CT表现为肺内纯磨玻璃样患者浸润性腺癌的影响因素

 目的 探讨CT表现为肺内纯磨玻璃样患者浸润性腺癌的影响因素。方法 回顾性分析CT表现为肺内纯磨玻璃样结节(pure ground glass nodule, pGGN)且经手术病理确诊的81例病例,根据手术病理分为非浸润性腺癌组(38例)和浸润性腺癌组(43例),对病灶最大径及CT值行受试者操作特征(ROC)曲线分析,比较两组临床及CT特征的差异并logistic回归分析浸润性腺癌独立影响因素。结果 ROC曲线显示预测浸润性腺癌的最佳临界值为病灶最大径15.5 mm和CT值-575 Hu,病灶最大径(AUC=0.897)的诊断效能大于CT值(AUC=0.701),两者联合诊断效能更佳。两组在病灶最大径、CT值、分叶征、毛刺征、空泡征、血管集束征差异具有统计学意义(P<0.05),而在性别、年龄、位置、胸膜凹陷征、支气管充气征、血管穿行及肺-瘤界面差异无统计学意义,logistic回归分析(后退法)显示病灶最大径≥15.5 mm、分叶征及CT值≥-575 Hu为浸润性肺腺癌独立影响因素。结论 pGGN浸润性腺癌多具有分叶征、毛刺征、空泡征集血管集束征等征象,最大径＞15.5 mm,CT值＞-575 Hu及分叶征为其独立危险因素,可为临床手术治疗提供依据。

Influencing factors of invasive adenocarcinoma in patients with pulmonary pure ground glass nodules on CT

Objective To investigate the influencing factors of invasive adenocarcinoma (IA) in patients with pulmonary pure ground glass nodules (pGGNs) on CT. Methods The clinical data and imaging features of 81 cases of pulmonary pGGN patients confirmed by surgical pathology in our hospital were analyzed retrospectively. These patients were divided into the IA group (43 cases) and non-IA group (38 cases). The maximum diameter and CT value were subjected to the receiver operational characteristic (ROC) curve analysis. The difference in clinical and CT features between the two groups was compared,and risk factors for IA were screened with logistic regression analysis. Results The ROC curve showed that the diagnostic threshold for predicting IA was 15.5 mm in maximum diameter and -575 Hu in CT value respectively. The diagnostic value of the maximum diameter (AUC=0.897) was higher than that of the CT value (AUC=0.701), and the combined use of the two was more effective. Between the IA group and non-IA group, there were significant differences in the maximum diameter, CT value, spiculation, lobulated-margin, bubble lucency and vascular convergence. No difference was found in gender, age, locations, pleural indentation, air bronchogram, or the vessel through sign and lung-tumor boundary. Logistic regression analysis showed that spiculation,a maximum diameter≥15.5 mm and CT value≥-575 Hu were risk factors for IA. Conclusions The features of pGGN IA mainly manifest themselves as spiculation, lobulated-margin, bubble lucency and vascular convergence. The pGGN with a maximum diameter≥15.5 mm, CT value≥-575 Hu, and presence of spiculation suggests that it is IA.