Tongue image feature correlation analysis in benign lung nodules and lung cancer

Objective To analyze the differences in the correlation of tongue image indicators among patients with benign lung nodules and lung cancer.Methods From July 1;2020 to March 31;2022;clinical information of lung cancer patients and benign lung nodules patients was collected at the Oncology Department of Longhua Hos-pital Affiliated to Shanghai University of Traditional Chinese Medicine and the Physical Ex-amination Center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chi-nese Medicine;respectively.We obtained tongue images from patients with benign lung nod-ules and lung cancer using the TFDA-1 digital tongue diagnosis instrument;and analyzed these images with the TDAS V2.0 software.The extracted indicators included color space pa-rameters in the Lab system for both the tongue body(TB)and tongue coating(TC)(TB/TC-L;TB/TC-a;and TB/TC-b);textural parameters[TB/TC-contrast(CON);TB/TC-angular second moment(ASM);TB/TC-entropy(ENT);and TB/TC-MEAN];as well as TC parameters(perAll and perPart).The bivariate correlation of TB and TC features was analyzed using Pearson’s or Spearman’s correlation analysis;and the overall correlation was analyzed using canonical correlation analysis(CCA).Results Samples from 307 patients with benign lung nodules and 276 lung cancer patients were included after excluding outliers and extreme values.Simple correlation analysis indi-cated that the correlation of TB-L with TC-L;TB-b with TC-b;and TB-b with perAll in lung cancer group was higher than that in benign nodules group.Moreover;the correlation of TB-a with TC-a;TB-a with perAll;and the texture parameters of the TB(TB-CON;TB-ASM;TB-ENT;and TB-MEAN)with the texture parameters of the TC(TC-CON;TC-ASM;TC-ENT;and TC-MEAN)in benign nodules group was higher than lung cancer group.CCA further demon-strated a strong correlation between the TB and TC parameters in lung cancer group;with the first and second pairs of typical variables in benign nodules and lung cancer groups indicat-ing correlation coefficients of 0.918 and 0.817(P<0.05);and 0.940 and 0.822(P<0.05);re-spectively.Conclusion Benign lung nodules and lung cancer patients exhibited differences in correla-tion in the L;a;and b values of the TB and TC;as well as the perAll value of the TC;and the texture parameters(TB/TC-CON;TB/TC-ASM;TB/TC-ENT;and TB/TC-MEAN)between the TB and TC.Additionally;there were differences in the overall correlation of the TB and TC be-tween the two groups.Objective tongue diagnosis indicators can effectively assist in the diag-nosis of benign lung nodules and lung cancer;thereby providing a scientific basis for the ear-ly detection;diagnosis;and treatment of lung cancer.

Difference in microvascular structure between benign and malignant pulmonary nodules and its relationship with CT enhancement

Objective： To investigate the enhancement basis and the mechanisms of solitary pulmonary nodules （SPNs） by comparing the differences in microvascular structure between benign and malignant lesions. Methods： Dynamic contrast-enhanced CT scan was performed on 53 patients with SPNs （diameter〈3 cm, 38 peripheral lung cancers, 5 hamartomas, 10 inflammatory lesions） using a Siemens Plus S or a Marconi MX8000 multi slices spiral CT scanner. The time-attenuation curves were interpreted. The microvascular density （MVD） and the continuity of the microvessels＇ basemental membrane in the dissected specimens were observed with the ABC （avldin-biotin complex） immuno-histochemical method in all patients. Results ：The CT enhancement values of lung cancer （49.05± 16.08 HU） and inflammatory lesions （49.59±21.30 HU） were significantly higher than those of hamartoma （8.98±4.56 HU） t=7.48, P〈0.051 t=8.35, P〈0.05）. But the enhancement of lung cancer was similar to that of inflammatory lesions （t=0.76, P±0. 05）. The time attenuation curve of inflammatory lesions tended to increase faster and reached a higher peak compared to the lung cancer, and both of them maintained a high plateau after crossing. The hamartoma showed a slight increase in the time-attenuation curve and demonstrated a lowplateau curve. The MVD of SPNs was positively correlated with CT enhancement （r=0. 8051）. The microvascular counts of peripheral lung cancer （48.45±10. 09） and inflammatory lesions （49. 60±19. 94） were significantly higher than those of hamartoma （8.70±7. 30） （t=11. 64, P〈0.001, t=6. 09, P〈0. 001 ）, but no significant difference was found between lung cancer and inflammatory lesions （t= -0.26, P=0.799）. There was no difference in the continuity of basement membrane between nodules with anen haneement less than 30 HU and those with an enhancement higher than 30HU （X^2=3. 13, P〉0.05 ）. Conclusion： The microvascular counts mainly contribute to the enhancement value of SPNs. The basement membrane is not related to nodule enhancement, but it might influence the pattern of the time-attenuation curve.

