MSCT影像学特征对结节型肺腺癌亚型的临床诊断价值

摘要/Abstract

摘要：

目的探讨多层螺旋CT(MSCT)影像学特征对结节型肺腺癌各亚型的临床诊断价值。方法回顾性分析滨州医学院烟台附属医院2017年1月至2019年5月住院并行手术治疗的160例结节型肺腺癌患者的影像学信息及一般临床资料。采用单因素分析筛选各病理亚型有统计学意义的影像学特征并进行二元logistic回归分析,采用受试者工作特征(ROC)曲线分析诊断价值,并计算曲线下面积(AUC),同时进行诊断效能比较。结果不典型腺瘤样增生和原位腺癌(AAH+AIS)、微浸润性腺癌(MIA)、浸润性腺癌(IAC)、浸润性腺癌变异型(VIAC)4种亚型结节型肺腺癌患者的年龄分别为(57.07±7.92)岁、(59.37±6.96)岁、(60.68±8.83)岁、(63.33±6.89)岁,差异无统计学意义(F=1.221,P=0.304),但呈现出AAH+AISvs.8.00(5.00) mmvs.16.00(11.90) mmvs.17.20(9.08) mm,H=55.107,P<0.001]、CT值[-563.50(176.63) HUvs.-536.00(293.50) HUvs.-235.50(346.50) HUvs.-23.00(30.50) HU,H=47.499,P<0.001]、结节实性占比[0 (0)vs.0(0)vs.49.00%(100.00%)vs.100.00% (0),H=44.242,P<0.001]、空泡征[14(87.50%)vs.35(100.00%)vs.84(81.55%)vs.3(50.00%),χ²=13.925,P=0.002]、充气支气管征[1(6.25%)vs.2(5.71%)vs.36(34.95%)vs.2(33.33%),χ²=16.578,P=0.001]、肿瘤内血管征[13(81.25%)vs.28(80.00%)vs.64(62.14%)vs.1(16.67%),χ²=11.168,P=0.009]、血管集束征[1(6.25%)vs.3(8.57%)vs.66(64.08%)vs.6(100.00%),χ²=54.232,P<0.001]、短毛刺征[3(18.75%)vs.11(31.43%)vs.77(74.76%)vs.6(100.00%),χ²=36.218,P<0.001]、分叶征[4(25.00%)vs.18(51.43%)vs.93(90.29%)vs.6(100.00%),χ²=43.302,P<0.001]、胸膜牵拉征[0(0)vs.6(17.14%)vs.70(67.96%)vs.5(83.33%),χ²=50.794,P<0.001]差异均有统计学意义。病灶最大径(OR=0.858,95%CI为0.754~0.977,P=0.021)、胸膜牵拉征(OR=0.288,95%CI为0.084~0.993,P=0.049)是MIA的独立影响因素,病灶最大径(OR=1.131,95%CI为1.030~1.241,P=0.010)、胸膜牵拉征(OR=3.441,95%CI为1.279~9.254,P=0.014)是IAC的独立影响因素。病灶最大径诊断MIA的最佳阈值为11.05 mm,AUC为0.798(95%CI为0.724~0.872),敏感性为68.00%,特异性为85.70%;胸膜牵拉征诊断MIA的AUC为0.714(95%CI为0.623~0.806);病灶最大径与胸膜牵拉征诊断MIA的效能比较,差异无统计学意义(Z=1.838,P=0.066)。病灶最大径诊断IAC的最佳阈值为11.05 mm,AUC为0.827(95%CI为0.759~0.895),敏感性为75.70%,特异性为78.90%;胸膜牵拉征诊断IAC的AUC为0.743(95%CI为0.663~0.823);病灶最大径与胸膜牵拉征诊断IAC的效能比较,差异有统计学意义(Z=2.114,P=0.035),病灶最大径>11.05 mm诊断IAC的价值更优。结论病灶最大径、胸膜牵拉征是诊断MIA、IAC的独立影响因素,病灶最大径>11.05 mm诊断IAC的价值更优。

关键词:肺肿瘤,腺癌,病理亚型,多层螺旋CT,影像特征

Abstract:

