CT定量分析在肺磨玻璃结节浸润前病变微浸润性及浸润性腺癌中的鉴别诊断价值

【摘要】 目的 分析表现为纯肺磨玻璃结节(pGGN)或混杂磨玻璃结节(mGGN)的浸润性腺癌(IAC)与癌前病变(AAH和AIS)或微浸润性腺癌(MIA)的CT影像特征及鉴别诊断,同时研究在pGGN中AIS和AAH的鉴别诊断。方法 根据2011年国际肺癌研究协会肺腺癌的新分类,将266例病理诊断为GGN的患者纳入本研究中。将GGN分为pGGN和mGGN,在pGGN和mGGN中对病理为AAH-MIA(AAH,AIS,MIA)和IAC的两组CT影像特征分别进行比较;同时,在pGGN中进一步区分AIS组和AAH组。利用回归分析和ROC曲线对相应变量进行研究。结果 在pGGN中,AAH-MIA组和IAC组中病灶大小(P<0.001,OR=1.76,95%CI:1.36～2.27)和CT值(P<0.001,OR=1.01,95%CI:1.00～1.10)存在显著差异,AAH组和AIS组中病灶大小(P=0.043,OR=2.13,95%CI:1.03～4.42)和CT值(P=0.037,OR=1.03,95%CI:1.00～1.07)存在显著差异。在mGGN中,AAH-MIA组和IAC组中CT值(P=0.008,OR=1.01,95%CI:1.00～1.20)存在显著差异。ROC分析显示,在pGGN中,病灶大小(AUC:0.849,敏感度:86.7%,特异度:67.3%)和CT值(AUC:0.777,敏感度:84.4%,特异度:61.8%)与IAC显著相关。mGGN中CT值(AUC:0.777,敏感度:86.7%,特异度:69%)与IAC显着相关。结论 CT影像特征尤其是病灶大小和CT值对肺GGN浸润前病变、微浸润性及浸润性腺癌有诊断鉴别意义,同时也为临床处理GGN提供依据。更多还原

【Abstract】 Objective To investigate the multi-detector computed tomography(MDCT) features and differential diagnosis of preinvasive lesions(AAH,AIS),minimally(MIA) and invasive adenocarcinoma(IAC) appearing as ground-glass nodule(GGN),and to analyze differential diagnosis of AIS and AAH in pGGN.Methods 266 patients with pathologically diagnosed GGNs according to the 2011 IASLC/ATS/ERS classification were included into this study.The CT features of the AAH-MIA group(AAH,AIS,MIA) and IAC were compared and analyzed respectively in pGGNs and mGGNs.In addition,further distinguish between AIS group and AAH group in pGGNs.The corresponding variables were analyzed using regression ana-lysis and ROC curves.Results In pGGNs,significant differences were found in the lesion size(P<0.001,OR=1.76,95%CI:1.36～2.27) and CT value(P<0.001,OR=1.01,95%CI:1.00-1.10) between AAH-MIA group and IAC group,and lesion size(P=0.043,OR=2.13,95%CI:1.03～4.42) and CT value(P=0.037,OR=1.03,95%CI:1.00～1.07) could distinguish AIS from AAH.In mGGNs,significant differences were found in CT value(P=0.008.OR=1.01.95%CI:1.00-1.20) between AAH-MIA group and IAC group.Multivaria-te and ROC analyses revealed that in pGGNs,lesion size(AUC:0.849,sensitivi-ty:86.7%,specificity:67.3%) and CT value(AUC:0.777,sensitivity:84.4%,specificity:61.8%) were significantly associated with IAC group.CT value of the lesion(AUC:0.777,sensitivity:86.7%,specificity:69%) in mGGNs were significantly associated with IAC.Conclusion CT features,especially lesion size and CT value,have diagnostic and differential significance for the pulmonary preinvasive lesion,minimally and invasive adenocarcinoma of lung GGN,and also provide a basis for clinical management of GGN strategics.更多还原