Clinical study of preoperative fT4/fT3 quotient and thyroid function test in distinguishing benign from malignant thyroid nodules

Objective:To analyze the clinical and pathological characteristics of thyroid nodules and to explore the related risk factors of malignant thyroid nodules.Methods: According to the criteria of inclusion and exclusion, a total of 283 patients with thyroid nodules during January 2015 and December 2017 were divided into benign group (benign nodule,n =172) and malignant group (malignant nodule,n = 111) based on postoperative histopathological results. The age, sex, serum thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), thyroid stimulating hormone (TSH), free thyroxine (fT4), free three iodine thyroxine (fT3) and fT4/ fT3 ratio were subjected to univariate analysis, and the risk factors of malignant thyroid nodule were screened by multivariate logistic regression analysis.Results:Univariate analysis showed that age, TgAb, fT4 (P < 0.05) and fT4/ fT3 quotient (P < 0.01) were significantly different between the two groups. The fT4/fT3 quotient is a risk factor of malignant nodules. Multivariate logistic regression analysis indicated that the risk factors of malignant thyroid nodule were age (0R: 0.934,95% CI:0.911-0.957), TgAb(0R: 2.069,95% CI: 1.008-4.247) and fT4 (0R: 1.206,95% CI: 1.038-1.401).Conclusion: The fT4/fT3 quotient has important diagnostic value in differentiating benign and malignant thyroid nodules. When fT4 / fT3 > 3, it increases the risk of malignancy. The age, TgAb and fT4 are independent risk factors for malignant thyroid nodule, which is of great value in distinguishing benign from malignant thyroid nodules.

Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: An update

Pancreatic ductal adenocarcinoma is the most common malignant tumor of the pancreas. The remaining pancreatic tumors are a diverse group of pancreatic neoplasms that comprises cystic pancreatic neoplasms, endocrine tumors and other uncommon pancreatic tumors. Due to the excellent soft tissue contrast resolution, magnetic resonance imaging(MRI) is frequently able to readily separate cystic from noncystic tumors. Cystic tumors are often easy to diagnose with MRI; however, noncystic non-adenocarcinoma tumors may show a wide spectrum of imaging features, which can potentially mimic ductal adenocarcinoma. MRI is a reliable technique for the characterization of pancreatic lesions. The implementation of novel motionresistant pulse sequences and respiratory gating techniques, as well as the recognized benefits of MR cholangiopancreatography, make MRI a very accurate examination for the evaluation of pancreatic masses. MRI has the distinctive ability of non-invasive assessment of the pancreatic ducts, pancreatic parenchyma, neighbouring soft tissues, and vascular network in one examination. MRI can identify different characteristics of various solid pancreatic lesions, potentially allowing the differentiation of adenocarcinoma from other benign and malignant entities. In this review we describe the MRI protocols and MRI characteristics of various solid pancreatic lesions. Recognition of these characteristics may establish the right diagnosis or at least narrow the differential diagnosis, thus avoiding unnecessary tests or procedures and permitting better management.

Pulmonary benign metastasizing leiomyoma: A case report and review of the literature

BACKGROUND Pulmonary benign metastatic leiomyoma(PBML),which is very rare,is a type of benign metastatic leiomyoma(BML).Here,we report a case of PBML,finally diagnosed through multidisciplinary team(MDT)discussions,and provide a literature review of the disease.CASE SUMMARY A 55-year old asymptomatic woman was found to have bilateral multiple lung nodules on a chest high-resolution computed tomography(HRCT)scan.Her medical history included total hysterectomy for uterine leiomyoma.The patient was diagnosed with PBML,on the basis of her clinical history,imaging manifestations,and computed tomography(CT)-guided percutaneous lung puncture biopsy,via MDT discussions.As the patient was asymptomatic,she received long-term monitoring without treatment.A follow-up of chest HRCT after 6 mo showed that the PBML lung nodules were stable and there was no progression.CONCLUSION For patients with a medical history of hysterectomy and uterine leiomyoma with lung nodules on chest CT,PBML should be considered during diagnosis based on the clinical history,imaging manifestations,CT-guided percutaneous lung puncture biopsy,and MDT discussions.

