计算机断层扫描（CT）上的肿瘤与胸膜关系可为肺影像报告和数据系统（Lung-RADS）评分为4X的周围型肺结节提供有效的风险分层。
Tumour-pleura relationship on computed tomography (CT) provides effective risk stratification for peripheral pulmonary nodules with Lung Imaging Reporting and Data System (Lung-RADS) score of 4X.
作者信息
Deng Liangna, Zhu Kaibo, Yang Jingjing, Zhang Yuting, Jing Mengyuan, Zhang Peng, Han Tao, Zhang Bin, Zhou Junlin
机构信息
Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.
Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China.
出版信息
Quant Imaging Med Surg. 2024 Oct 1;14(10):7138-7150. doi: 10.21037/qims-24-530. Epub 2024 Sep 21.
BACKGROUND
Pulmonary nodules with Lung Imaging Reporting and Data System (Lung-RADS) 4X are of greater clinical significance, and accurate differentiation of pathological types and visceral pleural invasion (VPI) of Lung-RADS 4X peripheral pulmonary nodules before treatment can aid in stratification. This study set out to investigate whether the tumour-pleura relationship on computed tomography (CT) can provide effective risk stratification for peripheral pulmonary nodules with Lung-RADS 4X.
METHODS
This was a single institution, retrospective study of 482 consecutive patients with Lung-RADS score 4X, who were pathologically diagnosed with tuberculous granuloma and adenocarcinoma from January 2019 to December 2023. We assessed clinical factors (baseline characteristics and tumour markers) and CT findings. Univariate and multivariate logistic regression analyses were used to determine the classification of pulmonary nodules and predictors of VPI.
RESULTS
Multivariate analysis revealed that gender [odds ratio (OR) =0.392; P<0.001], carcinoembryonic antigen (CEA) level (OR =8.331; P<0.001), type of nodules (OR =13.551 and 7.478; P<0.001 and P=0.016) and maximum base width of soft tissue component on the pleura side (OR =0.857; P=0.005) were significant independent factors for distinguishing tuberculous granuloma from adenocarcinoma. And the type of linear connection between lesion and pleura (OR =3.936; P<0.001), and the maximum base width of soft tissue components on the pleura side (OR =1.359; P=0.001) were correlated independently with VPI. The area under the curve (AUC) for predicting pulmonary nodules classification was 82.60% [95% confidence interval (CI): 78.85-86.35%), and the AUC for predicting VPI was 76.10% (95% CI: 69.83-82.38%).
CONCLUSIONS
The tumour-pleura relationship will be helpful in further risk stratification for peripheral pulmonary nodules with a score of Lung-RADS 4X.
背景
具有肺部影像报告和数据系统（Lung-RADS）4X类的肺结节具有更大的临床意义，在治疗前准确区分Lung-RADS 4X类周围型肺结节的病理类型和脏层胸膜侵犯（VPI）有助于进行分层。本研究旨在探讨计算机断层扫描（CT）上的肿瘤-胸膜关系能否为Lung-RADS 4X类周围型肺结节提供有效的风险分层。
方法
这是一项单机构回顾性研究，纳入了2019年1月至2023年12月期间连续482例Lung-RADS评分为4X的患者，这些患者经病理诊断为结核性肉芽肿和腺癌。我们评估了临床因素（基线特征和肿瘤标志物）以及CT表现。采用单因素和多因素逻辑回归分析来确定肺结节的分类及VPI的预测因素。
结果
多因素分析显示，性别[比值比（OR）=0.392；P<0.001]、癌胚抗原（CEA）水平（OR =8.331；P<0.001）、结节类型（OR =13.551和7.478；P<0.001和P=0.016）以及胸膜侧软组织成分的最大基底宽度（OR =0.857；P=0.005）是区分结核性肉芽肿与腺癌的显著独立因素。病变与胸膜之间的线性连接类型（OR =3.936；P<0.001）以及胸膜侧软组织成分的最大基底宽度（OR =1.359；P=0.001）与VPI独立相关。预测肺结节分类的曲线下面积（AUC）为82.60%[95%置信区间（CI）：78.85 - 86.35%]，预测VPI的AUC为76.10%（95%CI：69.83 - 82.38%）。
结论
肿瘤-胸膜关系有助于对Lung-RADS 4X评分的周围型肺结节进行进一步的风险分层。
Zotero 插件