摘要
目的：探讨结节三维定量分析对表现为纯磨玻璃结节（pGGN）的早期肺腺癌病理分级的预测价值。方法回顾性分析长征医院2012年6月至2015年10月经手术病理证实的CT表现为pGGN的肺腺癌105例，共110个pGGN，其中不典型腺瘤样增生（AAH）22个、原位腺癌（AIS）28个、微浸润性腺癌（MIA）28个、浸润性腺癌（IAC）32个。利用联影CT高级后处理工作站对结节进行三维容积测量，得到最大横断面长径、面积、体积、平均CT值、质量，最小CT值，最大CT值，2%、5%、25%、50%、75%、95%、98%位数CT值。多组之间以及浸润前后分组之间测量指标满足正态分布及方差齐性的采用单因素方差分析，不满足的数据采用Kruskal-Wallis H检验分析，并对各单独变量进行ROC曲线分析，再以结节是否为浸润性病变为因变量，结节的最大截面长径、面积、体积、最大CT值为自变量进行Logistic回归分析。结果 AAH、AIS、MIA、IAC 4组间结节大小参数（包括最大横截面长径、面积、体积），平均CT值，质量，5%、25%、50%、75%、95%、98%百分位数CT值，最大CT值差异有统计学意义（P〈0.05）。浸润前病变与浸润病变之间各结节大小参数，平均CT值，质量，2%、25%、50%、75%、95%、98%位数CT值，最大CT值差异有统计学意义（P〈0.05），对各单独变量进行ROC曲线分析，其中曲线下面积（AUC）大于0.7的变量为：结节最大截面长径（AUC=0.754，P〈0.001）、面积（AUC=0.787，P〈0.001）、体积（AUC=0.788，P〈0.001）、质量（AUC=0.822，P〈0.001）以及98%位数CT值（AUC=0.714，P〈0.001）、最大CT值（AUC=0.759，P〈0.001），Logistic回归分析显示，最大截面长径[优势比（OR）=1.143，95%CI 1.027~1.273, P=0.015]和最大CT值（OR=1.005，95%CI 1.002~1.009, P=0.001）是pGGN为浸润性病变的危险因素，对Logistic逐步回归预测概率进行ROC曲线分析，曲线下面积为0.793（P〈0.001）。结论三维定量分析得到pGGN的大小参数、质量、最大CT值对pGGN的病理分级具有预测作用。
Objective To investigate if quantitative analysis of early-stage lung adenocarcinoma manifesting as a pure ground-glass nodule （pGGN） on CT can predict its pathological grading. Methods One hundred and five patients who had undergone curative resection for lung adenocarcinoma, manifesting as a pure ground-glass nodule, were retrospectively enrolled from June 2012 to October 2015 in Changzheng Hospital. Among 110 lesions, there were 22 typical adenomatous hyperplasia （AAH）, 28 adenocarcinoma in situ （AIS）, 28 minimally invasive adenocarcinoma （MIA）, and 32 invasive adenocarcinoma （IAC）. We evaluated all CT images using United Imaging CT advanced post-processing workstation,and all pGGNs were analyzed as follows： long diameter and area of maximum section,volume,mean CT number,mass,＆nbsp;minimum CT number, maximum CT number,and 2%,5%,25%,50%,75%, 95%, 98% percentile CT number. Variables between different pathological grades and between before and after invasion satisfying the law of normal distribution and homoscedasticity were compared using one-way AVOVA,other variables were compared using Kruskal-Wallis H test. Each individual variable were enrolled in ROC analysis,and Logistic regression analysis was performed by taking if pGGN was invasive lesion as the dependent variable, and long diameter and area of maximum section,volume and maximum CT number were taken as independent variables. Results The lesion size（including long diameter and area of maximum section,volume）, mean CT number,mass, 5%, 25%, 50%, 75%, 95%, 98%percentile CT number and maximum CT number were statistically different among four pathological types of AAH, AIS, MIA and IAC（P〈0.05）. Between preinvasive lesion and invasive lesion, the lesion size, mean CT number, mass, 2%, 25%, 50%, 75%, 95%, 98%percentile CT number and maximum CT number were also statistically different（P〈0.05）. ROC analysis was taken for the individual variables, variables which area under the curve （AUC） of more than 0.7 were the long diameter of maximum section （AUC=0.754, P〈0.001）,area of maximum section volume（AUC=0.787, P〈0.001）, volume（AUC=0.788, P〈0.001）, mass（AUC=0.822, P〈0.001） and 98% percentile CT number（AUC=0.714, P〈0.001）, maximum CT number （AUC= 0.759,P〈0.001） . Logistic regression analysis showed that the long diameter of maximum section（OR=1.143,95%CI 1.027-1.273, P=0.015）and the mean CT number （OR=1.005, 95% CI 1.002-1.009, P=0.001）were independent risk factors that predicting pGGN was invasive lesion, the ROC analysis was performed based on the predicted probability of Logistic regression model, and the AUC was 0.793（P〈0.001）. Conclusion Quantitative analysis of early-stage lung adenocarcinoma manifesting as a pure ground-glass nodule on CT to get its size, the maximum CT number and mass,can be useful for predicting pathological grading.
作者
曹恩涛
于红
范丽
肖湘生
刘靖
李西
Cao Entao Yu Hong Fan Li Xiao Xiangsheng Liu Jing Li Xi(Department of Radiology and Nuclear Medicine, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China Present address： Department of Radiology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215002, China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2016年第12期940-945,共6页
Chinese Journal of Radiology
基金
基金项目：上海市科委重点项目（15411952000）
上海市卫生局重点项目（2012020）
上海申康医院发展中心项目（SHDC12014227）
总后勤部保健专项科研课题（CWS14BJ07）
