CT鉴别亚实性肺腺癌亚型

目的 观察CT鉴别亚实性肺腺癌亚型的价值。方法 纳入127例亚实性肺腺癌患者,根据病理结果分为浸润前病变(PL)组(n=33)、微小浸润性腺癌(MIA)组(n=67)及浸润性腺癌(IA)组(n=27),其中分别有23、47及14例存在胸膜下结节;比较3组临床资料及CT表现,对差异有统计学意义的参数行多元有序logistic回归分析,绘制受试者工作特征曲线,评估CT诊断IA的效能。结果 3组患者年龄、结节平均CT值、平均直径、类型、形状、边界特点、血管集束征及空泡征占比差异均有统计学意义(P均<0.05),胸膜下结节胸膜凹陷征占比差异亦有统计学意义(P=0.001)。结节平均CT值和平均直径是为亚实性肺腺癌浸润的独立危险因素[OR=1.009,95%CI(1.004,1.013),P<0.001;OR=1.330,95%CI(1.117,1.583),P=0.001],以结节平均CT值-645.50 HU及平均直径10.00 mm为截断值诊断IA的曲线下面积分别为0.743及0.817,敏感度分别为77.78%及74.07%,特异度分别为63.00%及75.00%。结论 CT可用于鉴别亚实性肺腺癌亚型。

CT differential diagnosis of subsolid lung adenocarcinoma subtypes

Objective To explore the value of CT for differentiating different subtypes subsolid lung adenocarcinomas. Methods Totally 127 patients with subsolid lung adenocarcinoma were enrolled and divided into preinvasive lesions (PL) group (n=33), minimally invasive adenocarcinomas (MIA) group (n=67) or invasive adenocarcinomas (IA) group (n=27) according to the pathologic results, each including 23, 47 and 14 subpleural nodules, respectively. Clinical data and CT findings were compared among 3 groups, and multivariate ordinal logistic regression analysis was performed for indexes being statistically different among groups. Then receiver operating characteristic curves were drawn to evaluate the efficacy of CT for identification of subtypes of subsolid lung adenocarcinomas. Results Patients'' age, the mean CT value, mean diameter, nodule type, shape, edge, vascular clustering sign and vacuole sign were statistical different among 3 groups (all P<0.05), also the ratios of pleural indentation sign of subpleural nodules (P=0.001). The mean CT value and the mean diameter were independent risk factors of invasion of subsolid lung adenocarcinoma (OR=1.009, 95%CI , P<0.001; OR=1.330, 95%CI , P=0.001). Taken -645.50 HU and 10.00 mm as the cut-off values, the area under the curve of the mean CT value and the mean diameter of nodules for diagnosing IA was 0.743 and 0.817, with the sensitivity of 77.78% and 74.07%, specificity of 63.00% and 75.00%, respectively. Conclusion CT could be used to differentiate subtypes of subsolid lung adenocarcinomas.