TSCT 特征在区分直径小于 3cm 的表现为亚实性结节的浸润前腺癌和微浸润性腺癌与浸润性腺癌中的价值。

Value of TSCT Features for Differentiating Preinvasive and Minimally Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as Subsolid Nodules Smaller Than 3 cm.

机构信息

Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China.

Department of Pathology, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, China.

出版信息

Acad Radiol. 2020 Mar;27(3):395-403. doi: 10.1016/j.acra.2019.05.005. Epub 2019 Jun 11.

DOI:10.1016/j.acra.2019.05.005

PMID:31201034

Abstract

BACKGROUND

To distinguish preinvasive (adenocarcinoma in situ/atypical adenomatous hyperplasia) and minimally invasive adenocarcinoma (MIA) from invasive adenocarcinoma (IA) appearing as solitary subsolid nodules (SSNs) less than 3 cm based on thin-section computed tomography (TSCT) features to guide therapeutic approaches.

METHODS

A total of 154 lesions that were histopathologically confirmed to have pre/minimally invasive adenocarcinoma (hereafter pre/MIA) and IA presenting as part-solid nodules (PSNs) or pure ground-glass nodules (pGGNs) were retrospectively reviewed. The TSCT features, including diameter, area, CT value, shape, air bronchogram, margins, and location, were compared and assessed. Receiver operating characteristic analyses were conducted to determine the cut-off values for the qualitative variables and their diagnostic performances.

RESULTS

Of 154 nodules, 89 IA, 53 MIA, eight adenocarcinoma in situ, and four atypical adenomatous hyperplasia lesions were found. Univariate and multivariate logistic regression of the pre/MIA and IA lesions were compared and analyzed among PSNs and pGGNs. Among pGGNs, a significant difference was found in the area (p = 0.004, odds ratio [OR] = 0.124, 95% confidence interval [CI] = 0.300-0.515) between the pre/MIA and IA groups. In PSNs, significant differences were found in the diameter (p = 0.001, OR = 0.171, 95% CI = 0.063-0.467) and CT value (p = 0.001, OR = 0.996, 95% CI = 0.993-0.998) between the pre/MIA and IA groups. According to the corresponding receiver operating characteristic curves, the optimal cut-off tumor area in pGGNs to differentiate pre/MIA from IA was 0.595 cm. A higher CT value of the lesion (≥ -298.500 HU) and a larger diameter (≥1.450 cm) in PSNs were significantly associated with IA.

CONCLUSION

Imaging features from TSCT contribute to distinguishing pre/MIA from IA in solitary subsolid nodules and may contribute to guide the clinical management of these lesions.

摘要

背景

为了根据薄层计算机断层扫描（TSCT）特征区分直径小于 3cm 的孤立实性结节（SSN）中表现为癌前（原位腺癌/非典型腺瘤性增生）和微浸润性腺癌（MIA）与浸润性腺癌（IA），指导治疗方法。

方法

回顾性分析了 154 例经组织病理学证实为部分/微浸润性腺癌（以下简称 pre/MIA）和表现为部分实性结节（PSN）或纯磨玻璃结节（pGGN）的 IA 的病变。比较并评估了 TSCT 特征，包括直径、面积、CT 值、形状、空气支气管征、边缘和位置。进行受试者工作特征分析以确定定性变量的截止值及其诊断性能。

结果

在 154 个结节中，发现 89 个 IA、53 个 MIA、8 个原位腺癌和 4 个非典型腺瘤性增生病变。在 PSN 和 pGGN 中对 pre/MIA 和 IA 病变进行了单变量和多变量逻辑回归比较和分析。在 pGGN 中，pre/MIA 和 IA 两组之间的面积有显著差异（p=0.004，优势比[OR] = 0.124，95%置信区间[CI] = 0.300-0.515）。在 PSN 中，pre/MIA 和 IA 两组之间的直径（p=0.001，OR=0.171，95%CI=0.063-0.467）和 CT 值（p=0.001，OR=0.996，95%CI=0.993-0.998）有显著差异。根据相应的受试者工作特征曲线，区分 pre/MIA 和 IA 的最佳 pGGN 肿瘤面积截断值为 0.595cm。PSN 中病变的 CT 值较高（≥-298.500HU）和直径较大（≥1.450cm）与 IA 显著相关。