胸膜尾征预测最大径≤3cm周围型非小细胞肺癌侵犯脏层胸膜的CT研究

The CT study of the pleural tail sign predicting visceral pleural invasion of the peripheral non-small cell lung cancer with the maximum diameter of less than 3 cm

目的利用胸膜尾征评价最大径≤3cm的周围型非小细胞肺癌侵犯脏层胸膜。方法回顾性分析经病理证实的37例有脏层胸膜侵犯及168例无脏层胸膜受侵的最大径≤3cm的周围型非小细胞肺癌患者,根据肿瘤与胸膜的关系分成三种类型,计算各型具有胸膜尾征的肺癌脏层胸膜侵犯诊断的准确性、敏感性、特异性、PPV、NPV、LR+。结果Ⅲ型胸膜尾征预测肺癌侵犯脏层胸膜优于Ⅰ型、Ⅱ型,其特异度为89. 52%,准确度为78. 87%,敏感度为48. 65%,阳性预测值为62. 07%,阴性预测值为83. 19%,阳性似然比为4. 64。在CT上未出现胸膜尾征的不和胸膜相贴的最大径≤3cm的周围型非小细胞肺癌可以排除脏层胸膜侵犯。结论 CT图像上Ⅲ型胸膜尾征能提高术前诊断最大径≤3cm的周围型非小细胞肺癌侵犯脏层胸膜诊断的准确性。

Objective By use of pleural tail sign, to evaluate the peripheral non-small cell lung cancer (NSCLC) with the maximum diameter of less than 3 cm invading visceral pleural. Methods We retrospectively analyzed imaging of the peripheral NSCLC with the maximum diameter of less than 3 cm in 37 cases with visceral pleural invasion and 168 cases without visceral pleural invasion, which were all proved by histopathology. The lesion's relation to the pleura was classified into 3 types. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio (LR) were calculated. Results Type III pleural tail sign predicts lung cancer invading the visceral pleura better than type I and type II, the following results are specificity, 89.52%; accuracy, 78.87%; sensitivity, 48.65%; PPV, 62.07%; NPV, 83.19%; positive LR, 4.64. No pleural tail sign on CT images of the peripheral NSCLC with the maximum diameter of less than 3 cm that does not abut the pleura can exclude visceral invasion. Conclusion III type pleural tail sign on CT images can increase the accurate diagnosis of visceral pleural invasion by the peripheral NSCLC with diameter less than 3 cm before surgery.