不同测量定义对不确定肺结节生长评估的敏感度和特异度评价

Sensitivity and specificity evaluation of different measurement definitions for evaluating the growth of uncertain pulmonary nodules

目的评价不同测量定义对不确定肺结节生长评估的敏感度和特异度。方法选取2020年5月至2022年6月通过低剂量计算机断层扫描(LDCT)筛查随访的不确定肺结节患者110例,使用三维可视化技术测量基线和随访LDCT上结节的直径和体积,分析体积增长>25%和平均直径生长>1.5 mm的不同定义评估结节性质的敏感度和特异度。结果110个结节中实性90个,部分实性20个。肺癌26个,其中实性11个,部分实性结节15个。1年随访期间体积增长29例,其中实性18例,部分实性11例,直径生长14例,其中实性7例,部分实性7例,肺癌结节中体积增长18例,直径生长11例,良性结节中体积增长11例,直径生长3例。体积和直径增长诊断肺癌的AUC分别为0.812和0.810,体积增长的敏感度为69.23%,高于直径生长的42.31%,体积增长的特异度为82.14%,低于直径生长的96.43%。结节平均直径和体积的类间相关系数分别为0.773和0.878。95%一致性界限(LoA)结节平均直径为-2.94~2.61 mm,结节体积为-85.53~107.41 mm^(3)。读者间一致性显示,体积增长的科恩kappa系数和百分比一致性为0.696和85.75%,直径生长为0.054和64.39%。结论在不确定肺结节的LDCT筛查后1年随访中,与平均直径生长>1.5 mm相比,结节体积增长>25%的生长评估具有更高的敏感度,但特异度较低。

Objective To evaluate the sensitivity and specificity of different measurement definitions in evaluating the growth of uncertain pulmonary nodules.Methods 110 patients with uncertain pulmonary nodules who underwent LDCT screening from May 2020 to June 2022 were selected.The diameter and volume of the nodules on baseline and follow-up LDCT were measured using three-dimensional visualization technology,and different definitions of volume growth>25%and average diameter growth>1.5 mm were analyzed to evaluate the sensitivity and specificity of nodule properties.Results Among the 110 nodules,90 were solid,20 were partially solid,and 26 were lung cancer,of which 11 were solid and 15 partial solid nodules.During the one-year follow-up period,there were 29 cases of volume increase,including 18 cases of solid,11 cases of partial solid,and 14 cases of diameter growth,including 7 cases of solid and 7 cases of partial solid.There were 18 cases of volume increase in lung cancer nodules,11 cases of diameter growth,11 cases of volume increase in benign nodules,and 3 cases of diameter growth.The AUC for volume and diameter growth were 0.812 and 0.810,respectively,and there was no significant difference between the two groups.The sensitivity of volume growth was 69.23%,higher than 42.31%of diameter growth,and the specificity of volume growth was 82.14%,lower than 96.43%of diameter growth.The inter class correlation coefficients for the average diameter and volume of nodules were 0.773 and 0.878,respectively.The average diameter of 95%LoA nodules was-2.94~2.61 mm,and the volume of nodules was-85.53~107.41 mm^(3).The inter reader consistency showed that the Cohen kappa coefficient and percentage consistency for volume growth were 0.696 and 85.75%,and diameter growth was 0.054 and 64.39%.Conclusion In the one-year follow-up of LDCT screening for uncertain pulmonary nodules,growth assessment with nodule volume growth>25%has higher sensitivity but lower specificity compared to average diameter growth>1.5 mm.