高分辨率CT对肺纯磨玻璃结节侵袭性的预测价值
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摘要
目的探讨高分辨率CT(HRCT)对肺纯磨玻璃结节(pGGO)侵袭性的预测价值。方法回顾性分析经手术病理证实的127例pGGO患者资料。统计分析pGGN侵袭性的最佳预测指标及其阈值。结果经纳入、排除标准后,44个pGGO纳入本研究,分为浸润组[包括微浸润腺癌(MIA)及浸润肺腺癌(IAC),n=19]和未浸润组[包括炎症、不典型腺瘤增生(AAH)及原位腺癌(AIS),n=25]。经两独立样本t检验,pGGO平均CT值、最大CT值、结节与肺组织的CT差值及结节的平均直径组间差异具有统计学意义(P值均<0.05)。观察者间测量重复性高,所有指标组内相关系数(ICC)>0.9。二元Logistics回归示CT差值、平均直径对预测pGGO的浸润性具有一定的预测价值(B=0.025,OR=1.026,P=0.038;B=0.558,OR=1.748,P=0.027)。通过受试者工作特征(ROC)曲线分析,CT差值及结节平均直径的阈值取>233.67 HU和>9.0 mm,预测pGGO浸润性的敏感度和特异度分别为81.4%、62.2%和60.1%、84.9%,联合这两个指标的预测效能大于单独指标[曲线下面积(AUC)为0.878;P=0.000]。结论 HRCT可以较好地预测pGGO的侵袭性,结节与肺组织的CT差值及结节平均直径可作为pGGO侵袭性的预测指标,联合这两个指标的预测效能大于单独指标。
Objective To investigate the prediction value of invasiveness in pure ground-glass opacity(pGGO)on lung high-resolution CT. Methods A total of 127 cases of pulmonary pGGOs confirmed by surgery and pathology were analyzed retrospectively.Then the optimal predictor and its threshold were acquired. Results After inclusion and exclusion criteria,44 pGGOs were divided into invasive group(including MIA and ICA,n=19) and noninvasive group(including inflammation,AAH and AIS,n=25).The mean CT value and the maximum CT value of pGGOs,the CT difference between nodules and lung tissue,and the mean diameter of pGGOs had statistical difference between groups(all P value <0.05).The results showed a high measurement reliability(ICC>0.9).Binary logistic regression demonstrated that the CT difference between nodules and lung tissue and the mean diameter had high-risk factors for predicting the invasiveness of pGGOs(B=0.025,OR=1.026,P=0.038; B=0.558,OR=1.748,P=0.027).According to receiver operating characteristic curve,the threshold values for CT difference between nodules and lung tissue and average diameter of pGGOs were greater than 233.67 HU and 9.0 mm,respectively.Their sensitivity and specificity for predicting invasiveness were 81.4% and 62.2%,60.1% and 84.9%,respectively,and a combination of both indexes had better predictive value than both indexes individually(AUC=0.870; P=0.000). Conclusion The CT difference between nodules and lung tissue and the mean diameter of pGGOs could be used to predict the invasiveness of pGGO on HRCT,and the combination of these two indexes had better predictive value than the indexes alone.
Objective To investigate the prediction value of invasiveness in pure ground-glass opacity(pGGO)on lung high-resolution CT. Methods A total of 127 cases of pulmonary pGGOs confirmed by surgery and pathology were analyzed retrospectively.Then the optimal predictor and its threshold were acquired. Results After inclusion and exclusion criteria,44 pGGOs were divided into invasive group(including MIA and ICA,n=19) and noninvasive group(including inflammation,AAH and AIS,n=25).The mean CT value and the maximum CT value of pGGOs,the CT difference between nodules and lung tissue,and the mean diameter of pGGOs had statistical difference between groups(all P value <0.05).The results showed a high measurement reliability(ICC>0.9).Binary logistic regression demonstrated that the CT difference between nodules and lung tissue and the mean diameter had high-risk factors for predicting the invasiveness of pGGOs(B=0.025,OR=1.026,P=0.038; B=0.558,OR=1.748,P=0.027).According to receiver operating characteristic curve,the threshold values for CT difference between nodules and lung tissue and average diameter of pGGOs were greater than 233.67 HU and 9.0 mm,respectively.Their sensitivity and specificity for predicting invasiveness were 81.4% and 62.2%,60.1% and 84.9%,respectively,and a combination of both indexes had better predictive value than both indexes individually(AUC=0.870; P=0.000). Conclusion The CT difference between nodules and lung tissue and the mean diameter of pGGOs could be used to predict the invasiveness of pGGO on HRCT,and the combination of these two indexes had better predictive value than the indexes alone.
