Takashima Shodayu, Sone Shusuke, Li Feng, Maruyama Yuichiro, Hasegawa Minoru, Matsushita Tsuyoshi, Takayama Fumiyoshi, Kadoya Masumi
Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
AJR Am J Roentgenol. 2003 Apr;180(4):955-64. doi: 10.2214/ajr.180.4.1800955.
We assessed thin-section CT features specific to benignity in solitary pulmonary nodules of 1 cm or smaller that were detected at population-based CT screening for lung cancer.
Two reviewers independently made qualitative (presence or absence of lobulation, spiculation, air bronchogram, cavity, satellite lesions, pleural tag, concave margins, polygonal shape, and peripheral subpleural lesion) and quantitative (lesion size, percentage of ground-glass opacity areas, and two- and three-dimensional ratios of lesion) assessments in CT images of 72 nodules (25 lung cancers, seven atypical adenomatous hyperplasias, and 40 benign lesions). Optimal criteria specific to benignity were studied.
The prevalence of polygonal shape (p = 0.005 and p = 0.019, reviewer 1 and reviewer 2), peripheral subpleural lesion (p = 0.011 and p = 0.033), a predominantly solid lesion (p < 0.001 and p < 0.001), and three-dimensional ratios (p < 0.001 and p < 0.001) were greater in benign lesions than in malignancies. The prevalence of a predominantly solid lesion (p < 0.001 and p < 0.001) was greater in benign lesions than in atypical adenomatous hyperplasias, and the prevalence of a peripheral subpleural lesion (p = 0.004 and p = 0.012) was greater in atypical adenomatous hyperplasias than in malignancies. Using a single CT feature, polygonal shape and a three-dimensional ratio of greater than 1.78 showed 100% specificity for both reviewers. Among all combinations of CT findings specific to benignity, a combined criterion of a predominantly solid lesion and peripheral subpleural lesion or polygonal shape or the three-dimensional ratio attained the highest sensitivity (63% and 60%) for both reviewers.
A combined criterion of CT features was optimal for predicting benign pulmonary lesions.
我们评估了在基于人群的肺癌CT筛查中发现的直径1 cm及以下的孤立性肺结节的良性特异性薄层CT特征。
两名阅片者独立对72个结节（25个肺癌、7个非典型腺瘤样增生和40个良性病变）的CT图像进行定性（有无分叶、毛刺、空气支气管征、空洞、卫星灶、胸膜尾征、边缘凹陷、多边形形态及外周胸膜下病变）和定量（病变大小、磨玻璃密度区百分比以及病变的二维和三维比率）评估。研究了良性特异性的最佳标准。
良性病变中多边形形态（阅片者1，p = 0.005；阅片者2，p = 0.019）、外周胸膜下病变（阅片者1，p = 0.011；阅片者2，p = 0.033）、实性为主的病变（阅片者1，p < 0.001；阅片者2，p < 0.001）及三维比率（阅片者1，p < 0.001；阅片者2，p < 0.001）的发生率高于恶性病变。实性为主的病变在良性病变中的发生率高于非典型腺瘤样增生（阅片者1，p < 0.001；阅片者2，p < 0.001），外周胸膜下病变在非典型腺瘤样增生中的发生率高于恶性病变（阅片者1，p = 0.004；阅片者2，p = 0.012）。对于两名阅片者，仅使用单一CT特征时，多边形形态及三维比率大于1.78显示出100%的特异性。在所有良性特异性CT表现的组合中，实性为主的病变与外周胸膜下病变或多边形形态或三维比率的联合标准对两名阅片者均达到最高敏感性（63%和60%）。
CT特征的联合标准对预测良性肺病变最为理想。