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT), usually the identification is accidental. The overall prevalence of malignancy is relatively low but identification of malignancy of nodule is of prime importance. There are different characters of nodules indicating malignancy, and also the exposure of person to risk factors increases the chances of malignancy of nodule. Chances of malignancy rise with increasing size, the irregular, lobulated border of the nodules is highly associated with higher probability of malignancy and nodules with pure ground grass appearance have higher probability of malignancy, irregularly marginated nodule displaying a corona radiata sign indicating neoplastic infiltration with distortion of neighbouring tissue is almost certainly a malignant nodule. Stippled, punctuate, and eccentric calcifications are suggestive of malignancy. There are 20% - 75% of chances of malignancy if nodule is appeared with ground-glass opacity. Malignant nodules have higher growth rate as compared with benign nodules, malignant nodules usually have doubling time (DT) of 30 - 400 days while DT of more than 450 days is sign of benignity whereas doubling time less than 30 days is usually acute infectious process. The presence of fat within nodule is sign of benignity. Increasing density of the nodule is suggestive of malignancy and requires shorter follow up. Besides the nodule evaluation the chances of malignancy can also be evaluated through the exposure of patient to risk factors like age, current and past smoking status and history of extra thoracic malignancy. The management depends upon various factors mainly three strategies are applied for management including careful observation of nodule, use of diagnostic techniques like CT FNA, PET, and broncoscopy and surgery.

Comparison of three mathematical prediction models in patients with a solitary pulmonary nodule

Background： Effective methods for managing patients with solitary pulmonary nodules（SPNs） depend critically on the predictive probability of malignancy.Methods： Between July 2009 and June 2011, data on gender, age, cancer history, tumor familial history, smoking status, tumor location, nodule size, spiculation, calcification, the tumor border, and the final pathological diagnosis were collected retrospectively from 154 surgical patients with an SPN measuring 3-30 mm. Each final diagnosis was compared with the probability calculated by three predicted models—the Mayo, VA, and Peking University（PU） models. The accuracy of each model was assessed using area under the receiver operating characteristics（ROC） and calibration curves.Results： The area under the ROC curve of the PU model [0.800; 95% confidence interval（CI）： 0.708-0.891] was higher than that of the Mayo model（0.753; 95% CI： 0.650-0.857） or VA model（0.728; 95% CI： 0.623-0.833）; however, this finding was not statistically significant. To varying degrees, calibration curves showed that all three models overestimated malignancy.Conclusions： The three predicted models have similar accuracy for prediction of SPN malignancy, although the accuracy is not sufficient. For Chinese patients, the PU model may has greater predictive power.Background： Here, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection.Methods： Ten patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old（the mean age was 48.5 years old）. Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge.Results： All the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation.Conclusions： This new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.Background： The purposes of this study were to explore the effects of high mobility group protein box 1（HMGB1） gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma. Methods： The expressions of HMGB1 in glioma cells（U251, U-87 MG and LN-18） and one control cell line（SVG p12） were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected： the expression of HMGB1 in human glioma cell lines U251 and U-87 MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87 MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected. Results： As shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells（U251, U-87 MG, and LN-18） in comparison with the control cell line（SVG p12）; the vitality, proliferation and invasive capabilities of U251 and U-87 MG cells in the HMGB1 siR NA-transfected group were significantly lower than those in the blank control group and negative control（NC） siR NA group（P〈0.05） but showed no significant difference between the blank control group and NC siR NA group. The percentage of apoptotic U251 and U-87 MG cells was significantly higher in the HMGB1 siR NA-transfected group than in the blank control group and NC siR NA group（P〈0.05） but was similar between the latter two groups. The HMGB1 siR NA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87 MG cells and significantly higher expression of Bax protein than in the blank control group and NC siR NA group（P〈0.05）; the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siR NA group. Conclusions： HMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.

