CT薄层影像特征制定的肺结节分级评估系统区分良恶性肺结节的应用价值

Study on the application value of pulmonary nodules grading evaluation system based on thin-section CT image characteristics in differentiating benign and malignant pulmonary nodules

目的探究CT薄层影像特征制定的肺结节分级评估系统区分孤立性肺结节(SPN)良恶性的应用价值。方法回顾性分析我院2018年9月至2020年7月确诊的122例SPN患者的临床资料。采用CT薄层影像特征制定的肺结节分级评估系统进行分级评定,并以病理诊断结果为“金标准”,分析其准确性、敏感度及特异度,并通过Kappa检验分析其与病理诊断结果的一致性。结果病理诊断证实良性SPN 56例,占45.9%(56/122),多为不典型增生及错构瘤,占28.6%(16/56),恶性SPN 66例,占54.1%(66/122),多为腺癌及鳞癌;肺结节分级标准分类2级31例、3级29例、4A级9例、4B级53例;肺恶性结节中,空泡征、宝石征、肿瘤血管征、毛刺征的发生率明显高于肺良性结节(均P<0.05),而病灶周围有卫星病灶的发生率明显低于肺良性结节(P<0.05);将肺结节分级标准中3级及以下归为阴性结节,4级及以上归为阳性结节,诊断准确率为90.2%。肺结节分级标准诊断肺良性结节与病理结果表现出了较好的一致性(Kappa=0.803),以肺结节分级标准诊断肺良性结节的结果与“金标准”(病理诊断结果)比较,得到的敏感度87.9%(58/66)和特异度92.9%(52/56)。结论影像诊断时,合理利用基于CT薄层影像特征制定的肺结节分级评估系统能有效地分类CT筛查出的肺结节,较好区分SPN的良、恶性。

Objective To explore the application value of pulmonary nodules grading evaluation system based on thin-section CT image characteristics in differentiating benign and malignant solitary pulmonary nodules(SPN).Methods The clinical data of 122 patients with SPN confirmed in our hospital from September 2018 to July 2020 were retrospectively analyzed.The pulmonary nodules grading evaluation system developed by thin-section CT imaging features were used for grading and evaluation,and the pathological diagnosis results were taken as the"gold standard"to analyze their accuracy,sensitivity,and specificity,and the consistency was further analyzed by Kappa test.Results Based on the pathologic findings,there were 56 benign SPN(45.9%)and 28.6%of which were atypical hyperplasia and hamartoma.Additionally,there were 66 malignant SPN cases(54.1%)and mostly were adenocarcinoma and squamous cell carcinoma.Based on the standard classification of pulmonary nodules,there were 31 cases of grade 2,29 cases of grade 3,9 cases of grade 4A,and 53 cases of grade 4B.The incidence of vacuole sign,gem sign,vascular sign,and burr sign in malignant pulmonary nodules were significantly higher than that of benign pulmonary nodules(All P<0.05),while the incidence of satellite lesions around the lesions was significantly lower than that of benign pulmonary nodules(P<0.05).According to the pulmonary nodules grading standard,grade 3 and below were classified as negative nodules,while grade 4 and above were classified as positive nodules,with a diagnostic accuracy of 90.2%.The diagnostic criteria for pulmonary nodules showed good consistency with the pathological results(Kappa=0.803).Compared with the“gold standard”(pathological diagnosis),the diagnostic sensitivity and specificity of pulmonary nodules grading evaluation system on benign pulmonary nodules were 87.9%(58/66)and 92.9%(52/56).Conclusion In the imaging diagnosis of pulmonary nodules,the rational use of the pulmonary nodules grading evaluation system based on CT thin-layer imaging features can effectively classify the pulmonary nodules and have the potential to distinguish benign and malignant SPN.