视网膜母细胞瘤视神经侵犯影像学与病理学检查一致性分析

Analysis of the concordance between imaging and histopathologic finds in patients with retinoblastoma optic nerve invasion

目的分析视网膜母细胞瘤(RB)视神经侵犯的影像学检查与临床病理学检查的一致性。方法回顾性病例研究。2017年11月至2022年1月在北京同仁医院眼科中心确诊为RB并行眼球摘除手术的15例患儿15只眼纳入研究。其中,男性9例9只眼,女性6例6只眼;年龄(1.75±1.61)岁。所有患眼国际RB眼内分期为E期。15例患儿中,继发新生血管性青光眼7例;视网膜脱离呈闭合"漏斗状"且肿瘤触及晶状体后囊2例;肿瘤触及晶状体达后房6例。所有患儿均行CT或核磁共振成像(MRI)检查。其中,行CT检查4例,MRI检查4例,同时行MRI及CT检查7例。所有患儿均行眼球摘除手术,取眼球制作石蜡切片,取带有球后视神经组织的眼球矢状切面切片行病理学检查。手术后对比分析影像学与临床病理学诊断RB视神经侵犯的一致性。影像学诊断依据为视神经增粗和(或)强化。病理学诊断依据为RB肿瘤细胞跨越筛板生长。采用受试者工作特征曲线的曲线下面积(AUC)评价影像学检查的诊断能力,并基于混淆矩阵得出影像学检查的灵敏度、阳性预测值(PPV)及其95%可信区间(CI)。以病理学检查为金标准,采用组内相关系数(ICC)检验影像学检查与病理学检查的一致性。结果15例患儿均经病理学检查诊断为RB。15例患儿中,影像学诊断RB视神经侵犯7例,无视神经侵犯8例;手术后病理学诊断RB视神经侵犯12例,无视神经侵犯3例。其中,影像学检查与病理学检查结果一致者4例,MRI及CT检查的灵敏度和PPV分别为0.33(95%CI 0.11~0.64)及0.57(95%CI 0.20~0.88)。MRI及CT检查诊断能力的AUC分别为0.51(95%CI 0.24~0.77)和0.52(95%CI 0.25~0.78),诊断准确性均较低。以病理学检查为金标准,MRI及CT检查的ICC分别为0.61(95%CI 0.97~0.87)和0.63(95%CI 0.12~0.88);两者与病理学检查的一致性均为中等水平。结论与病理学检查结果比较,MRI及CT检查对RB视神经侵犯诊断的灵敏度和准确性均较低,两者与病理学检查的一致性仅为中等水平。

Objective To analyze the consistency of clinical imaging and clinicopathological finds of retinoblastoma(RB)optic nerve invasion.Methods A retrospective case study.Fifteen children with 15 eyes who were diagnosed with RB and underwent enucleation at the Eye Center of Beijing Tongren Hospital from November 2017 to January 2022 were included in the study.Among them,there were 9 males with 9 eyes and 6 females with 6 eyes.The mean age was 1.75±1.61 years.All affected eyes were designated International Classification of Retinoblastoma group E.There were 7 cases with secondary neovascularization glaucoma,2 cases with closed funnel-shaped detachment of the retina and tumor touching the posterior capsule of the crystal,and 6 cases with tumor touching the back surface of the crystal and posterior chamber of the 15 children.All children underwent CT or magnetic resonance imaging(MRI).Among them,CT examination was performed in 4 cases,MRI examination in 4 cases,and MRI and CT examination in 7 cases.All the children underwent eyeball enucleation,paraffin sections were taken from the eyeball,and sagittal section of the eyeball with optic nerve tissue was taken for pathological examination.Imaging diagnosis was based on optic nerve thickening and/or enhancement.The pathological diagnosis was based on the growth of RB tumor cells across the post-laminar of optic nerve.The pathological diagnosis was based on the growth of RB tumor cells across the sieve plate.The area under the curve(AUC)of receiver operating characteristic curve was used to evaluate the diagnostic ability of imaging examination.The sensitivity,PPV and 95%confidence interval(CI)of imaging examination were obtained based on the confusion matrix.With pathology as the gold standard,intragroup correlation coefficient(ICC)was used to test the consistency of imaging and pathology.Results All the 15 cases were diagnosed with RB by pathological examination.Of the 15 cases,7 cases were diagnosed with RB optic nerve invasion by imaging and 8 cases without nerve invasion;12 cases of RB optic nerve invasion were diagnosed by pathology after operation.Three cases without nerve invasion.Among them,4 cases had identical imaging and pathological findings.The sensitivity and PPV of MRI and CT were 0.33(95%CI 0.11-0.64)and 0.57(95%CI 0.20-0.88),respectively.The value of AUC(the area under the curve)in the ROC curve of MRI and CT were 0.51(95%CI 0.24-0.77)and 0.52(95%CI 0.25-0.78),respectively.The AUC values of both were 0.5-0.7,indicating low diagnostic accuracy.ICC test evaluated the consistency of MRI and CT with pathological examination,0.61(95%CI 0.97-0.87)and 0.63(95%CI 0.12-0.88)for MRI and CT,respectively.Therefore,the consistency of MRI,CT and pathology was moderate.Conclusion Compared with the pathological findings,the sensitivity and accuracy of MRI and CT in the diagnosis of RB optic nerve post-laminar invasion are lower,and the consistency between MRI and CT with pathology is only moderate.