肺亚实性结节不同维度CT定量特征对病理等级的预测价值

目的 探讨不同维度下病理为腺癌的肺亚实性结节(SSN)大小及其实性成分的大小对病理等级的预测价值.方法 回顾性分析病理为肺腺癌的125例患者肺内127个SSN的术前胸部高分辨率CT.将所有SSN分为2组,A组共69个,包含22个原位癌(AIS)和47个微浸润性腺癌(MIA);B组包含58个浸润性腺癌(IAC).使用计算机辅助软件测量所有SSN的肺窗实性一维长径(1D-SCLW)、肺窗实性二维长径(2D-SCLW)、纵隔窗实性一维长径(1D-SCMW)、纵隔窗实性二维长径(2D-SCMW)、肺窗结节一维长径(1D-WNLW)、肺窗结节二维长径(2D-WNLW)和-300 HU阈值实性成分体积(SCT).结果 B组的1D-SCLW、2D-SCLW、1D-SCMW、2D-SCMW、1D-WNLW、2D-WNLW和SCT显著>A组(P=0.000).通过受试者工作特征(ROC)曲线分析得出,在以上7种CT定量特征中,SCT对病理等级的诊断价值最高[曲线下面积(AUC)=0.887,敏感度为81%,特异度为93%];1D-SCLW、2D-SCLW、1D-SCMW、2D-SCMW、1D-WNLW、2D-WNLW和SCT的最优阈值分别为17.50 mm、14.75 mm、9.50 mm、7.75 mm、0.50 mm、1.25 mm和139.00 mm3.多因素Logistic回归分析结果表明,SCT是SSN病理等级的独立预测因素(OR=4.978,95%CI=1.430~17.331,P=0.012),当SCT≥139.00 mm3时,高度提示SSN为IAC.结论 在不同维度SSN的大小及其实性成分大小中,SCT是AIS、MIA和IAC间的独立预测因素,能够为手术方式的选择提供参考.

Predictive value of quantitative CT features of pulmonary subsolid nodules in three different dimensions for the pathologic grade

Objective To investigate the predictive value of the whole nodule size and solid component size of lung adenocarcinoma manifesting as subsolid nodule(SSN) in three different dimensions for pathologic grade.Methods We evaluated retrospectively preoperative chest HRCT data of 125 patients with 127 SSNs surgically resected and pathologically conformed lung adenocarcinomas.All specimens were divided into two groups: a total of 69 SSNs in group A, including 22 AIS and 47 MIA;a total of 58 SSNs in group B, only including IAC.Computer aided diagnosis software were used to measure the one dimension maximum diameter of solid component with lung window setting(1D-SCLW),two dimension maximum diameter of solid component with lung window setting(2D-SCLW),one dimension maximum diameter of solid component with mediastinal window setting(1D-SCMW),two dimension maximum diameter of solid component with mediastinal window setting(2D-SCMW),one dimension maximum diameter of whole nodule with lung window setting (1D-WNLW), two dimension maximum diameter of whole nodule with lung window setting (2D-WNLW), and volume of solid component with threshold of-300 HU (SCT) of all SSNs.Results 1D-SCLW, 2D-SCLW,1D-SCMW,2D-SCMW,1D-WNLW,2D-WNLW and SCT of the group B were significantly larger than those of the group A(P=0.000).ROC analyses indicated that the diagnostic efficiency of SCT for the pathologic grade was the highest among 7 CT features(AUC=0.887, sensitivity:81%,specificity:93%);The cut-off values of 1D-SCLW,2D-SCLW,1D-SCMW,2D-SCMW,1D-WNLW, 2D-WNLW and SCT were 17.50 mm,14.75 mm,9.50 mm,7.75 mm,0.50 mm,1.25 mm and 139.00 mm3.Multiple Logistic regression analysis revealed that SCT was the independent predictor of pathologic grade(OR=4.978,95%CI=1.430-17.331,P=0.012).SCT of 139.00 mm3 or greater was a significant indicator of IAC.Conclusion Among the whole nodule size and solid component size of SSN in three different dimensions on preoperative HRCT, SCT is found to be the independent predictor of pathologic grade, which may provide reference for surgery.