自身抗体联合高分辨率CT用于评价纯磨玻璃结节中肺腺癌浸润性的价值

The value of evaluating the invasion of lung adenocarcinoma using autoantibodies combined with HRCT in pure ground⁃glass nodule

目的评估自身抗体联合高分辨率CT预测纯磨玻璃结节中肺腺癌浸润性的价值。方法收集湖北省第三人民医院行胸部高分辨率CT表现为单一纯磨玻璃结节,并经手术病理活检确诊为肺腺癌患者共101例,分为浸润前及浸润性病变组。观察两组的自身抗体阳性率及影像学征象,比较其差异性。结果分叶、毛刺、空泡征、空气支气管征、胸膜凹陷征、血管集束征在浸润前及浸润性病变间差异无统计学意义(P>0.05);浸润性病变的直径、平均CT值、自身抗体阳性率明显高于浸润前病变,差异均有统计学意义(P<0.05);受试者工作特征曲线示,浸润前与浸润性病变病灶直径、平均CT值的最佳临界值分别为10.33 mm、-526.21 HU,敏感度分别为75.5%、92.5%,特异度分别为89.6%、68.7%,曲线下面积分别为0.888、0.737;联合自身抗体时敏感度92.5%,特异度89.6%,曲线下面积0.956。结论纯磨玻璃结节的大小、平均CT值、自身抗体可有助于判断肺腺癌浸润与否;高分辨率CT与自身抗体联合诊断时,价值更高。

Objective To evaluate the value of autoantibodies combined with high resolution CT in predicting the invasion of lung adenocarcinoma in pure ground⁃glass nodule.Methods The surgical pathological biopsy of 101 cases of lung adenocarcinoma from Hubei Province′s third people′s hospital,and their chest high resolution CT revealed a single pure ground⁃glass nodule.The patients were divided into two groups:preinvasive and invasive.The positive rate of autoantibodies and imaging signs in the two groups were observed and compared.Results There were no significant differences in lobulation,Burr,vacuole sign,air bronchus sign,pleural indentation sign,and vascular bundle sign between preinvasive and invasive lesions(P>0.05).The diameter,average CT value and autoantibodies positive rate of invasive lesionswere significantly higher than those of preinva⁃sive lesions,the differences were statistically significant(P<0.05).According to the receiver operating character⁃istic curve,the best critical value of lesion diameter was 10.33 mm,and the mean CT value was⁃526.21 HU.To differentiate between preinvasive and invasive lesions,the sensitivity was 75.5%and 92.5%,respectively,the specificity was 89.6%and 68.7%,and the area under the curve was 0.888 and 0.737.The combined autoantibod⁃ies′sensitivity,specificity,and area under the curve were 92.5%,89.6%,and 0.956,respectively.Conclusion The size,mean CT value,and autoantibodies of a pure ground⁃glass nodule can help to determine whether adenocarcinoma of the lung is invasive.When high resolution CT is combined with autoantibodies,it becomes more valuable.