囊腔型肺结节CT影像学特征探究及良恶性预测模型的建立

Exploration of CT imaging features of cystic pulmonary nodules and establishment of a prediction model for benign and malignant pulmonary nodules

目的探讨囊腔型肺结节CT影像学特征及恶性结节的独立危险因素,建立囊腔型肺结节良恶性预测模型。方法回顾性纳入2017年1月—2022年2月内江市第一人民医院胸外科收治的囊腔型肺结节患者,根据病理结果分成恶性组与良性组。收集两组患者临床资料、术前胸部CT影像学特征,通过logistic回归分析筛选恶性囊腔型肺结节的独立危险因素,从而建立囊腔型肺结节良恶性预测模型。结果共纳入107例患者,其中恶性组76例,男36例、女40例,平均年龄(59.65±11.74)岁;良性组31例,男16例、女15例,平均年龄(58.96±13.91)岁。Logistic回归分析显示,囊腔壁结节[OR=3.538,95%CI(1.231,10.164),P=0.019]、短毛刺[OR=4.106,95%CI(1.454,11.598),P=0.008]、囊腔壁形态[OR=6.978,95%CI(2.374,20.505),P<0.001]、囊腔个数[OR=4.179,95%CI(1.438,12.146),P=0.009]是恶性囊腔型肺结节的独立危险因素。建立预测模型:P=e^(x)/(1+e^(x)),X=−2.453+1.264×囊腔壁结节+1.412×短毛刺+1.943×囊腔壁形态+1.430×囊腔个数。本预测模型受试者工作特征曲线下面积为0.830,灵敏度为82.9%,特异性为74.2%。结论囊腔壁结节、短毛刺、囊腔壁形态、囊腔个数是囊泡型肺癌的独立危险因素,所建立的预测模型可作为囊腔型肺结节良恶性筛查方法。

Objective To explore the CT imaging features and independent risk factors for cystic pulmonary nodules and establish a malignant probability prediction model.Methods The patients with cystic pulmonary nodules admitted to the Department of Thoracic Surgery of the First People's Hospital of Neijiang from January 2017 to February 2022 were retrospectively enrolled.They were divided into a malignant group and a benign group according to the pathological results.The clinical data and preoperative chest CT imaging features of the two groups were collected,and the independent risk factors for malignant cystic pulmonary nodules were screened out by logistic regression analysis,so as to establish a prediction model for benign and malignant cystic pulmonary nodules.Results A total of 107 patients were enrolled.There were 76 patients in the malignant group,including 36 males and 40 females,with an average age of 59.65±11.74 years.There were 31 patients in the benign group,including 16 males and 15 females,with an average age of 58.96±13.91 years.Multivariate logistic analysis showed that the special CT imaging features such as cystic wall nodules[OR=3.538,95%CI(1.231,10.164),P=0.019],short burrs[OR=4.106,95%CI(1.454,11.598),P=0.008],cystic wall morphology[OR=6.978,95%CI(2.374,20.505),P<0.001],and the number of cysts[OR=4.179,95%CI(1.438,12.146),P=0.009]were independent risk factors for cystic lung cancer.A prediction model was established:P=e^(x)/(1+e^(x)),X=–2.453+1.264×cystic wall nodules+1.412×short burrs+1.943×cystic wall morphology+1.430×the number of cysts.The area under the receiver operating charateristic curve was 0.830,the sensitivity was 82.9%,and the specificity was 74.2%.Conclusion Cystic wall nodules,short burrs,cystic wall morphology,and the number of cysts are the independent risk factors for cystic lung cancer,and the established prediction model can be used as a screening method for cystic pulmonary nodules.