CT 扫描中的胸膜标签预测不紧贴胸膜的非小细胞肺癌侵犯内脏胸膜。
Pleural Tags on CT Scans to Predict Visceral Pleural Invasion of Non-Small Cell Lung Cancer That Does Not Abut the Pleura.
机构信息
From the Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (J.S.H., T.S.J., G.C.L., C.Y.C.); Department of Medical Imaging, Kaohsiung Medical University Hospital, 100 Tz You 1st Road, Kaohsiung 807, Taiwan (J.S.H., I.T.H., T.H.T., T.S.J., G.C.L., C.Y.C.); Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.F.L.); Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (G.C.L.); Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (S.H.C.); Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S.H.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (I.W.C.); Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (I.W.C.); and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.C.).
出版信息
Radiology. 2016 May;279(2):590-6. doi: 10.1148/radiol.2015151120. Epub 2015 Dec 10.
PURPOSE
To evaluate the association of pleural tags with visceral pleural invasion of non-small cell lung cancer (NSCLC) that does not abut the pleural surface.
MATERIALS AND METHODS
This retrospective study was approved by the institutional review board. Informed consent was waived. The study of NSCLC that does not abut the pleura in 141 patients (44 patients [31.2%] with visceral pleural invasion proved by pathologic analysis and 97 patients [68.8%] without pleural invasion) was conducted at a single tertiary center. The pleural tags were classified into three types (type 1, one or more linear pleural tag; type 2, one or more linear pleural tag with soft tissue component at the pleural end; and type 3, one or more soft tissue cord-like pleural tag) and prioritized into types 3, 2, and 1 when more than one type was present. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio (LR) were calculated.
RESULTS
In the absence of pleural tags, no pleural invasion was found. The presence of type 2 pleural tags was moderately associated with visceral pleural invasion with the following results: positive LR, 5.06; accuracy, 71%; sensitivity, 36.4%; specificity, 92.8%; PPV, 76.2%; and NPV, 69.6%. Type 1 pleural tags provided weak evidence to rule out visceral pleural invasion (positive LR, 0.38). Type 3 pleural tags indicated minimal increase in the likelihood of visceral pleural invasion (positive LR, 1.68).
CONCLUSION
Type 2 pleural tags on conventional CT images can increase the accuracy of early diagnosis of visceral pleural invasion by NSCLC that does not abut the pleura.
目的
评估胸膜标签与不贴附胸膜的非小细胞肺癌（NSCLC）的内脏胸膜侵犯之间的关联。
材料和方法
本回顾性研究获得了机构审查委员会的批准。放弃了知情同意。在一家三级中心对 141 例不贴附胸膜的 NSCLC 患者（44 例[31.2%]经病理分析证实有内脏胸膜侵犯，97 例[68.8%]无胸膜侵犯）进行了研究。胸膜标签分为 3 种类型（1 型，一条或多条线性胸膜标签；2 型，一条或多条线性胸膜标签，胸膜末端有软组织成分；3 型，一条或多条软组织索状胸膜标签），当存在多种类型时，优先考虑 3 型、2 型和 1 型。计算了诊断准确性、敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和阳性似然比（LR）。
结果
在没有胸膜标签的情况下，没有发现胸膜侵犯。2 型胸膜标签的存在与内脏胸膜侵犯中度相关，结果如下：阳性 LR，5.06；准确性，71%；敏感性，36.4%；特异性，92.8%；PPV，76.2%；NPV，69.6%。1 型胸膜标签提供了排除内脏胸膜侵犯的弱证据（阳性 LR，0.38）。3 型胸膜标签表明内脏胸膜侵犯的可能性略有增加（阳性 LR，1.68）。
结论
常规 CT 图像上的 2 型胸膜标签可以提高不贴附胸膜的 NSCLC 内脏胸膜侵犯的早期诊断准确性。
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