多模态影像技术对不同病理类型肺癌患者骨转移的诊断及转移灶分布特点分析

Multimodal imaging technology for the diagnosis of bone metastasis in patients with different pathological types of lung cancer and the analysis of metastasis distribution characteristics

目的探讨多模态影像技术对不同病理类型肺癌患者骨转移的诊断效能及转移灶的分布特点。方法本研究为队列研究,选取2020年3月至2021年4月宝鸡市中心医院肿瘤科收治的632例肺癌患者,男480例,女152例,年龄(63.5±8.39)岁,年龄范围为38~84岁。患者分别行胸部CT检查及全身骨显像检查并行图像分析,统计患者的肺癌骨转移情况,比较胸部CT检查、全身骨显像检查及胸部CT检查联合全身骨显像检查(联合检查)的诊断效能及其一致性。结果632例患者中,肺鳞癌221例,肺腺癌251例,小细胞肺癌160例,骨转移164例。联合检查的灵敏度[98.8%(162/164)]及阴性预测值[99.5%(436/438)]高于全身骨显像检查[95.7%(157/164)、98.1%(418/425)]及胸部CT检查[61.6%(101/164)、88.1%(465/528)]、漏诊率[1.2%(2/164)]低于全身骨显像检查[4.3%(7/164)]及胸部CT检查[38.4%(63/164)]。肺腺癌患者的胸部CT检查(Kappa=0.707)、全身骨显像检查(Kappa=0.832)及联合检查(Kappa=0.906)一致性优于小细胞肺癌患者(Kappa=0.668、Kappa=0.800、Kappa=0.855)及肺鳞癌患者(Kappa=0.629、Kappa=0.642、Kappa=0.783);联合检查的一致性优于全身骨显像检查及胸部CT检查。肺鳞癌[13.6%(30/221)]、肺腺癌[35.5%(89/251)]、小细胞肺癌[28.1%(45/160)]骨转移发生率比较,差异有统计学意义(P<0.05)。肺鳞癌骨转移单发于胸廓骨[40.0%(12/30)]、脊柱骨[20.0%(6/30)]及四肢骨[3.3%(1/30)],单部位骨转移率为63.3%(19/30),多部位骨转移率为36.7%(11/30);肺腺癌骨转移单发于胸廓骨[11.2%(10/89)]、脊柱骨[9.0%(8/89)]、四肢骨[3.4%(3/89)]及骨盆骨[2.2%(2/89)],单部位骨转移率为25.8%(23/89),多部位骨转移率为74.2%(66/89);小细胞肺癌骨转移单发于胸廓骨[4.4%(2/45)]、脊柱骨[4.4%(2/45)]及四肢骨[2.2%(1/45)],单部位骨转移率为11.1%(5/45),多部位骨转移率为88.9%(40/45)。结论联合检查的灵敏度、阴性预测值及漏诊率优于全身骨扫描检查及胸部CT检查,肺腺癌的检查一致性优于小细胞肺癌及肺鳞癌,联合检查的一致性优于全身骨显像检查及胸部CT检查。肺鳞癌多单发于胸廓骨或脊柱骨,而小细胞肺癌骨转移常好发于多个部位,肺腺癌次之。

Objective To investigate the diagnostic efficacy of multimodal imaging in bone metastases of lung cancer patients with different pathological types and the distribution characteristics of metastases.Methods This study was a cohort study,a total of 632 patients with lung cancer were selected from the department of Medical Oncology in Baoji Centeral Hospital from March 2020 to April 2021,including 480 males and 152 females,aged(63.5±8.39)years old,ranging form 38 to 84 years old.The patients underwent chest CT examination and systemic bone imaging examination and parallel image analysis,counted the bone metastasis of lung cancer,and compared the diagnostic efficacy and consistency of chest CT examination,systemic bone imaging examination and chest CT examination combined with systemic bone imaging examination(combined examination).Results Of the 632 patients,including 221 patients had pulmonary squamous cell carcinoma and 251 patients had pulmonary adenocarcinoma and 160 patients had small cell lung carcinoma,with 164 patients had bone metastasis.The sensitivity[98.8%(162/164)]and negative predictive value[99.5%(436/438)]of combined examination were higher than those of whole body bone imaging[95.7%(157/164),98.1%(418/425)]and chest CT[61.6%(101/164),88.1%(465/528)],and the rate of missed diagnosis[1.2%(2/164)]was lower than those of whole body bone imaging[4.3%(7/164)]and chest CT[38.4%(63/164)].The consistency of chest CT(Kappa=0.707),body bone imaging(Kappa=0.832)and combined examination(Kappa=0.906)in patients with pulmonary adenocarcinoma was better than that in patients with small cell lung carcinoma(Kappa=0.668,Kappa=0.800,Kappa=0.855)and pulmonary squamous cell carcinoma(Kappa=0.629,Kappa=0.642,Kappa=0.783).The consistency of combined examination was better than that of whole body bone imaging and chest CT.The incidence of bone metastasis among pulmonary squamous cell carcinoma[13.6%(30/221)],pulmonary adenocarcinoma[35.5%(89/251)]and small cell lung carcinomathe[28.1%(45/160)]compare,differences were statistically significant(P<0.05).The bone metastasis of pulmonary squamous cell carcinoma occurred in thoracic bone[40.0%(12/30)],spine bone[20.0%(6/30)]and limbs bone[3.3%(1/30)],the single site metastasis rate was 63.3%(19/30),and the multiple site bone metastasis rate was 36.7%(11/30).The bone metastasis of pulmonary adenocarcinoma in thoracic bone[11.2%(10/89)],spine bone[9.0%(8/89)],limbs bone[3.4%(3/89)]and pelvis bone[2.2%(2/89)],the single site metastasis rate was 25.8%(23/89),and the multiple site bone metastasis rate was 74.2%(66/89).Small cell lung carcinoma bone metastases occur in the sternum bone[4.4%(2/45)],spine bone[4.4%(2/45)],and extremities bone[2.2%(1/45)],the single site metastasis rate was 11.1%(5/45),and the multiple site bone metastasis rate was 88.9%(40/45).Conclusions The sensitivity,negative predictive value and missed diagnosis rate of combined examination were superior to those of systemic bone imaging examination and chest CT,and the consistency of pulmonary adenocarcinoma was superior to that of small cell lung carcinoma and pulmonary squamous cell carcinoma,the consistency of combined examination was better than that of whole body bone imaging and chest CT.Pulmonary squamous cell carcinoma mostly occurs in the thoracic bone or spine,while metastasis of the small cell lung carcinoma bone usually occurs in multiple sites,followed by pulmonary adenocarcinoma.