高分辨率CT在肺腺癌病理分型中的鉴别诊断价值分析

Analysis of Differential Diagnosis Value of High Resolution CT in Pathological Classification of Lung Adenocarcinoma

目的 探讨高分辨率CT在肺腺癌不同病理分型中鉴别诊断价值。方法 选取本院2018年5月至2019年5月收治的肺腺癌患者200例,按病理结果分为浸润前组、微浸润组、浸润组,分别有85例、61例、54例,通过行高分辨率CT检查,观察各组影像征象差异,并分析其鉴别诊断价值。结果 肺腺癌患者三组在病灶分布位置上无明显差异(P>0.05);三组患者在分叶征、毛刺征、空泡征、胸膜凹陷/牵拉征等影像征象及CT值、病灶最大径上差异明显(P<0.05);ROC曲线分析显示:鉴别浸润前病变与微浸润腺癌CT值、病灶最大径最佳截断值分别为-538.65HU、11.11mm,二者联合指标曲线下面积为0.933明显高于CT值、病灶最大径的曲线下面积(P<0.05),鉴别浸润性腺癌与微浸润腺癌CT值、病灶最大径最佳截断值分别为-486.57HU、13.06mm,二者联合指标曲线下面积为0.898明显高于CT值的曲线下面积(P<0.05)。结论 高分辨率CT可通过观察肿瘤病灶的影像征象、CT值和最大径对肺腺癌各亚型进行鉴别,且其CT值及病灶最大径具有较高临床诊断鉴别效能。

Objective to evaluate the value of high resolution CT in differential diagnosis of different pathological types of lung adenocarcinoma. Methods two hundred patients with lung adenocarcinoma treated in our hospital from May 2018 to May 2019 were divided into three groups according to the pathological results: pre-invasion group, micro-infiltration group and infiltration group. There were 85 cases, 61 cases and 54 cases in the three groups respectively. The differences of imaging signs in different pathological types were observed by high-resolution CT, and the value of differential diagnosis was analyzed. Results there was no significant difference in the location of lesions among the three groups(P>0.05), but there were significant differences in lobulation sign, spiculation sign, vacuole sign and pleural indentation/traction sign among the three groups(P<0.05). The imaging signs in the microinvasion group and the infiltration group were significantly more than those in the pre-invasion group(P<0.05), while those in the infiltration group were slightly higher than those in the micro-infiltration group, but the difference was not statistically significant(P>0.05). There were significant differences in CT value and maximum lesion diameter among the three groups(P<0.05). Compared with the preinvasion group, the CT value and the maximum diameter of lesions in the micro-infiltration group and infiltration group were significantly higher than those in the pre-invasion group(P<0.05). The CT value and the maximum diameter of lesions in the infiltration group were significantly higher than those in the infiltration group(P<0.05). ROC curve analysis showed that the best truncation values of CT value and maximum diameter of lesions for differentiating preinvasive lesions from microinvasive adenocarcinomas were-538.65HU and 11.11mm, respectively. The area under the curve of the combined index(0.933) was significantly higher than that of CT values and the area under the curve of the maximum diameter of lesions(P<0.05,0.05). The CT values and maximum diameter of lesions for differential differentiation of invasive adenocarcinomas and microinvasive adenocarcinomas were-486.57HU and 13.06mm, respectively. The area under the curve of the combined index(0.898) was significantly higher than that of CT value(P<0.05). Conclusion high resolution CT can distinguish the subtypes of lung adenocarcinoma by observing the imaging signs, CT value and maximum diameter of tumor lesions, and the CT value and maximum diameter of lesions have high clinical diagnostic and differential efficacy.