracy 78.27%,sensitivity 82.91%,and specificity 69.48%,respectively),and the critical value of volume percentage of solid component determined under this threshold was 16.9%.Conclusion The volume percentage of solid component measured based on CT density histogram analysis may be helpful in the differential diagnosis of early stage lung adenocarcinoma subtypes.

关 键 词：肺腺癌 亚实性肺结节 CT密度直方图 实变肿瘤体积比 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]