引文
1 秦福兵,陆友金.纯磨玻璃结节定量CT鉴别肺浸润性腺癌与浸润前病变和微浸润腺癌[J].中国医学计算机成像杂志,2016,22:22-26.
2 Naidich DP,Bankier AA,MacMahon H,et al.Recommendations for the management of subsolid pulmonary nodules detected at CT:a statement from the Fleischner Society[J].Radiology,2013,266:304-317.
3 Wu H,Liu C,Xu M,et al.A Retrospective Study of Mean Computed Tomography Value to Predict the Tumor Invasiveness in AAH and Clinical Stage Ia Lung Cancer[J].Zhongguo Fei Ai Za Zhi,2018,21:190-196.
4 Eguchi T,Yoshizawa A,Kawakami S,et al.Tumor size and computed tomography attenuation of pulmonary pure ground-glass nodules are useful for predicting pathological invasiveness[J].PLoS One,2014,9:e97867.
5 Tamura M,Shimizu Y,Yamamoto T,et al.Predictive value of one-dimensional mean computed tomography value of ground-glass opacity on high-resolution images for the possibility of future change[J].J Thorac Oncol,2014,9:469-472.
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7 王欣,徐跃华,杜紫燕,等.孤立性肺结节的CT影像学特征及良恶性预测模型的建立[J].中华肿瘤杂志,2018,40:115-120.
8 超谢,谢晓东,娄可心,等.肺磨玻璃结节的CT VAL-plus在预测肿瘤病理侵袭性中的应用[J].临床放射学杂志,2018,37:234-238.
9 陈万青,郑荣寿,张思维,等.2013年中国老年人群恶性肿瘤发病和死亡分析[J].中华肿瘤杂志,2017,39:60-66.
10 Alberg AJ,Brock MV,Ford JG,et al.Epidemiology of lung cancer:Diagnosis and management of lung cancer,3rd ed:American College of Chest Physicians evidence-based clinical practice guidelines[J].Chest,2013,143:e1S-e29S.
11 Yu J,Zhu S,Ge Z,et al.Multislice spiral computed tomography in the differential diagnosis of ground-glass opacity[J].J Cancer Res Ther,2018,14:128-132.
12 Dai J,Yu G,Yu J.Can CT imaging features of ground-glass opacity predict invasiveness? A meta-analysis[J].Thorac Cancer,2018,9:452-458.
13 Wang Q.Management Strategies of Pulmonary Ground Galss Nodule[J].Zhongguo Fei Ai Za Zhi,2018,21:160-162.
14 Travis WD,Brambilla E,Noguchi M,et al.International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society:international multidisciplinary classification of lung adenocarcinoma:executive summary[J].Proc Am Thorac Soc,2011,8:381-385.
15 Kim D,Kim HK,Kim SH,et al.Prognostic significance of histologic classification and tumor disappearance rate by computed tomography in lung cancer[J].J Thorac Dis,2018,10:388-397.
16 Aoki T.Growth of pure ground-glass lung nodule detected at computed tomography[J].J Thorac Dis,2015,7:E326-E328.
17 Lee GD,Park CH,Park HS,et al.Lung Adenocarcinoma Invasiveness Risk in Pure Ground-Glass Opacity Lung Nodules Smaller than 2 cm[J].Thorac Cardiovasc Surg,2018.