甲状腺良、恶性结节发病的影响因素及其Ordinal回归分析

目的了解不同人群中甲状腺良、恶性结节的发病情况及其影响因素。方法采取分阶段整群随机抽样方法,选取在某医院进行体检的人群进行一般情况及甲状腺疾病发生影响因素的问卷调查,数据资料采用Wilcoxon秩和检验和Kruskal-Wallis H检验,并进行Ordinal回归分析。结果共调查8 090名体检者,有效问卷8 039份,有效率99.37%。甲状腺正常者2 912名,占36.2%,结节性甲状腺肿、其他甲状腺良性疾病和甲状腺癌分别为2 470,1 539和1 118例,各占30.7%、19.1%和13.9%。单因素分析显示,工作单位、生存环境、从事职业、饮食习惯、电磁辐射、尾气尘埃等对体检人群发生甲状腺良、恶性结节的影响差异有统计学意义(P<0.05)。Ordinal回归分析显示,从事电化企业、银行工作、厨卫保洁的人群甲状腺疾病发生的概率分别是医药卫生系统的8.53倍(OR=8.53,95%CI:7.02~9.89)、1.69倍(OR=1.69,95%CI:1.26~1.94)和7.29倍(OR=7.29,95%CI:5.81~9.03)。与普通街区比较,生活或工作在干道工地旁、电器高压线旁和新近装修、尾气油烟尘埃之中为发生甲状腺疾病的危险因素。接触手机、电脑等电磁辐射越多,以及碘、钙、氟的过度摄入,甲状腺疾病发生的概率越高。结论甲状腺良、恶性结节发病的风险因素有手机、电脑、微波、电器等电磁辐射,建筑尘埃、雾霾、装修以及油烟尾气等;保护性因素则是花园式绿色环境。

基于改进胶囊网络的肺结节良恶性分类

肺结节良恶性鉴别在肺癌早期诊断中具有重要价值,深度学习技术特别是卷积神经网络(CNN)已成为该领域核心方法。然而,当前方法在处理肺结节大小、形状、生长方向等特征之间的空间关系时尚显不足,易受无关特征和噪声干扰。胶囊网络在处理特征空间关系和噪声上具有独特优势,但原始胶囊网络因其初始为单层卷积结构,只能处理手写数字体等简单图像,因此,文中提出一种改进的胶囊网络架构来解决上述问题。文中改进主要是对原始胶囊网络模型的增强与扩展,融入了双路并行卷积结构和反卷积层。并行卷积结构强化了模型对复杂图像特征的捕获能力,反卷积层增强了模型的空间解析力,提升了图像局部细节的识别精度。结合两者,改进的胶囊网络在肺结节良恶性分类任务中展现出高效的特征捕获能力和对噪声的鲁棒性。实验结果表明,在LIDC⁃IDRI标准数据集上,文中提出模型的各项性能指标优于现有方法,精确率达到了95.70%,特异性达到了98.58%,同时AUC高达97.98%。

超声特征及甲状腺影像报告与数据系统对BethesdaⅢ类甲状腺结节的风险评估价值

目的探讨超声特征及美国放射学会甲状腺影像报告与数据系统(ACR TI-RADS)对BethesdaⅢ类(意义不明确的非典型病变/意义不明确的滤泡性病变)甲状腺结节的风险评估价值。方法回顾性分析在山西医科大学附属人民医院行超声引导下细针穿刺细胞学检查提示BethesdaⅢ类且经手术病理证实的175例甲状腺结节患者,共180个结节,其中良性66个,恶性114个,比较良、恶性结节间内部成分、回声、边缘、形态及强回声类型,并将差异有统计学意义的指标纳入多因素Logistic回归分析。对每个甲状腺结节进行ACR TI-RADS分类,Spearman相关分析ACR TI-RADS分类与结节恶性风险的相关性。绘制受试者工作特性(ROC)曲线分析ACR TI-RADS分类对BethesdaⅢ类甲状腺恶性结节的诊断效能。结果单因素分析显示,良、恶性结节内部成分、回声、边缘、形态、强回声类型比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,纵横比>1、低回声、微钙化及混合钙化是恶性结节的独立危险因素(OR=4.903、4.608、4.458、3.821,均P<0.05)。相关性分析显示,随着ACR TI-RADS分类的增加,结节的恶性风险明显增加(r=0.653,P<0.05);ACR TI-RADS 5类为截断点,诊断BethesdaⅢ类甲状腺结节的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为83.3%、80.3%、82.2%、88.0%、73.6%,曲线下面积为0.841。结论BethesdaⅢ类甲状腺良恶性结节的常规超声特征存在差异,纵横比>1、低回声、微钙化及混合钙化为恶性结节的独立危险因素;ACR TI-RADS分类评分系统有助于BethesdaⅢ类甲状腺结节良恶性的判断,可用于指导临床管理。

