CT对肺部磨玻璃结节各病理类型肺腺癌的鉴别价值

Diagnostic value of CT for pulmonary adenocarcinoma of different pathologic types in grinding glass nodule

目的:分析计算机断层扫描(computed tomography,CT)对肺部磨玻璃结节(ground-glass nodule,GGN)患者各病理类型肺腺癌的鉴别价值。方法:回顾性收集池州市人民医院胸心外科2021年1月至2022年6月收治的138例GGN患者临床资料。所有患者经术后病理检查确诊,根据不同病变情况分为浸润前病变[原位肺腺癌(adenocarcinoma in situ,AIS)组,n=30]与浸润性病变[微浸润性肺腺癌(minimally invasive adenocarcinoma,MIA)组,n=57;浸润性肺腺癌(invasive adenocarcinoma,IAC)组,n=51]。所有患者行CT检查,分析3组CT征象差异,以临床病理结果为金标准,通过多因素logistics回归分析与受试者操作特征(receiver operating characteristic,ROC)曲线分析不同CT征象鉴别浸润前病变与浸润性病变的诊断价值。结果:3组间分叶征例数、胸膜凹陷征例数、病灶最大直径、实性成分出现比例、CT值与结节内及邻近血管异常改变比较:AIS组<MIA组<IAC组(均P<0.05)。多因素logistics回归分析结果显示:分叶征、实性成分出现比例、实性结节CT值是GGN患者浸润性病变的危险因素(均P<0.05)。ROC曲线分析结果显示:分叶征、实性成分出现比例、实性结节CT值鉴别浸润性病变的曲线下面积(area under the curve,AUC)分别为0.576、0.979、0.879,敏感度分别为38.46%、91.70%、82.40%,特异度分别为76.67%、96.70%、83.30%。结论:在GGN患者的CT征象中,分叶征、实性成分出现比例、实性结节CT值对鉴别浸润前病变与浸润性病变的诊断效能较高,分叶征占比、实性成分出现比例及实性结节CT值越高,患者浸润性病变可能性越大。

Objective:To analyze the diagnostic value of CT for pulmonary adenocarcinoma of different pathologic types in patients with ground-glass nodules(GGN).Methods:The clinical data of 138 patients with GGN who were admitted to the Department of Cardiothoracic Surgery of Chizhou People’s Hospital from January 2021 to June 2022 were retrospectively collected.All patients were diagnosed by postoperative pathological examination.According to different lesions,they were divided into pre invasive lesions[adenocarcinoma in situ(AIS)group,n=30]and invasive lesions[minimally invasive adenocarcinoma(MIA)group,n=57;invasive adenocarcinoma(IAC)group,n=51].All patients were examined by CT scanning,and the differences of CT features among the 3 groups were analyzed.Using clinicopathological diagnosis results as the gold standard,the multivariate logistics regression analysis and receiver operating characteristic(ROC)curve analysis were used to determine the diagnostic value of different CT features in differentiating pre-invasive lesions from invasive lesions.Results:The number of cases of lobular lesions,pleural depression,maximum lesion diameter,proportion of solid component,CT value of nodules,ground glass component CT value,solid nodules CT value and the number of cases of abnormal vascular changes in the nodules and adjacent vessels were compared among the 3 groups:AIS group<MIA group<IAC group(all P<0.05).The results of multivariate logistics regression analysis showed that the lobular lesions,the proportion of solid components and the CT value of solid nodules were the risk factors of invasive lesions in GGN patients(all P<0.05).ROC curve analysis results showed that the area under the curve(AUC)for differentiation of invasive lesions by lobular lesions,proportion of solid components and CT value of solid nodules were 0.576,0.979,and 0.879,respectively;the sensitivity was 38.46%,91.70%,and 82.40%,respectively;the specificity was 76.67%,96.70%,and 83.30%,respectively.Conclusion:In the CT features of GGN patients,the diagnostic efficacy of lobular lesions,proportion of solid components and CT value of solid nodules are higher in differentiating pre-invasive lesions from invasive lesions.The higher the proportion of lobular lesions,proportion of solid components and CT value of solid nodules are,the greater the possibility of invasive lesions is.