孤立性肺结节CT征象的综合评价

The comprehensive evaluation on CT signs of single pulmonary nod.

目的 探讨CT征象的综合评价在孤立性肺结节(SPN)的应用价值。方法 (1)参照文献中SPN常见的12种对其良恶性鉴别价值较大的CT征象为评判依据。(2)用上述评判依据对回顾组(1998年1月～1999年10月期间)的68例经病理证实的SPN进行分析统计 ,得出良恶性两组各征象出现率分布情况 ;再对每一征象在两组的分布数据进行统计处理 ,征象发生率有明显差异 ,此征象恶性倾向为1 ,差异较小或不显著者恶性倾向为0.5 ,无此征象者为0。(3)对回顾组的每个病例进行恶性倾向的得分统计 ,再与病理对照 ,发现良性组得分均≤4 ,恶性组78.9 %得分>4 ,设定以4分为良恶性界定线 ,得分≥4 ,考虑为恶性诊断。(4)对1999年12月～2001年5月期间的60例SPN进行前瞻性研究 ,先用常规法诊断 ,再用上述综合评价的方法诊断 ,最后与病理加以对照。结果 60例SPN采用常规诊断法 ,符合率为73.3 %(44/60) ;采用综合评价方法诊断 ,符合率为88.3%(53/60)。经统计处理(p<0.05) ,两者有显著差异。结论 综合评价的诊断方法在SPN的良恶性鉴别中有重要意义 ,应取得大样本进一步完善。恶性倾向的得分在3.5～4.0之间的病例错判率为50% 。

Objective To explore the applied value of comprehensive evaluation on CTsigns of single pulmonary nod(SPN). Methods (1)The valuable CTsigns of distinguishing benign and malignant SPNfrom12common SPNrefering to literature were used as evaluation standard.(2)68cases SPN(from1998-1to1999-10,diagnosed by pathology)were analysed retrospectively and got signs information of benign and malignant SPN.Then each sign distributing data in benign and malignant SPN were statistical analysed and found that signs incidence had obvious difference.Sign that had malignant tendency was scored1.Sign that had little malignant trendency or had not significant malignant trendency was scored0.5and sign that had not malignant trendencywas scored0.(3)The score of malignant trendency in each case of retrospective analysis was added up and compared with pathological diagnosis,then we found that in benign SPNs,the scores were all less than4,but in malignant SPNs,78.9%scores were more than4.Thus score4could be used as boundary between benign and malignant SPN,those SPNs(score≥4)could be diagnosed as malignant SPNs.(4)60cases SPNs(from1999-12to2001-5)were investigated prospectively.Firstly all SPNs were diagnosed routinely,then the comprehensive evaluation method mentioned above was used,finally the diagnosis was contrasted with pathological diagnosis. Results Diagnosis correspondence rate with routine method in60SPNs was73.3%(44/60),while with comprehensive evaluation method,the diagnosis correspondence rate was88.3%(53/60),which had significant difference(P<0.05). Conclusions The diagnosis method of comprehensive evaluation was important in distinguishing diagnosis of benign and malignant SPN.The rate of diˉagnosing wrongly in those scored of malignant trendency were3.5-4.0were50%and these cases(scored3.5-4.0)should marked as suspect diagnosis