MRI多b值DWI定量参数诊断实性肺结节良恶性的价值研究

目的 探讨MRI多b值DWI定量参数对实性肺结节良恶性的诊断价值。方法 分析本院经手术、穿刺活检及随访证实80例实性肺结节的临床及MRI资料为研究对象,恶性肺结节50例,良性30例。80例患者均行MRI多b值DWI序列检查, b值选取300、600、900、 1200s/mm^(2)。计算不同b值肺结节的表观弥散系数(ADC)值及DWI图像上测量病灶/脊髓信号比值(LSR)、病灶/骨骼肌信号比值(LMR)。符合正态分布的计量资料,采用组间t检验比较良恶性实性肺结节DWI各参数的差异,对于统计学分析有差异的参数,采用ROC并计算出AUC,分析DWI各参数诊断实性肺结节良恶性的诊断效能,获取最佳b值和阈值。结果 b值选取300、600、900、1200s/mm^(2)时,恶性肺结节ADC值均低于良性肺结节,差异有统计学意义(P<0.05),ROC曲线的AUC分别为0.672、0.714、0.850、0.728。且b值取900s/mm^(2)时,ADC值的诊断效能最大,鉴别诊断肺结节良恶性病变的阈值为1.29×10^(3)mm^(2)/s。b值选取300、600、900s/mm^(2)时,恶性肺结节LSR高于良性肺结节,差异有统计学意义(P<0.05),b值选取1200s/mm^(2)时,恶性肺结节LSR与良性肺结节的参数差异无统计学意义(P>0.05),ROC曲线的AUC分别为0.721、0.948、0.737。当b值取600s/mm^(2)时,LSR的诊断效能最大,鉴别诊断肺结节良恶性病变的阈值为0.36。b值选取300、600、900、1200s/mm^(2)时,恶性肺结节LMR与良性肺结节各参数差异无统计学意义(P>0.05)。结论MRI多b值DWI定量参数鉴别实性肺结节良恶性有较高的价值,b值取600 s/mm^(2)时,LSR的诊断效能最大,其次b值取900s/mm^(2)时,ADC值的诊断效能最大。

基于超声纹理特征与基于超声造影的预测模型鉴别最大径≤2 cm乳腺良恶性结节的对比研究

目的比较基于二维超声纹理特征(2D-Ultrasomics)的预测模型与基于超声造影(CEUS)的预测模型鉴别最大径≤2 cm乳腺良恶性结节的诊断价值。方法选取我院经病理确诊的乳腺结节患者109例(共112个结节),依据病理结果分为良性组58个和恶性组54个,均行二维超声及彩色多普勒(2D-CDUS)、CEUS检查,比较两组超声检查结果的差异;基于二维超声图像提取2D-Ultrasomics,使用最小绝对收缩和选择算子(LASSO)进行特征筛选。采用多因素Logistic回归分别构建2D-CDUS模型、2D-CDUS结合CEUS(2D-CD+CEUS)模型、2D-CDUS结合2D-Ultrasomics(2DCDUS+Ultrasomics)模型,绘制受试者工作特征(ROC)曲线评估各模型鉴别最大径≤2 cm乳腺良恶性结节的诊断效能;采用Hosmer-Lemeshow拟合优度检验评估模型的拟合度;绘制临床决策曲线评估模型的临床适用性。结果两组结节2D-CDUS图像特征(内部回声、边界、血流、短径)和CEUS图像特征(增强方式、增强时相、造影边界、增强均匀性、增强病灶范围)比较差异均有统计学意义(均P<0.05)。共提取818个2D-Ultrasomics,经过LASSO筛选后保留6个关键特征。根据多因素Logistic回归分析结果,纳入边界、短径构建2D-CDUS模型,纳入边界、短径、造影边界构建2D-CD+CEUS模型,纳入短径、灰度游程长度矩阵、灰度依赖矩阵、灰度大小区矩阵构建2D-CDUS+Ultrasomics模型。ROC曲线分析显示,2D-CDUS+Ultrasomics模型鉴别最大径≤2 cm乳腺良恶性结节的曲线下面积(AUC)为0.917,高于2D-CD+CEUS模型、2D-CDUS模型的AUC(0.892、0.823),且2D-CD+CEUS模型的AUC高于2D-CDUS模型的AUC,差异均有统计学意义(均P<0.001)。Hosmer-Lemeshow拟合优度检验显示,2D-CDUS模型、2D-CD+CEUS模型和2D-CDUS+Ultrasomics模型均具有良好的拟合度(P=0.818、0.103、0.281)。临床决策曲线分析显示,2D-CDUS+Ultrasomics模型在0.20~0.39、0.43~0.78及0.88~0.91概率阈值范围内具有较高的临床获益。结论基于2D-Ultrasomics的预测模型较基于CEUS的预测模型能更准确地鉴别最大径≤2 cm乳腺良恶性结节,有助于临床早期准确诊断乳腺小结节和制定治疗决策。