18 Takahashi M,Shigematsu Y,Ohta M,Tokumasu H,Matsukura T,Hirai T.Tumor invasiveness as defined by the newly proposed IASLC/ATS/ERS classification has prognostic significance for pathologic stage IA lung adenocarcinoma and can be predicted by radiologic parameters[J].J Thorac Cardiovasc Surg,2014,147:54-59.
2 Naidich DP,Bankier AA,MacMahon H,et al.Recommendations for the management of subsolid pulmonary nodules detected at CT:a statement from the Fleischner Society[J].Radiology,2013,266:304-317.
3 Wu H,Liu C,Xu M,et al.A Retrospective Study of Mean Computed Tomography Value to Predict the Tumor Invasiveness in AAH and Clinical Stage Ia Lung Cancer[J].Zhongguo Fei Ai Za Zhi,2018,21:190-196.
4 Eguchi T,Yoshizawa A,Kawakami S,et al.Tumor size and computed tomography attenuation of pulmonary pure ground-glass nodules are useful for predicting pathological invasiveness[J].PLoS One,2014,9:e97867.
5 Tamura M,Shimizu Y,Yamamoto T,et al.Predictive value of one-dimensional mean computed tomography value of ground-glass opacity on high-resolution images for the possibility of future change[J].J Thorac Oncol,2014,9:469-472.
6 Kitami A,Kamio Y,Hayashi S,et al.One-dimensional mean computed tomography value evaluation of ground-glass opacity on high-resolution images[J].Gen Thorac Cardiovasc Surg,2012,60:425-430.
7 王欣,徐跃华,杜紫燕,等.孤立性肺结节的CT影像学特征及良恶性预测模型的建立[J].中华肿瘤杂志,2018,40:115-120.
8 超谢,谢晓东,娄可心,等.肺磨玻璃结节的CT VAL-plus在预测肿瘤病理侵袭性中的应用[J].临床放射学杂志,2018,37:234-238.
9 陈万青,郑荣寿,张思维,等.2013年中国老年人群恶性肿瘤发病和死亡分析[J].中华肿瘤杂志,2017,39:60-66.
10 Alberg AJ,Brock MV,Ford JG,et al.Epidemiology of lung cancer:Diagnosis and management of lung cancer,3rd ed:American College of Chest Physicians evidence-based clinical practice guidelines[J].Chest,2013,143:e1S-e29S.
11 Yu J,Zhu S,Ge Z,et al.Multislice spiral computed tomography in the differential diagnosis of ground-glass opacity[J].J Cancer Res Ther,2018,14:128-132.
12 Dai J,Yu G,Yu J.Can CT imaging features of ground-glass opacity predict invasiveness? A meta-analysis[J].Thorac Cancer,2018,9:452-458.
13 Wang Q.Management Strategies of Pulmonary Ground Galss Nodule[J].Zhongguo Fei Ai Za Zhi,2018,21:160-162.
14 Travis WD,Brambilla E,Noguchi M,et al.International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society:international multidisciplinary classification of lung adenocarcinoma:executive summary[J].Proc Am Thorac Soc,2011,8:381-385.
15 Kim D,Kim HK,Kim SH,et al.Prognostic significance of histologic classification and tumor disappearance rate by computed tomography in lung cancer[J].J Thorac Dis,2018,10:388-397.
16 Aoki T.Growth of pure ground-glass lung nodule detected at computed tomography[J].J Thorac Dis,2015,7:E326-E328.
17 Lee GD,Park CH,Park HS,et al.Lung Adenocarcinoma Invasiveness Risk in Pure Ground-Glass Opacity Lung Nodules Smaller than 2 cm[J].Thorac Cardiovasc Surg,2018.
18 Takahashi M,Shigematsu Y,Ohta M,Tokumasu H,Matsukura T,Hirai T.Tumor invasiveness as defined by the newly proposed IASLC/ATS/ERS classification has prognostic significance for pathologic stage IA lung adenocarcinoma and can be predicted by radiologic parameters[J].J Thorac Cardiovasc Surg,2014,147:54-59.