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    HRCT定量参数预测亚实性结节肺腺癌病理侵袭性的价值

    Application of the quantitative parameters of HRCT in predicting the pathological invasiveness of subreal nodule lung adenocarcinoma

    • 摘要: 目的 探讨HRCT定量参数对以亚实性结节(SSN)形式存在的浸润性腺癌(IAC)与微浸润腺癌(MIA)和浸润前病变(PIL)的鉴别价值。方法 选取2017年6月—2021年6月于徐州医科大学第二附属医院经手术病理证实且术前CT表现为SSN的周围型肺腺癌患者116例,收集临床资料进行回顾性分析。上述患者共SSN 116个,其中纯磨玻璃结节(pGGN)56个、部分实性结节(PSN)60个。根据预后情况,将患者分为2组:PIL/MIA组(n=65)和IAC组(n=51)。采用单因素和二元logistic回归分析,确定IAC的独立危险因素。结果 单因素分析显示,2组患者平均CT值、CT差值、质量、体积、最大CT值、3D长径比较,差异有统计学意义(P<0.001)。二元logistic回归和受试者工作特征曲线(ROC)分析表明,质量和CT差值是IAC的独立危险因素。CT差值诊断IAC的阈值为420.83 HU(AUC 0.873,灵敏度82.4%,特异度81.5%),质量诊断IAC的阈值为513.89 mg(AUC 0.888,灵敏度72.5%,特异度92.3%)。CT差值联合质量诊断IAC的AUC值达0.944,灵敏度为90.2%,特异度为89.2%。结论 CT差值和质量是预测SSN侵袭性的可靠指标。CT差值联合质量预测其侵袭性的价值较单独使用CT差值或质量更高。

       

      Abstract: Objective To evaluate the application of HRCT quantitative parameters in differentiating subsolid nodules (SSNs) in the forms of invasive adenocarcinoma (IAC), minimally invasive adenocarcinoma (MIA) and preinvasive lesions (PIL). Methods A total of 116 patients with peripheral lung adenocarcinoma who were pathologically diagnosed with and characterized in SSNs through CT scanning in the Second Hospital of Xuzhou Medical University from June 2017 to June 2021 were enrolled. Their clinical data were retrospectively analyzed, with 116 SSNs including 56 pure ground glass nodules (pGGNs) and 60 partial solid nodules (PSNs). According to their prognosis, the patients were divided into two groups: a PIL/MIA group (n=65) and an IAC group (n=51). Univariate and binary logistic regression analyses were performed to identify the independent risk factors for predicting IAC. Results According to univariate analysis, there were statistical differences in average CT value, the maximal CT value, CT difference between nodules and lung tissue, mass, volume, and 3D long diameter between the two groups (all P<0.001). According to binary logistic regression and receiver operating characteristic (ROC) analysis, CT difference and mass were the independent risk factors for IAC. The threshold of CT difference for diagnosing IAC was 420.83 HU AUC: 0.873; sensitivity: 82.4%; and specificity: 81.5%, while the threshold of mass for diagnosing IAC was 513.89 mg AUC: 0.888; sensitivity: 72.5%; and specificity: 92.3%. The AUC of CT difference combined with mass to diagnose IAC was 0.944, with a sensitivity of 90.2% and a specificity of 89.2%. Conclusions Mass and CT difference are reliable indicators to predict the invasiveness of SSNs. The combined use of mass and CT difference has a higher value in predicting their invasiveness than mass or CT difference alone.

       

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