基因突变型NSCLC的CT特征在穿刺中的应用研究

The Application of CT Features of Gene-mutant NSCLC in Puncture

目的研究基因突变型非小细胞肺癌(non-smallcell lung cancer,NSCLC)的生物学改变,及引起CT影像组学特征之间的关联性,探讨CT影像组学特征对基因突变型NSCLC基因突变位置判断及指导精准穿刺的临床应用价值。方法回顾性分析本院2018年1月至2023年1月,病理证实为基因突变型NSCLC患者191例并已经全部进行基因检测,以病理学检查结果为对照,统计NSCLC的影像组学信息,分为4组,分别为对照组、CT值差异最大组、特殊形态学组、影像学综合评估组,进行对照分析,通过CT学特征评估精准选择活检定位区域,运用受试者工作特征(ROC)曲线分析评价各组对临床穿刺基因突变型NSCLC的诊断效能,分析各组临床活检基因突变型NSCLC的灵敏度、特异度、准确度及成功率。结果191例中,表皮生长因子受体基因(epidermal growth factor receptor,EGFR)基因突变94例、鼠类肉瘤病毒癌基因(Kirsten ratsarcoma viral oncogene homolog,KRAS)基因突变14例、人类表皮生长因子受体2(Human Epidermal GrowthFactor Receptor 2,HER2)基因突变30例、间质上皮转化因子(mesenchymal-epithelial transition factor,MET)基因突变18例、间变性淋巴瘤激酶(Anaplastic Lymphoma Kinase,ALK)基因突变35例。影像学综合评估组穿刺准确度97.2%,灵敏度100.0%,特异度92.3%,活检成功率100%。结论穿刺前进行影像学综合评估,能够精准获取较多的瘤体内有效组织成分,能够提高基因突变型NSCLC穿刺取材活检的成功率和准确率,为基因突变型NSCLC的靶向治疗方案选择提供精准性、前瞻性及科学性依据,减少患者穿刺取材的次数,减轻患者痛苦。

Objective To study the biological changes in the non-small-cell lung carcinoma of genetically mutated NSCLC(NSCLC),causing the association between CT imaging features,to evaluate the clinical value of CT imaging features in the diagnosis of gene mutation location and guidance of accurate puncture in gene-mutant NSCLC.Methods Retrospective analysis:from January 2018 to January 2023 in our hospital,191 cases of NSCLC with gene Mutant were pathologically confirmed and all of them had undergone Genetic testing.With the results of pathological examination as the control,we counted the imageomics information of NSCLC and divided them into four groups:the control group,the area with the highest CT value,the special morphology group,and the imaging comprehensive evaluation group for comparative analysis.The biopsy location area was specifically selected through CT radiological evaluation,Evaluate the diagnostic efficacy of each group for clinical biopsy gene mutant NSCLC using receiver operating characteristic(ROC)curve analysis,and analyze the sensitivity,specificity,accuracy,and success rate of each group for clinical biopsy gene mutant NSCLC.Results A study was conducted on 191 patients,Among them,there were 94 cases of Epidermal growth factor receptor(EGFR)gene mutation,14 cases of murine sarcomatosis oncogene(KRAS)gene mutation,30 cases of human Epidermal growth factor receptor receptor 2(HER2)gene mutation,and 18 cases of mesenchymal epithelial transition factor(MET)gene mutation,35 cases of anaplastic lymphoma kinase(ALK)gene mutations.The imaging comprehensive evaluation group had a puncture accuracy of 97.2%,sensitivity of 100.0%,specificity of 92.3%,and a biopsy success rate of 100%.Conclusion Comprehensive imaging evaluation before biopsy can accurately obtain more effective tissue components,and can improve the success rate and accuracy rate of biopsy in patients with mutated NSCLC,to provide accurate,prospective and scientific basis for the selection of targeted therapy for gene-mutant NSCLC,and to reduce the number of biopsy samples and alleviate the pain of patients.