ObjectiveTo investigate the clinic diagnostic value of multi-slice CT (MSCT) imaging features in various subtypes of nodular lung adenocarcinoma.MethodsThe imaging information and general clinical data of 160 patients with nodular lung adenocarcinoma who were admitted to Yantai Affiliated Hospital of Binzhou Medical University and received surgical treatment from January 2017 to May 2019 were retrospectively analyzed. Univariate analysis was used to screen statistically significant imaging features of each pathological subtype, and binary logistic regression analysis was performed. The diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, the area under the curve (AUC) was calculated, and the diagnostic efficacy was compared.ResultsThe age of patients with atypical adenomatous hyperplasia and adenocarcinomain situ(AAH+AIS), minimally invasive ademocarcinoma (MIA), invasive adenocarcinoma cancer (IAC) and variant of invasive adenocarcinoma cancer (VIAC) were (57.07±7.92), (59.37±6.96), (60.68±8.83), (63.33±6.89) years old, with no statistically significant difference (F=1.221,P=0.304). The age of patients with VIAC, IAC, MIA and AAH+AIS decreased in turn. The imaging features of AAH+AIS, MIA, IAC and VIAC that exhibited statistically significant differences were as following in turn: the maximum diameter of lesion [6.85 (3.73) mmvs.8.00 (5.00) mmvs.16.00 (11.90) mmvs.17.20 (9.08) mm,H=55.107,P<0.001], CT value [-563.50 (176.63) HUvs.-536.00 (293.50) HUvs.-235.50 (346.50) HUvs.-23.00 (30.50) HU,H=47.499,P<0.001], solid ratio [0 (0)vs.0 (0)vs.49.00% (100.00%)vs.100.00% (0),H=44.242,P<0.001], vacuolar sign [14 (87.50%)vs.35 (100.00%)vs.84 (81.55%)vs.3 (50.00%),χ²=13.925,P=0.002], inflatable bronchus sign [1 (6.25%)vs.2 (5.71%)vs.36 (34.95%)vs.2 (33.33%),χ²=16.578,P=0.001], intratumoral vascular sign [13 (81.25%)vs.28 (80.00%)vs.64 (62.14%)vs.1 (16.67%),χ²=11.168, P=0.009], vessel convergence sign [1 (6.25%)vs.3 (8.57%)vs.66 (64.08%)vs.6 (100.00%),χ²=54.232,P<0.001], short burr sign [3 (18.75%)vs.11 (31.43%)vs.77 (74.76%)vs.6 (100.00%),χ²=36.218,P<0.001], lobulation sign [4 (25.00%)vs.18 (51.43%)vs.93 (90.29%)vs.6 (100.00%),χ²=43.302,P<0.001], pleural traction sign [0 (0)vs.6 (17.14%)vs.70 (67.96%)vs.5 (83.33%),χ²=50.794,P<0.001]. The maximum diameter of lesion (OR=0.858, 95%CI: 0.754-0.977,P=0.021) and pleural traction sign (OR=0.288, 95%CI: 0.084-0.993,P=0.049) were independent influencing factors of MIA. The maximum diameter of lesion (OR=1.131, 95%CI: 1.030-1.241,P=0.010) and pleural traction sign (OR=3.441, 95%CI: 1.279-9.254,P=0.014) were independent influencing factors of IAC. The optimum threshold of the maximum diameter of lesion in diagnosis of MIA was 11.05 mm, AUC was 0.798 (95%CI: 0.724-0.872) sensitivity was 68.00%, and specificity was 85.70%. The AUC of pleural traction sign in diagnosis of MIA was 0.714 (95%CI: 0.623-0.806). The diagnostic efficacy exhibited no statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of MIA (Z=1.838, P=0.066). The optimum threshold of the maximum diameter of lesion in diagnosis of IAC was 11.05 mm, AUC was 0.827 (95%CI: 0.759-0.895), sensitivity was 75.70%, and specificity was 78.90%. The AUC of pleural traction sign in diagnosis of IAC was 0.743 (95%CI: 0.663-0.823). The diagnostic efficacy exhibited statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of IAC (Z=2.114,P=0.035), and the maximum diameter of lesion > 11.05 mm was better for the diagnosis of IAC.ConclusionThe maximum diameter of lesion and pleural traction sign are independent influence factors in diagnosis of MIA and IAC, and the maximum diameter of lesion > 11.05 mm is better for the diagnosis of IAC.

Key words:Lung neoplasms,Adenocarcinoma,Pathological subtype,Multi-slice CT,Imaging features

王军, 赵霞, 李海飞, 张承. MSCT影像学特征对结节型肺腺癌亚型的临床诊断价值[J]. 国际肿瘤学杂志, 2021, 48(9): 537-543.

Wang Jun, Zhao Xia, Li Haifei, Zhang Cheng. Clinic diagnostic value of MSCT imaging features in nodular lung adenocarcinoma subtype[J]. Journal of International Oncology, 2021, 48(9): 537-543.

