低剂量CT在筛查及鉴别疑似肺癌患者中的应用

目的:探讨低剂量CT在筛查及鉴别疑似肺癌患者中的应用价值.方法:回顾性分析2015年1月~2016年10月我院接诊的18例疑似肺癌患者影像学资料,均在我院行胸部数字化X线及低剂量CT(LDCT)筛查,分析肺癌影像特征,并以病理结果为准,评价LDCT与X线诊断肺癌的效能,根据病变密度分为非实性结节与部分实性结节,根据病理结果将部分实性结节分为浸润前+微浸润性病变组,另一组为浸润性病变组,分析LDCT的鉴别要点及鉴别准确性.结果:本组18例疑似肺癌患者中共发现肺结节与肿块(>3cm)20个,平均大小(2.10±0.01)cm,其中非实性、部分实性、实性分别占15.00%、65.00%、20.00%;18例中,15例证实为肺癌,其中12例发现癌结节13个,中央型3个、周围型10个,平均大小(1.61±0.02)cm;LDCT对肺癌的阳性检出率73.33%明显高于胸部X线33.33%;浸润前病变+微浸润性病变组病变大小、实性成分百分比及毛刺征、分叶征、胸膜牵拉征发生率明显低于浸润性病变组;多因素Logistics回归分析显示病灶直径、实性成分比例为鉴别浸润前及微浸润性病变与浸润性病变的独立危险因素,两者联合诊断时ROC曲线下面积为0.861,95%可信区间:0.761,0.956.结论:低剂量CT在筛查及鉴别疑似肺癌患者中具有较高应用价值,病灶较小结合实性部分少是将浸润前及微浸润性病变从浸润性病变中鉴别出的诊断点.

Application of low-dose CT in screening and identifying suspected lung cancer

Objective To investigate the application value of low-dose CT inscreening and identifying suspected lung can-cer. Methods The imaging data of 18 patients with suspected lung cancer who were admitted to our hospital during January 2015 to October 2016 were retrospectively analyzed. All patients were screened by digital chest low-dose CT (LDCT), and the imaging features of lung cancer were analyzed. According to pathological results, the efficiency of LDCT and X-ray in diagnosis of lung cancer was evaluated. According to lesion density, they were divided into non-solid nodules and solid nodules. Accord-ing to the pathological results, some solid nodules were divided into preinvasive + micro-invasive lesions group and invasive lesions group. The key points and accuracy of LDCT in differential diagnosis were analyzed. Results Among 18 patients with suspected lung cancer in the study, there were 20 pulmonary nodules and masses (>3cm), with an average size of (2.10±0.01) cm, of which the proportions of non - solid, partly solid and solid ones were 15.00%, 65.00% and 20.00%, respectively. In 18 cases, there were 15 cases of lung cancer, including 13 cancer nodules in 12 cases, 3central ones and 10 peripheral ones, with an average size of (1.61±0.02) cm. The positive detection rate of LDCT for lung cancer was significantly higher than that of chest X-ray (73.33% vs. 33.33%). The size of lesions, the percentage of solid components, the incidence rates of spicule sign, lobula-tion sign and pleural traction sign were significantly lower in the preinvasive + micro-invasive lesions group than the invasive lesions group. Multivariate Logistics regression analysis showed that the diameter of lesions, proportion of solid component were independent risk factors for identifying preinvasive and micro-invasive lesions and invasive lesions. The area under ROC curve of the two combined diagnosis was 0.861, 95% confidence interval was 0.761, 0.956. Conclusion Low-dose CT has high appli-cation value in screening and identifying suspected lung cancer. Smaller lesions and few solid part can be taken as the points for differential diagnosis.