钙化点大小对肺结节良恶性诊断的价值

The Clinical Value of Pulmonary Calcified Lesion Size in Differentiating Malignant from Benign Lung Nodules

目的定量研究肺结节内钙化点大小对肺结节性质预测的能力。方法经病理或随访证实的肺结节240例(良性70例,恶性170例)。利用最大方差和阈值生长法提取肺结节内钙化点,并计算每个钙化点的面积(Area Ca)及面积比(Sr)。结果良性钙化点的Area Ca和Sr均明显大于恶性(Area Ca:17.31 mm2vs 1.53 mm2;Sr:5.31%vs 0.38%),二者之间差异显著(P=0.000),当良恶性钙化点的Area Ca和Sr的截断值分别为7.055mm2和1.725%时,以肺结节内最大钙化点大小的良恶性来预测肺结节性质的灵敏度、特异度及ROC曲线下面积分别为81.25%、100%和0.885。结论肺结节内最大钙化点的大小能较好反映肺结节的特性,大面积钙化点是良性钙化模式。

Objective To quantitatively evaluate the pulmonary calcified lesion size in predicting the pathologic nature of benign and malignant lung nodules. Methods A total of 240 cases with pathologically-confirmed pulmonary nodules,including 170 malignant and 70 benign lesions,were enrolled in this study. Chest CT examination was performed in all patients. A segmentation algorithm based on maximal variance was use to determine each area of calcification（ Area Ca） and area ratio（ Sr）. Results The Area Ca and Sr of calcification in benign nodules were obviously higher than those in malignant nodules（ Area Ca： 17. 31 mm2 vs. 1. 53 mm2; Sr： 5. 31% vs. 0. 38% respectively）. The difference between the two groups was statistically significant（ P = 0. 000）. When the cut-off points of Area Ca and Sr were 7. 05 and 1. 725 respectively,the predicting sensitivity,specificity of the largest calcification for pulmonary malignant and benign lesions were81. 25% and 100% respectively,and the area under ROC was 0. 885. Conclusion The size of the largest calcification within pulmonary nodule can well reflect the nature of lung nodules,and large area calcification should be regarded as a benign calcification pattern.