CT征象与Lung-RADS分级对孤立性肺结节良恶性鉴别价值

目的探讨肺部影像报告和数据系统(Lung-RADS分级)、CT征象对孤立性肺结节良恶性鉴别价值。方法选取2019年10月-2021年4月在我院确诊的84例孤立性肺结节患者,所有患者均经病理组织学确诊良性38例,恶性46例。分别对84例患者实施Lung-RADS分级、CT检查。以病理诊断为“金标准”,采用kappa一致性分析比较Lung-RADS分级和CT征象对孤立性肺结节良恶性的鉴别诊断价值。结果CT诊断敏感度为82.61%,特异度为86.84%,准确度为84.52%,恶性预测值为88.37%,良性预测值为80.49%,Kappa值为0.690;Lung-RADS分级诊断敏感度为76.09%,特异度为73.68%,准确度为75.00%,恶性预测值为77.78%,良性预测值为71.79%,Kappa值为0.497;联合两种方法诊断孤立性肺结节的敏感度为86.96%,特异度为89.47%,准确度为88.10%,恶性预测值为90.91%,良性预测值为85.00%,Kappa值为0.761。结论CT征象联合Lung-RADS分级对孤立性肺结节良恶性鉴别价值较高,与“金标准”具有较高的一致性。

气道内超声弹性成像鉴别肺癌患者肺门纵隔淋巴结良恶性的临床价值

目的探讨气道内超声弹性成像鉴别诊断肺癌患者肺门纵隔淋巴结良恶性的临床应用价值。方法选取于我院就诊的疑似肺癌患者87例(共147个淋巴结),经超声引导下支气管针吸活检证实良性56个,恶性91个。应用二维超声观察淋巴结形态、最大径、回声类型、内部回声分布及边缘是否清晰;气道内超声弹性成像获取淋巴结弹性评分及应变率比值,比较良恶性淋巴结二维超声和气道内超声弹性成像检查结果的差异。绘制受试者工作特征(ROC)曲线分析二维超声图像特征和定量参数,以及气道内超声弹性成像参数鉴别肺癌患者肺门纵隔淋巴结良恶性的诊断效能。结果二维超声检查显示,良恶性淋巴结最大径、形态回声类型、内部回声分布及边缘是否清晰比较差异均有统计学意义(均P<0.05)。气道内超声弹性成像检查显示,良恶性淋巴结弹性评分分别为(1.85±0.97)分和(3.36±0.91)分,应变率比值分别为20.62±17.12和87.67±49.17,差异均有统计学意义(均P<0.001)。ROC曲线分析显示,弹性评分和应变率比值鉴别肺癌患者肺门纵隔淋巴结良恶性的曲线下面积(AUC)分别为0.854和0.931,二者比较差异有统计学意义(P<0.05),且均高于二维超声图像特征和定量参数的AUC,差异均有统计学意义(均P<0.05)。结论气道内超声弹性成像可有效鉴别肺癌患者肺门纵隔淋巴结良恶性,具有较好的临床应用价值。

超声AI、弹性应变率及TSH检测在甲状腺结节良恶性鉴别中的应用研究

目的探讨超声人工智能(AI)、弹性应变率及促甲状腺激素(TSH)检测在甲状腺结节良恶性鉴别中的应用价值。方法本研究为回顾性研究,选取2022年1月至2024年2月延安市人民医院收治的甲状腺结节患者168例为研究对象,根据临床病理学检查结果分为良性组(n=106)和恶性组(n=62)。两组患者均行超声AI、弹性应变率及TSH检测。记录患者的病理检查结果,并以此为金标准,计算超声AI诊断结果、弹性应变率诊断结果、TSH水平诊断结果诊断甲状腺结节良恶性的特异度、灵敏度、误诊率、漏诊率,比较两组患者的TSH水平,采用受试者操作特征(ROC)曲线分析不同检查方法及联合检查的诊断效能。结果168例甲状腺结节患者中,共有206个甲状腺结节;经病理组织检查,良性组中20例淋巴细胞性甲状腺炎,28例增生性结节,58例甲状腺腺瘤;恶性组中52例甲状腺乳头癌,9例滤泡状癌,1例未分化癌。超声AI的诊断结果与病理检查结果比较,其灵敏度为90.32%,特异度为80.19%,漏诊率为9.68%,误诊率为19.81%。弹性应变率诊断结果与病理检查结果比较,其灵敏度为87.10%,特异度为87.74%,漏诊率为12.90%,误诊率为12.26%。恶性组患者的TSH水平为(2.54±0.52)mIU/L,显著高于良性组[(1.34±0.45)mIU/L],差异有统计学意义(P<0.05)。TSH诊断结果与病理检查结果比较,其灵敏度为88.71%,特异度为89.62%,漏诊率为11.29%,误诊率为10.38%。超声AI、弹性应变率、TSH及其联合诊断甲状腺结节良恶性的曲线下面积(AUC)值为0.809、0.824、0.841、0.903。结论超声AI、弹性应变率及TSH水平检测对于甲状腺结节良恶性诊断的效能较高,其中联合检测的应用价值更高。

