三维重建技术在肺腺癌新分类标准诊断中的价值

目的探讨三维重建技术对肺腺癌新分类标准在术前外科诊断中的应用价值,助力于开发人工智能在肺癌辅助诊疗方面的深度学习模型系统。方法回顾性分析2018年10月至2020年6月我院收治的173例经手术病理证实且肿瘤直径≤2 cm肺磨玻璃结节患者的临床资料,其中男55例、女118例,中位年龄61(28~82)岁。同一患者不同部位肺结节视为独立事件,共纳入181例研究对象。按照病理类型新分类标准,将其分为浸润前病变不典型腺瘤样增生(AAH)和原位腺癌(AIS)]、微浸润腺癌(MIA)及浸润性腺癌(IAC),利用多平面重建(multiplanar reconstruction,MPR)和容积重建(volume reconstruction,VR)等技术,分析研究三维重建相关参数与肺腺癌不同病理亚型之间的关系及其诊断价值。结果肺腺癌不同病理类型肺结节的直径(P<0.001)、平均CT值(P<0.001)、实性成分比值(P<0.001)、结节类型(P<0.001)、结节形态(P<0.001)、胸膜凹陷征(P<0.001)、空气支气管征(P=0.010)、结节内有无血管出入(P=0.005)、TNM分期(P<0.001)差异均有统计学意义,而结节生长部位差异无统计学意义(P=0.054)。同时还发现随着肺腺癌不同病理亚型侵袭性增加,各组参数显性征象比例也逐渐升高。多因素logistic回归分析结果显示,结节直径和平均CT值或实性成分比值是浸润前病变进展为IAC的独立危险因素。结论三维重建下肺小结节各种影像征象,包括结节直径、平均CT值、实性成分比值、形态、类型、血管出入情况、空气支气管征、胸膜凹陷征对肺腺癌新分类标准的诊断具有重要价值,在临床能够为患者个性化治疗提供指导。

Diagnostic value of three-dimensional reconstruction technique in new classification criteria of lung adenocarcinoma

Objective To evaluate the application value of three-dimensional(3 D)reconstruction in preoperative surgical diagnosis of new classification criteria for lung adenocarcinoma,which is helpful to develop a deep learning model of artificial intelligence in the auxiliary diagnosis and treatment of lung cancer.Methods The clinical data of 173 patients with ground-glass lung nodules with a diameter of≤2 cm,who were admitted from October 2018 to June 2020 in our hospital were retrospectively analyzed.Among them,55 were males and 118 were females with a median age of 61(28-82)years.Pulmonary nodules in different parts of the same patient were treated as independent events,and a total of 181 subjects were included.According to the new classification criteria of pathological types,they were divided into preinvasive lesions(atypical adenomatous hyperplasia and and adenocarcinoma in situ),minimally invasive adenocarcinoma and invasive adenocarcinoma.The relationship between 3 D reconstruction parameters and different pathological subtypes of lung adenocarcinoma,and their diagnostic values were analyzed by multiplanar reconstruction and volume reconstruction techniques.Results In different pathological types of lung adenocarcinoma,the diameter of lung nodules(P<0.001),average CT value(P<0.001),consolidation/tumor ratio(CTR,P<0.001),type of nodules(P<0.001),nodular morphology(P<0.001),pleural indenlation sign(P<0.001),air bronchogram sign(P=0.010),vascular access inside the nodule(P=0.005),TNM staging(P<0.001)were significantly different,while nodule growth sites were not(P=0.054).At the same time,it was also found that with the increased invasiveness of different pathological subtypes of lung adenocarcinoma,the proportion of dominant signs of each group gradually increased.Meanwhile,nodule diameter and the average CT value or CTR were independent risk factors for malignant degree of lung adenocarcinoma.Conclusion Imaging signs of lung adenocarcinoma in 3 D reconstruction,including nodule diameter,the average CT value,CTR,shape,type,vascular access conditions,air bronchogram sign,pleural indenlation sign,play an important role in the diagnosis of lung adenocarcinoma subtype and can provide guidance for personalized therapy to patients in clinics.