图/表8

项目	AAH+AIS(n=16)	MIA(n=35)	IAC(n=103)	VIAC(n=6)	χ²值	P值
性别
男	3(6.00)	8(16.00)	37(74.00)	2(4.00)	3.370	0.338
女	13(11.82)	27(24.55)	66(60.00)	4(3.64)
结节类型					56.385	<0.001
实性结节	0(0)	1(2.86)	36(34.95)	6(100.00)	43.850	<0.001
混合性结节	1(6.25)	6(17.14)	28(27.18)	0(0)	6.123	0.106
纯磨玻璃样结节	15(93.75)	28(80.00)	39(37.87)	0(0)	42.538	<0.001

表1

表2

160例结节型肺腺癌患者各亚型影像学特征分布[M(QR)/例(%)]"

影像学特征	AAH+AIS(n=16)	MIA(n=35)	IAC(n=103)	VIAC(n=6)	H/χ²值	P值
病灶最大径(mm)	6.85(3.73)	8.00(5.00)	16.00(11.90)	17.20(9.08)	55.107	<0.001
CT值(HU)	-563.50(176.63)	-536.00(293.50)	-235.50(346.50)	-23.00(30.50)	47.499	<0.001
结节实性占比(%)	0(0)	0(0)	49.00(100.00)	100.00(0)	44.242	<0.001
空泡征	14(87.50)	35(100.00)	84(81.55)	3(50.00)	13.925	0.002
充气支气管征	1(6.25)	2(5.71)	36(34.95)	2(33.33)	16.578	0.001
肿瘤内血管征	13(81.25)	28(80.00)	64(62.14)	1(16.67)	11.168	0.009
瘤肺界面(模糊)	8(50.00)	14(40.00)	65(63.11)	3(50.00)	6.146	0.099
血管集束征	1(6.25)	3(8.57)	66(64.08)	6(100.00)	54.232	<0.001
短毛刺征	3(18.75)	11(31.43)	77(74.76)	6(100.00)	36.218	<0.001
分叶征	4(25.00)	18(51.43)	93(90.29)	6(100.00)	43.302	<0.001
胸膜牵拉征	0(0)	6(17.14)	70(67.96)	5(83.33)	50.794	<0.001

表2

表3

16例肺腺癌AAH+AIS型患者影像学特征的因素分析"

变量	β值	OR值	95%CI	P值
病灶最大径	-0.042	0.959	0.798~1.151	0.652
CT值	-0.001	0.999	0.993~1.005	0.650
结节实性占比	-0.018	0.982	0.932~1.034	0.485
空泡征	1.647	5.190	0.345~77.984	0.234
充气支气管征	-0.508	0.602	0.035~10.267	0.726
肿瘤内血管征	-0.203	0.816	0.141~4.711	0.820
血管集束征	-0.644	0.525	0.027~10.324	0.672
短毛刺征	-0.486	0.615	0.093~4.074	0.614
分叶征	-0.887	0.412	0.084~2.010	0.273
胸膜牵拉征	-18.593	0	0	0.997

表3

变量	β值	OR值	95%CI	P值
病灶最大径	-0.153	0.858	0.754~0.977	0.021
CT值	0	1.000	0.995~1.004	0.890
结节实性占比	-0.001	0.999	0.973~1.026	0.963
空泡征	-19.193	0	0	0.998
充气支气管征	0.020	1.020	0.161~6.471	0.983
肿瘤内血管征	0.074	1.077	0.293~3.963	0.911
血管集束征	-1.462	0.232	0.037~1.466	0.120
短毛刺征	-0.128	0.880	0.248~ 3.124	0.843
分叶征	0.459	1.583	0.476~5.261	0.454
胸膜牵拉征	-1.244	0.288	0.084~0.993	0.049

表4

表5

103例肺腺癌IAC型患者影像学特征的因素分析"

变量	β值	OR值	95%CI	P值
病灶最大径	0.123	1.131	1.030~1.241	0.010
CT值	0.001	1.001	0.996~1.005	0.728
结节实性占比	-0.004	0.996	0.975~1.018	0.727
空泡征	-0.270	0.763	0.163~3.565	0.731
充气支气管征	-0.171	0.843	0.227~3.135	0.799
肿瘤内血管征	0.157	1.170	0.344~3.974	0.801
血管集束征	0.928	2.529	0.688~9.296	0.162
短毛刺征	0.409	1.506	0.484~4.682	0.480
分叶征	0.702	2.018	0.648~6.283	0.226
胸膜牵拉征	1.234	3.441	1.279~9.254	0.014

表5

表6

6例肺腺癌VIAC型患者影像学特征的因素分析"

变量	β值	OR值	95%CI
病灶最大径	-0.047	0.954	0.826~1.103	0.525
CT值	0.013	1.013	0.988~1.039	0.307
结节实性占比	0.000	1	0.961~1.040	1.000
空泡征	-0.138	0.871	0.074~10.265	0.913
充气支气管征	1.217	3.378	0.356~32.070	0.289
肿瘤内血管征	-0.009	0.991	0.076~12.929	0.995
血管集束征	13.122	499 735.300	0.000	0.996
短毛刺征	14.219	1 497 307.819	0.000	0.996
分叶征	16.295	11 934 542.510	0.000	0.997
胸膜牵拉征	0.835	2.306	0.172~30.937	0.528

表6

图1

图2

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