Ye Wenjun, Fu Wenhai, Li Caichen, Li Jianfu, Xiong Shan, Cheng Bo, Xu Bin, Wang Qixia, Feng Yi, Chen Peiling, He Jianxing, Liang Wenhua
Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Department of Thoracic Surgery and Oncology, Hengqin Hospital, First Affiliated Hospital of Guangzhou Medical University, Hengqin, Guangdong, China.
Thorax. 2025 Jan 17;80(2):76-85. doi: 10.1136/thorax-2024-221642.
Limited research exists on screening thresholds for low-dose CT in detecting malignant pure ground-glass lung nodules (pGGNs) in the Chinese population.
A retrospective analysis of the Guangzhou Lung-Care programme was conducted, retrieving average transverse diameter, location, histopathology, frequency and follow-up intervals. Diagnostic performances for 'lung cancers' were evaluated using areas under the curve (AUCs), decision curve analysis (DCA), sensitivities and specificities, with thresholds ranging from 5 mm to 10 mm. We divide malignant pGGNs into three groups: (1) minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IA), (2) atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS) and MIA and IA and (3) IA-only.
In 'MIA+IA', increasing the threshold from 5 mm to 8 mm improved specificity (60.97% to 88.85%, p<0.001) and positive predictive values (PPVs; 5.87% to 14.88%, p<0.001), but decreased sensitivity (94.44% to 75.56%, p<0.001). Further raising threshold from 8 mm reduced sensitivity (75.56% to 60.00%, p<0.001), while slightly increasing specificity (88.85% to 93.47%, p<0.001) and PPVs (14.88% to 19.15%, p<0.001). Increasing threshold from 5 mm to 7 mm enhanced the AUC for 'MIA+IA' (from 0.711 to 0.829), 'AAH+AIS+MIA+IA' (from 0.748 to 0.804) and 'IA-only' (from 0.783 to 0.833). At 8 mm, the AUCs for these categories were similar. However, increasing the threshold from 7 mm to 10 mm resulted in reduced AUCs for 'MIA+IA' (0.829 to 0.767), 'AAH+AIS+MIA+IA' (0.804 to 0.744) and 'IA-only' (0.833 to 0.800). DCA reveals that the 8 mm predictive model demonstrates greater clinical utility compared with models with other thresholds.
Increasing the diameter threshold for positive results for pGGNs, up to 8 mm could enhance diagnostic performance.
NCT04938804.
关于低剂量CT在中国人群中检测恶性纯磨玻璃肺结节（pGGN）的筛查阈值的研究有限。
对广州肺部关爱项目进行回顾性分析，获取平均横径、位置、组织病理学、频率和随访间隔。使用曲线下面积（AUC）、决策曲线分析（DCA）、敏感性和特异性评估“肺癌”的诊断性能，阈值范围为5毫米至10毫米。我们将恶性pGGN分为三组：（1）微浸润腺癌（MIA）和浸润性腺癌（IA），（2）非典型腺瘤样增生（AAH）和原位腺癌（AIS）以及MIA和IA，（3）仅IA。
在“MIA+IA”组中，将阈值从5毫米提高到8毫米可提高特异性（从60.97%提高到88.85%，p<0.001）和阳性预测值（PPV；从5.87%提高到14.88%，p<0.001），但降低敏感性（从94.44%降低到75.56%，p<0.001）。将阈值从8毫米进一步提高会降低敏感性（从75.56%降低到60.00%，p<0.001），同时略微提高特异性（从88.85%提高到93.47%，p<0.001）和PPV（从14.88%提高到19.15%，p<0.001）。将阈值从5毫米提高到7毫米可提高“MIA+IA”（从0.711提高到0.829）、“AAH+AIS+MIA+IA”（从0.748提高到0.804）和“仅IA”（从0.783提高到0.833）的AUC。在8毫米时，这些类别的AUC相似。然而，将阈值从7毫米提高到10毫米会导致“MIA+IA”（从0.829降低到0.767）、“AAH+AIS+MIA+IA”（从0.804降低到0.744）和“仅IA”（从0.833降低到0.800）的AUC降低。DCA显示，与其他阈值的模型相比，8毫米预测模型具有更大的临床实用性。
提高pGGN阳性结果的直径阈值至8毫米可提高诊断性能。
NCT04938804。
