ⅠA期周围型肺腺癌CT形态学征象与脉管浸润的关系

Relationship between morphological features of CT and vascular invasion in early peripheral lung adenocarcinoma

目的:探讨临床ⅠA期周围型肺腺癌CT形态学征象与病理性脉管浸润的关系。方法:选择本院70例ⅠA期周围型肺腺癌患者,并将患者分为病理性脉管浸润组(37例)和无病理性脉管浸润组(33例),分析CT形态学征象与病理性脉管浸润的关系并评价其对病理性脉管浸润的诊断能力。结果:多因素Logistic回归分析显示,肺结节直径、混合磨玻璃结节(m GGN)实性成分直径、肿瘤中实性成分的比例(C/T)、毛刺征、异常静脉为病理性脉管浸润的独立危险因素,差异有统计学意义(均P <0. 05)。评价病理性脉管浸润的敏感性、特异性毛刺征高于异常静脉(毛刺征的敏感性为86. 5%,特异性为81. 8%;异常静脉的敏感性为70. 3%,特异性为63. 6%)。C/T评价病理性脉管浸润的曲线下面积(AUC)最高(0. 893),当利用Logistic回归模型结合毛刺征后,两者联合的AUC提高到0. 956,显著高于C/T单独诊断的AUC(z=2. 286,P=0. 022)。联合诊断的拟合方程为logit(P)=8. 871-1. 257×C/T值-4. 562×毛刺征。结论:肺结节直径、m GGN实性成分直径、C/T值、毛刺征和异常静脉是病理性脉管浸润的独立影响因素,C/T值联合毛刺征有望评估病理性脉管浸润的发生。

Objective: To explore the relationship between CT morphological signs and pathological vascular invasion in clinical stage Ⅰ A peripheral lung adenocarcinoma. Methods: Totally 70 patients with stage Ⅰ A peripheral lung adenocarcinoma in our hospital were enrolled. They were divided into pathologic vascular invasion group( n = 37) and no pathological vascular invasion group( n = 33). The relationship between CT morphological signs and pathological vascular invasion and its diagnostic value for pathologic vascular invasion was analyzed.Results: Multivariate Logistic regression analysis revealed that lung nodular diameter,mixed ground-glass nodule( m GGN) solid component diameter,consolidation/tumor( C/T),burr sign,and abnormal vein were independent risk factors for pathological vascular invasion,and the differences were statistically significant( all P < 0. 05). The sensitivity and specificity of burr symptom to evaluate pathologic vascular invasion was higher than that of abnormal vein( burr symptom: sensitivity = 86. 5%,specificity = 81. 8%;abnormal vein: sensitivity = 70. 3%,specificity =63. 6%). The highest AUC for pathologic vascular invasion was C/T( 0. 893). After using Logistic regression model combined with burr symptom,the combined AUC increased to 0. 956,which was significantly higher than the AUC of C/T( z = 2. 286,P = 0. 022). The fitted diagnostic equation was logit( P)= 8. 871-1. 257 × C/T value-4. 562 × burr symptom. Conclusion: The pulmonary nodule diameter,m GGN solid component diameter,C/T value,burr syndrom and abnormal vein are independent influencing factors for pathological vascular invasion. C/T value and burr syndrome are expected to evaluate pathological vascular invasion.