影像学指标预测胆囊肿瘤性息肉效果的研究

Study on the effect of imaging index in predicting the tumorous polyps of gallbladder

目的分析影像学指标预测胆囊肿瘤性息肉的效果。方法回顾分析2021年9月至2023年4月在北京大学第三医院因胆囊息肉样变(PLG)行胆囊切除术的223例患者资料, 其中男性94例, 女性129例, 年龄(48.0±13.9)岁。依据术后病理223例患者分为肿瘤性息肉组(n=51, 其中腺瘤性息肉50例、腺癌1例)和非肿瘤性息肉组(n=172, 均为胆固醇性息肉)。比较两组男性、合并其他恶性肿瘤(乳腺癌、甲状腺癌等)、彩超指标息肉长径、合并胆囊结石以及磁共振胰胆管成像(MRCP)息肉稍短T1信号、短T1信号等情况。将两组比较P<0.1的变量进一步代入多因素logistic回归, 分析胆囊肿瘤性息肉的影响因素。受试者工作特征(ROC)曲线分析预测PLG良性与恶性效果。结果肿瘤性息肉组合并其他恶性肿瘤比例高于非肿瘤性息肉组, 差异有统计学意义(χ^(2)=5.29, P=0.021)。与非肿瘤性息肉组比较, 肿瘤性息肉组息肉更大、合并胆囊结石更少, 息肉稍短T1信号、短T1信号更多, 差异均有统计学意义(均P<0.05)。将合并其他恶性肿瘤、MRCP短T1信号、MRCP稍短T1信号、男性、合并胆囊结石等P<0.1的变量进一步纳入多因素logistic回归分析。多因素分析结果显示, 合并胆囊结石(OR=3.027, 95%CI:1.234~7.426)和息肉更大(OR=3.665, 95%CI:1.567~8.573)的胆囊息肉患者为肿瘤性息肉风险增加, 合并其他恶性肿瘤(OR=0.200, 95%CI:0.052~0.765)的胆囊息肉患者为肿瘤性息肉风险降低(均P<0.05)。彩超指标息肉长径预测肿瘤性息肉的ROC曲线下面积为0.722(95%CI:0.643~0.801), 当息肉长径为1.05 cm时为最佳界值, 预测肿瘤性息肉的灵敏度为82.4%, 特异度为43.6%。结论息肉长径、合并胆囊结石、合并其他恶性肿瘤是胆囊肿瘤性息肉的影响因素, 彩超指标息肉长径预测胆囊肿瘤性息肉效果良好。

Objective To analyze the effect of imaging index in predicting the tumorous polyps of gallbladder.Methods Clinical data of 223 patients undergoing cholecystectomy due to polypoid lesion of gallbladder(PLG)in Peking University Third Hospital from September 2021 to April 2023 were retrospectively analyzed,including 94 males and 129 females,aged(48.0±13.9)years.According to postoperative pathology,patients were divided into the tumorous polyp group(n=51,including 50 adenomatous polyps and one adenocarcinoma)and a non-tumorous polyp group(n=172,all were cholesterol polyps).The two groups were compared in terms of concomitant malignant tumors(breast cancer,thyroid cancer,etc.),long diameter of polyp by ultrasound,combined gallstones,and slightly short T 1 signal and short T 1 signal of magnetic resonance cholangiopancreatography(MRCP)of polyps.The variables with P<0.1 between the groups were further substituted into multivariate logistic regression to analyze the influencing factors of gallbladder tumorous polyps.The receiver operating characteristic(ROC)curve was used to analyze the predictive effect.Results The proportion of patients with concomitant malignant tumors was higher in tumorous polyp group than that in non-tumorous polyp group(χ^(2)=5.29,P=0.021).Compared with the non-tumorous polyps,the tumorous polyps were larger in diameter,less combined with gallstones,and with more slightly short T 1 signals and short T 1 signals(all P<0.05).The variables with P<0.1,such as with other concomitant malignant tumors,slightly short T 1 and short T 1 signals on MRCP,male,and combined with gallstones,were further substituted into the multivariate logistic regression analysis,which showed that patients with larger polyps(OR=3.665,95%CI:1.567-8.573),combined with gallbladder stones(OR=3.027,95%CI:1.234-7.426)had an increased risk of tumorous polyps,with other concomitant malignant tumors(OR=0.200,95%CI:0.052-0.765)had decreased risk of tumorous polyps(all P<0.05).The area under the ROC curve(AUC)of the long diameter of polyp to predict tumorous polyps was 0.722(95%CI:0.643-0.801).When the long diameter of polyp was 1.05 cm,the predictive sensitivity was 82.4%and the specificity was 43.6%.Conclusion The long diameter of polyps,combined with gallbladder stones,and with other concomitant malignant tumors are influencing factors for tumorous polyps of gallbladder.The long diameter of polyps measured by ultrasound has a good predictivity of tumorous polyps.