CT影像学检查对肺部磨玻璃样小结节良恶性的鉴别诊断价值及影响因素分析

Value and Influencing Factors of CT Imaging in the Differential Diagnosis of Benign and Malignant Pulmonary Ground-glass Nodules

目的 研究CT影像学检查对肺部磨玻璃样小结节良恶性的鉴别诊断价值及影响因素。方法 选取2020年2月-2022年10月在我院诊治的75例肺部磨玻璃样小结节患者为研究对象,以病理诊断为标准(恶性22例,良性53例),均进行CT影像学检查,比较良恶性患者基线资料、CT影像学特征(胸膜凹陷征、毛刺征、分叶征、空泡征、边界清楚)、磨玻璃影形态特点(圆或椭圆、不规则状、斑片状、多结节融合状),分析CT影像鉴别结节良恶性的诊断效能(灵敏度、特异度、准确率、阳性预测值、阴性预测值),Logistic回归分析肺部磨玻璃样小结节良恶性的影响因素。结果 良、恶性患者性别比较,差异无统计学意义(P>0.05),良、恶性患者年龄、吸烟史、居住地、CT值比较,差异有统计学意义(P<0.05);恶性患者胸膜凹陷征、毛刺征、分叶征、空泡征、边界清楚率均高于良性患者(P<0.05);恶性患者圆或椭圆形态占比低于良性患者,不规则状、斑片状、多结节融合状形态占比均大于良性患者(P<0.05);CT影像鉴别诊断肺部磨玻璃样小结节良恶性的灵敏度为94.34%、特异度为86.96%、准确率为93.33%、阳性预测值为94.34%、阴性预测值为86.96%;Logistic回归分析显示,年龄、CT值、胸膜凹陷征、毛刺征、分叶征、空泡征为肺部磨玻璃样小结节良恶性的影响因素。结论 CT影像学检查对肺部磨玻璃样小结节良恶性的鉴别具有较高价值。同时,良恶性患者在CT影像学、磨玻璃影形态方面具有各自的临床特点。年龄、胸膜凹陷征、毛刺征、分叶征、空泡征以及CT值升高是恶性肺部磨玻璃样小结节的危险因素。

Objective To study the value and influencing factors of CT imaging in the differential diagnosis of benign and malignant pulmonary ground-glass nodules.Methods A total of 75 patients with pulmonary ground-glass nodules diagnosed and treated in our hospital from February 2020 to October 2022 were selected as the research objects.All patients were examined by CT imaging with pathological diagnosis as the standard(22 patients of malignant and 53 patients of benign).The baseline data,CT imaging features(pleural indentation sign,burr sign,lobulation sign,vacuole sign,clear boundary)and morphological characteristics of ground-glass shadow(round or oval,irregular,patchy,multi-nodular fusion)of benign and malignant patients were compared,and the diagnostic efficacy(sensitivity,specificity,accuracy,positive predictive value,negative predictive value)of CT imaging in differentiating benign and malignant nodules was analyzed.Logistic regression analysis was used to analyze the influencing factors of benign and malignant pulmonary ground-glass nodules.Results There was no significant difference in gender between benign and malignant patients(P>0.05).There were significant differences in age,smoking history,place of residence and CT value between benign and malignant patients(P<0.05).The pleural indentation sign,burr sign,lobulation sign,vacuole sign and boundary clarity rates of malignant patients were higher than those of benign patients(P<0.05).The proportion of round or elliptical morphology in malignant patients was lower than that in benign patients,and the proportion of irregular,patchy and multi-nodular fusion morphology was higher than that in benign patients(P<0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CT imaging in the differential diagnosis of benign and malignant pulmonary ground-glass nodules were 94.34%,86.96%,93.33%,94.34%and 86.96%,respectively.Logistic regression analysis showed that age,CT value,pleural indentation sign,burr sign,lobulation sign and vacuole sign were the influencing factors of benign and malignant pulmonary ground-glass nodules.Conclusion CT imaging examination has a high value in the differential diagnosis of benign and malignant pulmonary ground-glass nodules.At the same time,benign and malignant patients have their own clinical characteristics in CT imaging and ground glass shadow morphology.Age,pleural indentation sign,spiculation sign,lobulation sign,vacuole sign and increased CT value were risk factors for malignant pulmonary ground-glass nodules.