CT定量参数预测评估肺混合磨玻璃结节侵袭性的临床价值

The clinical value of predicting the invasiveness of pulmonary mixed ground-glass nodules by CT quantitative parameters

目的:探讨CT定量参数对肺混合磨玻璃结节侵袭性的预测价值。方法:回顾性分析天津医科大学肿瘤医院2013年1月至2016年9月经手术病理证实的164例肺混合磨玻璃结节(mixed ground glass nodules,mGGNs)患者的CT图像。利用受试者工作曲线(ROC)及Logistic回归分析法评估微浸润腺癌(minimally invasive adenocarcinoma,MIA)和浸润性腺癌(invasive adenocarcinoma,IAC)的CT定量参数(肺窗最大径、肺窗最大径的最大垂直径、肺窗病灶体积、平均CT值、纵隔窗最大径、纵隔窗最大径的最大垂直径、纵隔窗病灶体积以及肿瘤影消失率(tumor disappearance rate,TDR)差异。结果:Logistic回归分析显示病灶肺窗最大径(OR=3.080,95%CI:1.135~8.355,P=0.027)及纵隔窗最大径(OR=5.881,95%CI:1.634~21.166,P=0.007)可独立预测mGGNs的侵袭性;两者联合应用所对应的曲线下面积为0.855,灵敏度为77.61%,特异度为86.67%,其截断点对应的肺窗最大径和纵隔窗最大径分别为1.902 cm和1.273 cm。结论:CT定量参数有助于预测评估肺混合磨玻璃结节的侵袭性,病灶肺窗最大径及纵隔窗最大径是其独立预测因子。

Objective： To discuss the value of CT quantitative parameters in prediction of the invasiveness of pulmonary mixed ground glass nodules （mGGNs）. Methods： CT images of 164 patients with pulmonary ground-glass nodules （mGGNs）, enrolled in Tianjin Medi- cal University Cancer Institute and Hospital from January 2013 to September 2016, confirmed by surgical pathology were analyzed ret- rospectively. CT quantitative parameters including maximum diameter, largest diameter perpendicular to the maximum diameter, vol- ume on both pulmonary window and mediastinal window, mean CT value and TDR （tumor shadow disappear rate） were evaluated be- tween minimally invasive adenocarcinoma （MIA） and invasive adenocarcinoma （IAC） with ROC and Logistic regression analysis. Re- sults： Logistic regression analysis showed that the maximum diameter of the pulmonary window （OR=3.080, 95%C1：1.135-8.355,P= 0.027） and the maximum diameter of the mediastinal window （OR=5.881, 95%Chl.634-21.166,P=0.007） independently predicted the invasiveness of mGGNs, the corresponding values of area under the curve of the combination of two parameters were 0.855, with sensitivity of 77.61% and specificity of 86.67 %. The cut-off point to the corresponding value of the maximum diameter on pulmonary win- dow and mediastinal window was 1.902cm and 1.273cm, respectively. Conclusions： CT quantitative parameters are helpful in predicting the invasiveness of mGGNs. The maximum diameters on both pulmonary window and mediastinal window are independent predictors.