手术前CT检查对磨玻璃样肺腺癌老年患者病理型别的判断效果

Effect of Preoperative CT Examination on the Pathological Type of Elderly Patients with Glass-like Lung Adenocarcinoma

目的:探讨手术前CT检查对磨玻璃样肺腺癌老年患者病理型别的判断效果。方法:回顾性分析30例磨玻璃样肺腺癌老年患者的临床资料。收集老年患者CT图像上病灶的大小、磨玻璃成分所占比例、病灶内实性成分的长径、最长径及大小,以病理结果为金标准评价CT对病理型别的判断效果。结果:微浸润腺癌(MIA)患者病灶的大小,病灶内实性成分长径、最长径及大小均明显低于浸润性腺癌(IAC)患者(P<0.05);MIA患者磨玻璃成分所占比例明显高于IAC患者(P<0.05)。结节大小、磨玻璃成分比例、实性成分长径、实性成分最长径和实性成分大小的AUC面积和诊断界值分别为0.682,14.39 mm;0.794,59.72%;0.891,4.41 mm;0.901,6.73 mm;0.803,4.51 mm。以病理诊断为金标准:结节大小、磨玻璃成分比例、实性成分长径、实性成分最长径和实性成分大小的阳性似然比和阴性似然比分别为0.63和0.65,0.68和0.71,0.75和0.84,0.80和0.87,0.73和0.82。结论:术前CT成像中的磨玻璃样结节实性成分对肺腺癌老年患者的病理类型有较好的鉴别价值,可作为老年患者的术前参考。

Objective： To investigate the effect of preoperative CT examination on the pathological types of elderly patients with grinding glass lung adenocarcinoma.Method：The clinical data of 30 elderly patients with glass lung adenocarcinoma were retrospectively analyzed.The size of the lesion, the proportion of ground glass components, the long diameter, the longest diameter and the size of the solid components in the CT images were collected.The pathological results were used as the gold standard to evaluate the effect of CT on the pathological types.Result： The size of the lesion, the solid component within the lesion size, the length and size of minimally invasive adenocarcinoma（MIA） were significantly lower than those of invasive adenocarcinoma（IAC） patients（P〈0.05）. Ground glass proportion in MIA patients was significantly higher than that in patients with IAC（P〈0.05）.The AUC area and cut-off values of size of the nodules and ground glass composition, the solid component diameter, the longest diameter of solid component and solid components size were 0.682, 14.39 mm; 0.794, 59.72%; 0.891, 4.41 mm; 0.901, 6.73 mm; 0.803, 4.51 mm.Pathological diagnosis as the gold standard： The positive and negative likelihood ratio of nodules size, proportion of ground glass composition, diameter of solid component, longest diameter of solid component and solid component size were 0.63 and 0.65, 0.68 and 0.71, 0.75 and 0.84, 0.80 and 0.87, 0.73 and 0.82.Conclusion： The solid component of the ground glass nodule in preoperative CT imaging is a valuable method for the diagnosis of lung adenocarcinoma in elderly patients, which can be taken as reference to elderly patients with preoperative.