26151例无症状健康体检人群低剂量CT肺癌筛查结果及肺癌结节的CT影像学特征与病理学研究

The low-dose computed tomography(LDCT)screening for early lung cancer in 26151 asymptomatic partici⁃pants and their CT characteristics and pathology

目的探讨低剂量CT(LDCT)在无症状健康体检人群中早期肺癌的筛查效果,并分析肺癌结节的CT影像学特征与病理学之间的相关性。方法回顾性分析2017年1月至2019年12月期间在我院行胸部LDCT早期肺癌筛查的26 151例无症状健康人群,分析LDCT的肺癌筛查效果,并按照肺腺癌多学科分类标准将肺癌结节分为不典型增生结节(AAH)组、原位癌(AIS)组、微浸润癌(MIA)组及浸润癌(IAC)组,总结肺癌结节的CT影像学特征、病理资料,分析不同病理类型结节之间的差异。结果 26 151例LDCT早期肺癌筛查人群中,共检出肺癌患者135例,总检出率为5.16‰,男性检出率为3.87‰(52/13 449),女性检出率为6.53‰(83/12 702);检出肺癌结节数目为154个。结节分叶征、分叶类型、毛刺征、毛刺类型、空泡征、空气支气管征、胸膜凹陷及结节性质在四组间具有统计学差异(χ~2分别=52.78、6.74、38.56、5.86、13.04、17.54、23.53、56.22,P均<0.05);利用最大径、m-CT值评估结节是否为浸润性病变(含微浸润癌、浸润癌)的ROC曲线下面积分别为0.78、0.84,当结节的最大径≥10.5 mm时,提示结节为浸润性病变的特异度为88.90%,灵敏度为55.10%;当结节的m-CT值≥-548 HU时,提示结节为浸润性病变的特异度为88.90%,灵敏度为72.90%;并且m-CT值评估结节为浸润性病变的诊断效能优于结节最大径,差异具有统计学意义(χ~2=4.76,P<0.05)。结论 LDCT检查能够良好评估结节的影像学特征,可明显提高无症状体检人群早期肺癌的检出率,帮助临床制定个体化治疗方案、改善肺癌患者的预后。

Objective To explore the screening result of low-dose computed tomography(LDCT)for early lung cancer in asymptomatic participants and analyze the correlations between LDCT characteristics and pathology of nodules.Meth⁃ods Totally 26151 asymptomatic participants who underwent chest LDCT scanning in our hospital from January 2017 to December 2019 were retrospectively reviewed.According to the multidisciplinary classification criterion of lung adenocarcinoma,the nodules were divided into atypical adenomatous hyperplasia(AAH)group,adenocarcinoma in situ(AIS)group,minimally invasive carcinoma(MIA)group and invasive cancer(IAC)group.The CT imaging features and pathological data of nodules were summarized,and the differences among different pathological types of nodules were analyzed.Results Of the 26151 participants,a total of 135 lung cancer patients and 154 nodules were found,with the detection rate of 5.16‰,3.87‰(52/13449)in males and 6.53‰(83/12702)in females.The lobulated sign,lobulation type,spiculated sign,spiculation type,vacuole sign,air bronchogram,pleural indentation,and vessel through of nodules were significantly different among the four groups(χ2=52.78,6.74,38.56,5.86,13.04,17.54,23.53,56.22,P<0.05).The areas under the ROC curve of maximum diameter of nodule and m-CT value for diagnosing infiltrating lesion(including MIA and IAC)were 0.78 and 0.84,respectively.When the maximum diameter of nodule was greater than 10.5mm,the diagnostic specificity and sensitivity were 88.90%and 55.10%.When the m-CT value was greater than-548 HU,the diagnostic specificity and sensitivity were 88.90%and 72.90%.The m-CT value was significantly better than the maximum diameter of nodule in diagnosing infiltrating lesion(χ2=4.76,P<0.05).Conclusion LDCT can shows the imaging features of nodules well and significantly improve the detection rate of early lung cancer in asymptomatic participants,which would help design individualized treatment strategies and improve prognosis of lung cancer patients.