CT征象鉴别纯磨玻璃结节中高分化浸润性腺癌的价值

The value of CT features in differentiating moderately and highly differentiated invasive adenocarcinoma in pure ground glass nodule

目的探讨CT征象对鉴别纯磨玻璃结节(pGGN)中分化浸润性腺癌(IAC)与高分化IAC的价值。方法收集经手术病理确诊为IAC,胸部CT表现为pGGN的83例患者(84个病灶)的影像资料。根据病理结果分为高分化组(附壁为主型46个病灶,45例)和中分化组(腺泡或乳头为主型38个病灶,38例),比较2组患者的临床资料及pGGN的CT征象的差异,分析影响患者分化程度的因素及诊断价值。结果中分化组的最大直径、平均CT值水平及毛刺征、异常血管征、异常支气管征的发生率高于高分化组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,较高水平的平均CT值(OR=1.042,95%CI:1.022~1.062)与异常血管征(OR=5.869,95%CI:1.105~31.161)是预测中分化IAC的独立危险因素。ROC曲线分析显示,平均CT值与异常血管征两者联合诊断中分化IAC的曲线下面积为0.903(0.842~0.964),敏感度为0.870,特异度为0.789,其诊断效能及敏感度高于平均CT值,但平均CT值的诊断特异度较高。结论平均CT值与异常血管征的联合诊断对CT表现为pGGN的中分化IAC具有较高的预测价值。

Objective To investigate the value of CT signs in differentiating pure ground glass nodule(pGGN)between moderately differentiated and highly differentiated invasive adenocarcinoma(IAC).Methods The clinical data of 83 patients with IAC and imaging data of 84 pGGNs were retrospectively collected.According to the pathological results,patients were divided into the highly differentiated group(46 lesions of lepidic dominant type,45 patients)and the moderately differentiated group(38 lesions of acinar or papillary dominant type,38 patients).The clinical data and CT features of pGGN were compared between the two groups,and the factors influencing the differentiation degree and diagnostic value in patients were analyzed.Results There were significant differences in maximum diameter,mean CT value,burrs,abnormal vascular signs and abnormal bronchus signs between the moderately differentiated group and the highly differentiated group(P<0.05).Multivariate Logistic regression analysis showed that the higher mean CT value and abnormal vascular signs were important influencing factors in the prediction of moderately differentiated IAC,and the odds ratios(95%confidence interval)were 1.042(1.022-1.062)and 5.869(1.105-31.161)respectively.ROC curve analysis showed that in the combined diagnosis of mean CT value and abnormal vascular signs,the area under the curve of moderately differentiated IAC was 0.903(0.842-0.964),the efficiency was 0.870,the sensitivity was 0.789.The diagnostic efficacy and sensitivity were higher than the mean CT value,but the diagnostic specificity of average CT value was higher.Conclusion The combined diagnosis of mean CT value and abnormal vascular signs has high predictive value for moderately differentiated IAC with pGGN on CT.