刘欣然 李志伟

【摘要】 目的：探討多层螺旋CT（MSCT）对周围型肺癌（PLC）的诊断价值及与组织病理学的相关性。方法：选取本院2018年6月-2019年10月收治的121例疑似PLC患者。所有患者均行MSCT检查，以病理结果为金标准，评估MSCT对PLC组织病理学类型的诊断符合率及诊断效能，分析PLC患者MSCT征象及其与组织病理学类型相关性。结果：121例疑似PLC患者中，101例经病理结果确诊为PLC，其中98例经MSCT检查提示为PLC，诊断符合率为97.03%（98/101）。MSCT对腺鳞癌与小细胞癌的诊断符合率均为100%;对腺癌的诊断符合率为97.83%（45/46）;对鳞癌的诊断符合率为95.56%（43/45）。以病理结果作为金标准，MSCT诊断PLC的阳性预测值为97.96%，阴性预测值为78.26%，敏感度为95.05%，特异度为90.00%，诊断准确率为94.21%。MSCT对PLC诊断的ROC曲线下面积为0.714[95%CI（0.703，0.864）]。鳞癌深分叶征发生例数多于腺癌，而空泡征、磨玻璃征、空气支气管征、毛刺征、胸膜凹陷征及支气管血管集束征的发生例数均少于腺癌（P<0.05）;鳞癌发生率与深分叶征呈正相关（P<0.05），腺癌发生率与空泡征、磨玻璃征、空气支气管征、毛刺征、胸膜凹陷征及支气管血管集束征均呈正相关（P<0.05）。结论：MSCT对PLC在疾病诊断、组织病理学类型诊断中具有较高的准确率，且深分叶征、空泡征、磨玻璃征、空气支气管征、毛刺征、胸膜凹陷征、支气管血管集束征与鳞癌、腺癌的鉴别具有一定相关性。

【关键词】 周围型肺癌 多层螺旋CT 组织病理学

Multislice Spiral CT in the Diagnosis of Peripheral Lung Cancer and Its Correlation with Histopathology/LIU Xinran， LI Zhiwei. //Medical Innovation of China， 2021， 18（05）： 0-071

[Abstract] Objective： To investigate the diagnostic value of multislice spiral CT （MSCT） in peripheral lung cancer （PLC） and its correlation with histopathology. Method： A total of 121 suspected PLC patients admitted to our hospital from June 2018 to October 2019 were selected. All patients underwent MSCT examination， the diagnostic coincidence rate and diagnostic efficiency of MSCT for PLC histopathological types were evaluated using pathological results as the gold standard， and the MSCT signs of PLC patients and their correlation with histopathological types were analyzed. Result： Among the 121 suspected PLC patients， 101 cases were diagnosed as PLC by pathological results， of which 98 cases were diagnosed as PLC by MSCT examination， and the diagnostic coincidence rate was 97.03% （98/101）. The coincidence rate of MSCT in the diagnosis of adenosquamous carcinoma and small cell carcinoma was 100%. The coincidence rate of MSCT in the diagnosis of adenocarcinoma was 97.83% （45/46）. The coincidence rate of MSCT in the diagnosis of squamous carcinoma was 95.56% （43/45）. Using pathological results as the gold standard， the positive predictive value of MSCT for PLC diagnosis was 97.96%， the negative predictive value was 78.26%， the sensitivity was 95.05%， the specificity was 90.00%， and the diagnostic accuracy was 94.21%. The area under the ROC curve of MSCT for PLC diagnosis was 0.714 [95%CI（0.703， 0.864）]. The incidence of squamous cell carcinoma with deep lobulation sign was more than that of adenocarcinoma， while the incidence of vacuole sign， ground glass sign， air bronchogram sign， spicule sign， pleural indentation sign and bronchovascular bundle sign were less than those of adenocarcinoma （P<0.05）. The incidence of squamous cell carcinoma was positively correlated with deep lobulation sign （P<0.05）， and the incidence of adenocarcinoma was positively correlated with vacuole sign， ground glass sign， air bronchogram sign， spicule sign， pleural indentation sign and bronchovascular bundle sign （P<0.05）. Conclusion： MSCT has a high accuracy in the diagnosis of diseases and histomathological types by PLC， and the deep lobulation sign， vacuole sign， ground glass sign， air bronchial sign， spicule sign， pleural indentation sign and bronchovascular bundle sign are correlated with the differentiation of squamous carcinoma and adenocarcinoma.

[Key words] Peripheral lung cancer Multi-slice spiral CT Histopathology

First-authors address： Jiamusi Traditional Chinese Medicine Hospital， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2021.05.018

数据显示，肺癌发病率约为54/10万，其中周围型肺癌（peripheral lung cancer，PLC）约占肺癌发病率的30%，严重威胁人类生命健康安全[1]。PLC常用的早期诊断方法包括支气管镜检、X线检查、常规CT扫描等，诊断准确率均较低，易出现漏诊或误诊[2-3]。近年来，随着CT扫描的不断发展，已由常规CT扫描发展为多层螺旋CT（multi-slice spiral CT，MSCT）增强扫描，其具有扫描时间短、速度快等特点，且后处理重建能够获得详细的容积扫描信息，获取高质量图像，可从多方位、多角度观察肺小结节，可显著提高PLC的诊断准确率。据此，本研究分析了MSCT对PLC的诊断价值及与组织病理学的相关性，现报道如下。……