CT平扫图像中的胸膜标记预测非毗邻非小细胞肺癌对脏层胸膜侵犯的初步研究

Preliminary study of pleural tags on CT scan to predict visceral pleura invasion of non-small cell lung cancer that does not abut the pleura

目的 :探讨CT平扫图像中的胸膜标记在预测非毗邻非小细胞肺癌(非毗邻NSCLC)对脏层胸膜侵犯程度中的应用。方法:回顾性分析非毗邻NSCLC患者138例。CT平扫图像中将胸膜标记分为3种类型:1型,1个或多个线性胸膜标记;2型,1个或多个具有线性胸膜标记,并在胸膜侧可见软组织成分;3型,1个或多个软组织条索状胸膜标记,当存在多种类型时,优先判定为3型、2型和1型。根据第7版TNM分期将非毗邻NSCLC对脏层胸膜侵犯程度分为3个层次:PL0,无胸膜侵犯;PL1,肿瘤侵犯脏层胸膜的弹性层,但未达到脏层胸膜表面;PL2,肿瘤侵犯脏层胸膜表面;PL3,肿瘤侵犯壁层胸膜或胸壁。计算阳性似然比、精度、灵敏度、特异度、阳性预测值和阴性预测值。结果:胸膜标记27例(19.6%)缺失;1型59例(42.8%),2型21例(15.2%),3型31例(22.5%)。胸膜侵犯程度:PL0 95例(68.8%);PL1 21例(15.2%)、PL2 22例(16.0%)。无胸膜标记患者均无胸膜侵犯,具有胸膜标记111例中43例(38.7%)存在脏层胸膜侵犯。2型胸膜标记能够适当预测非毗邻NSCLC患者存在脏层胸膜侵犯的可能性,其精度为70.8%,1型胸膜标记与脏层胸膜侵犯相关稍低,3型胸膜标记与脏层胸膜侵犯相关最低。结论:CT平扫图像中的2型胸膜标记可作为预测非毗邻NSCLC患者是否存在脏层胸膜侵犯的依据,以帮助外科医师把握最佳手术时机,进而改善非毗邻NSCLC患者的生存质量。该方法简单、易于掌握,适合在基层医疗机构推广。

Objective：To evaluate the association of pleural tags with visceral pleural invasion of non-small cell lung cancer（NSCLC） that does not abut the pleural. Methods：138 patients of NSCLC that does not abut the pleura were retrospectively analyzed. The pleural tags were classified into three types：type 1,one or more linear pleural tags;type 2,one or more linear pleural tags with soft tissue cord-like pleural end;type 3,one or more soft tissue cord-like pleural tags,and prioritized into type3,2 and 1 when more than one types were present. The pathologic analysis staged pleural invasion according to the TNM staging system（7 th Ed） as follows：PL0,no pleural involvement;PL1,tumor invasion to the elastic layer of the visceral pleura but without reaching the visceral pleural surface;PL2,tumor invasion to the visceral pleural surface;PL3,tumor invasion to the parietal pleura or chest wall. Positive likelihood ratio,diagnostic accuracy,sensitivity,specificity,positive and negative predictive value were calculated. Results：The results of pleural tags were following：27 cases（19.6%） absent,59 cases（42.8%） in type 1,21 cases（15.2%） in type 2 and 31 cases（22.5%） in type 3. The results of staged pleural invasion were following：95 cases（68.8%） in PL0,21 cases（15.2%） in PL1,22 cases（16.0%） in PL2,0 case in PL3. In the absence of pleural tags,no pleural invasion was found. In the pleural tags,pleural invasion was found in 43 cases（38.7%）. The presence of type 2 pleural tags was moderately associated with visceral pleural invasion（accuracy 70.8%）. Type 1 pleural tags provided weak evidence to rule out visceral pleural invasion. Type 3 pleural tags indicated minimum correlation to visceral pleural invasion. Conclusions：Type 2 pleural tags can be used as the basis for prediction of visceral pleura invasion in NSCLC that does not abut the pleura. This method is a view to the surgeon to good timing of surgery,thereby improving the life quality of patients with NSCLC that does not abut the pleura. This method is simple and easy to grasp and suitable for promotion in primary medical institutions.