乳腺超声BI-RADS 4类在乳腺癌患者良恶性鉴别中的应用

目的:探讨乳腺超声BI-RADS 4类在乳腺癌患者良恶性鉴别中的应用价值。方法:回顾性分析2023年1月—10月在盐城市妇幼保健院治疗的50例乳腺影像报告和数据系统(BI-RADS)4类乳腺结节患者的临床资料,均实施乳腺超声检查,以病理检查结果为金标准,分析乳腺超声对乳腺结节良恶性的诊断效能,对比良恶性结节的超声征象。结果:病理结果显示,恶性14例,良性36例;乳腺超声检查显示,恶性15例,良性35例,乳腺超声检查的灵敏度为85.71%、特异度为91.67%、准确率为90.00%,Kappa值=0.849,与病理检查结果一致性良好;恶性结节与良性结节在年龄、单发或多发、内部回声、后方回声方面差异无统计学意义(P>0.05),但恶性结节直径大于良性结节,且形态、边缘、高回声声晕、微钙化、汇聚征、弹性评分、血流分布等与良性结节相比差异有统计学意义(P<0.05)。结论:乳腺超声BI-RADS 4类在乳腺良恶性鉴别中的应用效果显著,良恶性病灶具有不同的超声影像特征,能提高对乳腺癌的诊断效能。

MSCT在孤立性肺结节良恶性鉴别诊断中的应用价值分析

目的探究多层螺旋CT(MSCT)在孤立性肺结节良恶性鉴别诊断价值。方法选取河南科技大学附属许昌市中心医院2021年1月至2023年1月收入孤立性肺结节总计72例,所有患者入院后均接受常规CT及MSCT检查,并以病理检查结果作为诊断金标准,分析MSCT在孤立性肺结节诊断效能以及良性结节与恶性结节CT征象特征。结果72例孤立性结节患者经病理检查,结果显示良性结节51例(70.83%)、恶性结节21例(29.17%)。MSCT的诊断准确率、特异性(93.06%、94.12%),高于常规CT(79.17%、80.39%),差异有统计学意义(P<0.05);恶性结节中钙化(14.29%)低于良性结节(39.22%),恶性结节中分叶征、毛刺征、胸膜凹陷征(85.71%、76.19%、71.43%),高于良性结节(13.73%、15.69%、7.84%),差异有统计学意义(P<0.05),而良性结节与恶性结节在空泡征对比差异无统计学意义(P>0.05);恶性结节中常规CT、MSCT中定量参数增强峰值(PH)、孤立性肺结节与主动脉强化峰值的比值(S_(PH)/A_(PH))均高于良性结节,差异有统计学意义(P<0.05)。结论MSCT应用于孤立性肺结节良恶性鉴别诊断中具有较高准确性,同时良恶性结节CT征象上差异显著,为临床早期鉴别诊断提供合理依据,医师能依据诊断结果制定出合理治疗方案。

高分辨率CT用于肺部小结节良恶性鉴别诊断的效果分析

目的分析高分辨率CT对肺部小结节良恶性的鉴别诊断效果。方法选取2021年2月至2023年4月我院收治的肺部小结节患者96例,均予以常规CT及高分辨率CT检查,评估图像质量,以最终手术病理结果为依据,分别进行两种检查方法与手术病理结果的一致性分析,比较两种检查方式的诊断效能。结果高分辨率CT图像质量优良率显著高于常规CT(P<0.05)。96例患者经手术病理检查确诊为肺癌阳性70例,阴性26例;高分辨率CT与手术病理诊断结果的一致性较好(κ=0.906,P<0.001);常规CT与手术病理诊断结果的一致性一般(κ=0.729,P<0.001)。高分辨率CT的灵敏度、特异度、准确率分别为97.14%、92.31%、95.83%,显著高于常规CT的80.00%、50.00%、71.88%(P<0.05)。结论与常规CT相比,高分辨率CT在肺部小结节良恶性鉴别诊断中的图像质量更佳,诊断效能更好,值得临床应用。

