倍增时间在磨玻璃结节随访中的应用价值

Doubling Time of Ground Glass Nodules Follow-up of Application Value

目的探讨肿瘤倍增时间(DT)在肺内磨玻璃结节(GGNs)中的应用价值。方法回顾性分析2008年9月至2015年12月在华东医院诊治的78例肺内GGNs的影像学资料,结节均经手术切除,术后病理证实为微浸润性腺癌(MIA)和浸润性腺癌(IAC)。根据密度差异将初诊结节分为纯磨玻璃结节(pGGN)及混合性磨玻璃结节(mGGN),采用体积倍增时间(VDT)计算,不同类型结节的DT具有统计学差异。结果 78例GGNs中共有pGGN40例,mGGN 38例,术后病理:MIA 38例,IAC 40例。pGGN的平均DT为845天,mGGN的平均DT为538天,使用独立样本t检验,两者差异具有统计学意义(P<0.05)。设定DT≤730天、1095天、1460天,分别作为MIA和IAC的诊断阈值,pGGN诊断为MIA敏感性分别为67%、78%、73%,特异性33%、50%、29%,准确性50%、60%、56%。设定DT≤365天、730天、1095天,分别作为MIA和IAC的诊断阈值,mGGN诊断为MIA敏感性分别为25%、27%、24%,特异性50%、88%、89%,准确性33%、59%、58%。结论 mGGN较pGGN增长快速,随访中应缩短随访间隔及随访时间;初诊为pGGN时,以DT≤1095天作为手术点有较高的价值;初诊为mGGN时,以DT≤730天作为手术点有较高的价值。

Objective To explore the tumor doubling time of the pulmonary GGNs（ gound glass nodules） follow-up of the application value. Methods To follow-up and analyze CT imaging of 78 GGNs between September 2008 and December2015 in Shanghai Huadong Hospital. The nodules were confirmed as minimally invasive adenocarcinoma（ MIA） and invasive adenocarcinoma（ IAC） by surgery pathology. It is divided to 2 groups p GGN（ pure ground-glass nodule） and m GGN（ mixed ground-glass nodule） according to the density. Adopting VDT（ Volume doubling time） to calculate,doubling time of different types of GGNs had statistical differences. Results There are 40 p GGN and 38 m GGN,final postoperative pathology：38 MIA and 40 IAC. Averagely p GGN doubling time is 845 days,m GGN doubling time is 538 days. Adopting t-test of independent sample（ P〈0. 05）,thus the difference between both had statistical significance. Set the DT ≤ 730 days,1095days,1460 days,respectively as the diagnostic threshold for MIA and IAC,the sensitivity p GGN diagnosed as MIA was 67%,78%,73% respectively,the specificity is 33%,50%,29% respectively and the accuracy is 50%,60%,56%respectively. Set the DT≤365 days,730 days,1095 days,respectively as the diagnostic threshold for MIA and IAC,sensitivity p GGN diagnosed as MIA is of 25%,27%,24% respectively,the specificity is 50%,88%,89% respectively,the accuracy is 33%,59%,58% respectively. Conclusion m GGN growth is faster than p GGN,we should shorten the followup interval and follow0 up time. When firstly diagnosed as p GGN,it has higher value to set time of operation according to setting DT≤1095days; When firstly diagnosed as m GGN,it has higher value to set time of operation according to setting DT≤730days.