CT征象对胸腺鳞状细胞癌的诊断价值研究

The Diagnostic Value of CT Features for Thymic Squamous Cell Carcinoma

目的:探讨CT征象对胸腺鳞状细胞癌的诊断价值。方法:搜集25例经病理证实的胸腺鳞状细胞癌患者的临床及CT资料,回顾性分析其CT征象,并与同时期病理证实的胸腺瘤低危组12例、胸腺瘤高危组14例共26例胸腺瘤对照分析。采用方差分析、χ^(2)检验或Fisher确切概率检验及k-w检验,进行组间CT征象差异比较。将组间差异有统计学意义的指标作为自变量,以胸腺鳞状细胞癌作为因变量进行二元Logistic回归分析,并最终得到与胸腺鳞状细胞癌诊断相关的独立危险因素。采用ROC曲线评价独立危险因素诊断胸腺鳞状细胞癌的效能。结果:25例胸腺鳞状细胞癌均位于前上纵隔。CT形态学征象单因素分析显示,胸腺鳞状细胞癌与胸腺瘤(低危组及高危组)在肿块形态、边界、大血管侵犯、心包侵犯、淋巴结转移、纵隔脂肪浸润的差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,肿块形态分叶状、淋巴结转移、纵隔脂肪浸润为诊断胸腺鳞状细胞癌的独立危险因子(OR值分别为2.998、10.558、42.251,P<0.05),三者的ROC曲线下面积(AUC)分别为0.741、0.699、0.788;肿块形态、分叶状诊断灵敏度最高(79.2%),纵隔内脂肪浸润的特异度最高(90.9%)。结论:前上纵隔肿瘤形态呈分叶状,伴淋巴结转移及纵隔脂肪浸润时,提示为胸腺鳞状细胞癌。CT征象对诊断胸腺鳞状细胞癌具有重要价值。

Objective:To investigate the diagnostic value of CT features for thymic squamous cell carcinoma(TSCC).Methods:The clinical and CT data of 25 patients with thymic squamous cell carcinoma confirmed by pathology were collected,and their CT features were analyzed retrospectively,and compared with 26 cases of thymoma(including 12 cases in thymoma low-risk group,and 14 cases in thymoma high-risk group)confirmed by pathology at the same period.Analysis of variance,chi-square test or Fisher′s exact probability test and kruskd-wallis test for independent samples were used to compare the differences of CT signs among the groups.Binary logistic regression analysis was conducted with the indexes with statistically significant differences between groups as independent variables and thymic squamous cell carcinoma as dependent variables,and finally the independent risk factors related to the diagnosis of thymic squamous cell carcinoma were obtained.ROC curve was used to evaluate the efficacy of independent risk factors in the diagnosis of thymic squamous cell carcinoma.Results:All the 25 cases of thymic squamous cell carcinoma were located in anterior mediastinum.Univariate CT morphologic analysis showed that there were statistically significant differences between TSCC and thymoma(low-risk group and high-risk group)in tumor shape,border,macrovascular invasion,pericardial invasion,lymph node metastasis and mediastinal fat infiltration(P<0.05).Logistic Regression analysis showed that lobulated mass,lymph node metastasis and mediastinal fat infiltration were independent risk factors for diagnosis of TSCC(with OR values of 2.998,10.558,42.251 respectively,and P<0.05).Their AUCs of ROC cure were 0.741,0.699,and 0.788 respectively.The diagnostic sensitivity of lobulated tumor was the highest(79.2%).and the diagnostic specificity of metastasis fat infiltration was the highest(90.9%).Conclusion:Lobulated anterior superior mediastinum tumor with lymph node metastasis and mediastinal fat infiltration is suggestive of thymic squamous cell carcinoma.CT diagnosis of thymic squamous cell carcinoma is of great value.