肺部良、恶性混合磨玻璃结节实性成分的CT特征比较
Comparison of CT Features of Solid Components in Benign and Malignant Mixed Ground-Glass Nodules
张越 1李琦 1欧阳祖彬 1范欣 1邹佩伶1
作者信息
- 1. 重庆医科大学附属第一医院放射科,重庆 400016
- 折叠
摘要
目的 探讨肺部良、恶性混合磨玻璃结节(mGGO)及恶性mGGO中微浸润腺癌(MIA)和浸润性腺癌(IAC)实性成分CT特征的差异,以提高mGGO的术前诊断准确度.资料与方法 回顾性分析 2016 年 1 月—2022 年 7 月重庆医科大学附属第一医院收治的 313 例混合mGGO患者的影像资料,根据随访或手术病理结果分为良性组 95 例和恶性组 218 例,比较两组临床特征及实性成分的CT特征,同时将恶性组分为MIA组118例和IAC组100例,比较两组实性成分的CT特征.利用上述差异有统计学意义的CT特征构建Logistic回归模型,使用曲线下面积评估模型的诊断效能.结果 ①临床特征:恶性组比良性组年龄更大、女性多、不吸烟患者多(Z=-3.776,χ2=13.587、19.257,P均<0.001).②良、恶性组实性成分CT特征比较:良性组单发者占比较高(84.21%比55.50%),恶性组多发者占比较高(44.50%比15.79%),差异有统计学意义(χ2=23.728,P<0.001).对于单发者,恶性组实性成分形态不规则、偏心分布、与血管及胸膜相连的发生率高于良性组,差异有统计学意义(χ2=23.795、5.025、7.264,P均<0.05);恶性组实性成分CT值[-153.00(-254.00,-80.50)Hu]高于良性组[-265.00(-363.25,-122.00)Hu],而相对CT值(0.30±0.16)低于良性组(0.41±0.22),差异均有统计学意义(P均<0.001).Logistic回归分析显示实性成分形态不规则(OR=0.236,P<0.001)、CT值较高(OR=1.009,P<0.05)为恶性mGGO的独立预测因子,该模型诊断恶性mGGO的曲线下面积、准确度、敏感度和特异度分别为0.772、70.65%、74.40%及65.00%.③恶性组中MIA与IAC实性成分CT特征比较:MIA单发者占比较高(74.58%比33.00%),而IAC多发者占比较高(67.00%比25.42%),差异有统计学意义(χ2=37.885,P<0.001).对于单发者,IAC组实性成分偏心分布的出现率显著高于MIA组,其面积、比例及CT值较MIA组更高,而相对CT值更低,差异有统计学意义(χ2=7.563,Z=-4.388、-3.923、-3.996,P均<0.05).Logistic回归分析显示实性成分偏心分布(OR=0.083,P<0.05)、面积较大(OR=1.063,P<0.05)为IAC的独立预测因子,该模型预测IAC的曲线下面积、准确度、敏感度和特异度分别为 0.865、83.47%、87.90%、68.20%.结论 良、恶性mGGO、恶性mGGO中MIA和IAC实性成分具有不同的CT特征,有助于提高mGGO的术前诊断准确度,指导临床制订治疗方案.
Abstract
Purpose To explore the CT features of solid components between benign and malignant mixed ground-glass nodules(mGGO),and between minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC),and to improve the accuracy of preoperative diagnosis of mGGO.Materials and Methods The clinical and imaging data of 313 patients with mGGO admitted to the First Affiliated Hospital of Chongqing Medical University from January 2016 to July 2022 were retrospectively analyzed,and all patients were divided into benign group(95 cases)and malignant group(218 cases)according to follow-up or pathological results.All patients in malignant group were further divided into MIA(118 cases)and IAC(100 cases)groups.Logistic regression analysis models were established using the statistically significant CT features above,and the area under the curve(AUC)was calculated to evaluate the effectiveness of the model.Results ① Comparison of clinical characteristics between benign and malignant groups:malignant mGGO were more common in older people,females and nonsmokers,without smoking history,and the differences between two groups were significantly different(Z=-3.776,χ2=13.587,19.257;all P<0.001).②Comparison of CT features between benign and malignant groups:benign group existed a higher proportion of single solid component(84.21%vs.55.50%),while malignant group existed a higher proportion of multiple solid components(44.50%vs.15.79%),and the difference between two groups was significantly different(χ2=23.728,P<0.001).As for patients with single solid component,the solid components in malignant group were more likely to be irregular,mostly with eccentric distribution,and the proportion of solid components connected with blood vessels and pleura were higher than the benign group,the differences between two groups were significant(χ2=23.785,5.025,7.264;all P<0.05).Meanwhile,the benign group also had higher CT value[-153.00(-254.00,-80.50)Hu vs.-265.00(-363.25,-122.00)Hu],while lower relative CT value(0.30±0.16 vs.0.41±0.22),the differences between two groups were significant(all P<0.001).Logistic regression analysis:irregular morphology of the solid component(OR=0.236,P<0.001)and higher CT value(OR=1.009,P<0.05)were independent predictors of malignant mGGO.Receiver operator characteristic(ROC)curve analysis showed that the AUC was 0.772,and its accuracy,sensitivity and specificity was 70.65%,74.40%and 65.00%,respectively.③Comparison of CT features between MIA and IAC groups:MIA group existed a higher proportion of single solid component(74.58%vs.33.00%),while IAC group existed a higher proportion of multiple solid components(67.00%vs.25.42%),and the difference between two groups was significantly different(χ2=37.885,P<0.001).As for patients with single solid component,the solid components in IAC group were more likely to be irregular,it also had higher area,area proportion,and CT value,while lower relative CT value than the MIA group,the differences between two groups were significant(χ2=7.563,Z=-4.388,-3.923,-3.996;all P<0.05).Logistic regression analysis:eccentric distribution of the solid component(OR=0.083,P<0.05)and large area(OR=1.063,P<0.05)were independent predictors of IAC.ROC curve analysis showed that the AUC was 0.865,and its accuracy,sensitivity and specificity was 83.47%,87.90%and 68.20%,respectively.Conclusion The solid components between benign and malignant nodules as well as between MIA and IAC show different CT features.Based on these different features,it's helpful to improve the preoperative diagnostic accuracy of mGGO and guide the clinical treatment plans.
关键词
肺疾病/肺腺癌/体层摄影术,X线计算机/诊断,鉴别Key words
Lung diseases/Adenocarcinoma of lung/Tomography,X-ray computed/Diagnosis,differential引用本文复制引用
出版年
2024
NETL
NSTL
万方数据