改良 Lung-RADS 提高了高非吸烟相关性肺癌患病率人群中 LDCT 筛查的性能。
Modified Lung-RADS Improves Performance of Screening LDCT in a Population with High Prevalence of Non-smoking-related Lung Cancer.
机构信息
Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung, 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
出版信息
Acad Radiol. 2018 Oct;25(10):1240-1251. doi: 10.1016/j.acra.2018.01.012. Epub 2018 Mar 9.
OBJECTIVES
We proposed a modification of the ACR Lung Imaging Reporting and Data System (Lung-RADS) to clarify the characteristics of subsolid nodules with categories 1-11, and to compare the diagnostic accuracy with Lung-RADS and National Lung Screening Trial criteria in an Asian population with high prevalence of adenocarcinoma.
METHODS
We analyzed a retrospective cohort of 1978 consecutive healthy subjects (72.8% nonsmoker) who underwent low-dose computed tomography from August 2013 to October 2014 (1084 men, 894 women). Lung-RADS categories 2 and 3 were modified to include subcategories of 2A/2B/2C and 3A/3B/3C, respectively. Clinical information and nodule characteristics were recorded. Receiver operating characteristic curves were used to compare diagnostic accuracy at different cutoffs.
RESULTS
Thirty-two subjects (30 nonsmokers) had pathology-proven adenocarcinoma spectrum lesions in the follow-up period (1.6 ± 0.5 years). Modified Lung-RADS, using modified Lung-RADS category 2C as cutoff, had an area under the curve (AUC) of 0.973 in predicting adenocarcinoma spectrum lesions (sensitivity of 100%, specificity of 89.3%), which was significantly higher than that of Lung-RADS (AUC = 0.815, P < .001) and National Lung Screening Trial (AUC = 0.906, P < .001). Furthermore, modified Lung-RADS showed an AUC of 0.992 in predicting invasive adenocarcinoma (sensitivity of 95%, specificity of 97.8%) when category 3B was used as cutoff.
CONCLUSIONS
Modified Lung-RADS may substantially improve sensitivity while maintaining specificity for detection of adenocarcinoma spectrum lesions in an Asian population. Compared to Lung-RADS, it has enhanced ability to differentiate invasive from indolent adenocarcinoma by more refined subclassification of subsolid nodules using two cutoff values of category 2C and 3B. The effect of using modified Lung-RADS in clinical practice must be carefully studied in prospective large cohort studies.
目的
我们提出了一种 ACR 肺部成像报告和数据系统（Lung-RADS）的改良方法，以阐明 1-11 类亚实性结节的特征，并在亚洲高腺癌患病率人群中与 Lung-RADS 和国家肺癌筛查试验标准进行比较。
方法
我们分析了 1978 例连续的健康受试者（72.8%为非吸烟者）的回顾性队列，他们在 2013 年 8 月至 2014 年 10 月期间接受了低剂量计算机断层扫描（1084 名男性，894 名女性）。Lung-RADS 类别 2 和 3 分别被修改为包括 2A/2B/2C 和 3A/3B/3C 的亚类别。记录临床信息和结节特征。使用接收器工作特性曲线比较不同截点的诊断准确性。
结果
在随访期间（1.6±0.5 年），32 例（30 名非吸烟者）有经病理证实的腺癌谱病变。使用改良的 Lung-RADS，以改良的 Lung-RADS 类别 2C 为截断值，预测腺癌谱病变的曲线下面积（AUC）为 0.973（敏感性为 100%，特异性为 89.3%），明显高于 Lung-RADS（AUC=0.815，P<0.001）和国家肺癌筛查试验（AUC=0.906，P<0.001）。此外，当使用类别 3B 作为截断值时，改良的 Lung-RADS 预测侵袭性腺癌的 AUC 为 0.992（敏感性为 95%，特异性为 97.8%）。
结论
改良的 Lung-RADS 可以显著提高亚洲人群检测腺癌谱病变的敏感性，同时保持特异性。与 Lung-RADS 相比，通过使用类别 2C 和 3B 的两个截断值对亚实性结节进行更精细的亚分类，它具有更好的区分侵袭性和惰性腺癌的能力。在大样本前瞻性队列研究中，必须仔细研究使用改良的 Lung-RADS 在临床实践中的效果。
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