肺癌七项自身抗体联合检测在肺结节良恶性鉴别诊断中的应用价值

目的探讨肺癌七项自身抗体检测在肺结节良恶性鉴别诊断中的临床价值。方法选取肺癌患者45例作为观察组,另选同期收治的良性肺结节患者45例作为对照组,所有患者均采集血液进行抑癌基因53(p53)、干细胞转录因子2(SOX2)、肿瘤睾丸抗原7(GAGE7)、蛋白基因产物9.5(PGP9.5)、人癌抗原(Cage)、黑色素瘤抗原A1(MAGEA1)、肿瘤抗原4-5(Gbu4-5)检测,比较2组各抗体间差异;并依据肺癌肿瘤分期分为Ⅰ~Ⅱ、Ⅲ~Ⅳ期患者,比较2组各抗体间水平差异;绘制ROC曲线,分析各抗体及联合检测鉴别诊断良恶性肺结节的临床价值。结果观察组p53、SOX2、GAGE7、PGP9.5、Cage、MAGEA1、Gbu4-5水平高于对照组,差异有统计学意义(P<0.05)。45例肺癌患者中Ⅰ~Ⅱ期29例,Ⅲ~Ⅳ期16例;Ⅲ~Ⅳ期患者p53、SOX2、GAGE7、PGP9.5、Cage、MAGEA1、Gbu4-5水平高于Ⅰ~Ⅱ期患者,差异有统计学意义(P<0.05)。绘制ROC曲线显示,联合肺癌七项自身抗体检测鉴别诊断肺结节良恶性价值更高。结论肺癌七项自身抗体检测在肺结节良恶性鉴别诊断中价值高,可提高诊断灵敏度及特异度,有助于后续针对性治疗工作的开展。

C-TIRADS与ACR-TIRADS对甲状腺结节的诊断效能对比研究

目的 对比研究由中华医学会制定的中国甲状腺影像报告与数据系统(C-TIRADS)与美国放射学院制定的甲状腺影像报告与数据系统(ACR-TIRADS)对甲状腺结节的诊断效能。方法 回顾性分析经手术病理证实的511例(527个结节)甲状腺结节患者的超声图像,分别按照C-TIRADS、ACR-TIRADS标准进行分类。以病理结果作为金标准,计算各分类的恶性率,并与指南推荐恶性率进行对比;绘制受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC)。根据约登指数确定分类的最佳截断值,根据最佳截断值评价两种TIRADS对甲状腺结节良恶性的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。结果 病理结果显示,527个结节中,良性结节333个,其中结节性甲状腺肿311个,腺瘤12个,桥本甲状腺炎3个、亚急性甲状腺炎3个,单纯囊肿3个,肉芽肿结节1个;恶性结节194个,其中乳头状癌182个,滤泡癌8个,髓样癌2个,转移癌2个。以病理结果作为金标准,C-TIRADS 2、3、4A、4B、4C和5类的恶性率分别为0、1.97%、10.34%、46.58%、88.19%和91.67%;ACR-TIRADS 1、2、3、4和5类的恶性率分别为0、1.30%、3.73%、20.18%和83.42%。C-TIRADS各分类间恶性率对比,差异有统计学意义(P<0.05);ACR-TIRADS各分类间恶性率对比,差异有统计学意义(P<0.05)。除C-TIRADS 5类和ACR-TIRADS 3~5类恶性率高于指南推荐恶性率外,其余各分类实际恶性率低于指南推荐恶性率,或基本相符。C-TIRADS、ACR-TIRADS诊断甲状腺结节良恶性ROC曲线的AUC分别为0.865、0.864,AUC相当。C-TIRADS、ACR-TIRADS诊断甲状腺结节良恶性的最佳截断值分别为4B类、5类。C-TIRADS、ACR-TIRADS的敏感度、特异度、PPV、NPV分别为92.27%(179/194)、82.88%(276/333)、75.85%(179/236)、94.85%(276/291)和85.57%(166/194)、90.09%(300/333)、83.42%(166/199)、91.46%(300/328)。C-TIRADS的敏感度高于ACR-TIRADS,特异度低于ACR-TIRADS,差异有统计学意义(P<0.05);C-TIRADS的NPV略高于ACR-TIRADS,PPV略低于ACRTIRADS,差异均无统计学意义(P>0.05)。结论 C-TIRADS与ACR-TIRADS对甲状腺结节的良恶性鉴别诊断均具有较高的价值,诊断效能相当,但C-TIRADS较ACR-TIRADS更简便易行。