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目的探讨CT预测胸腺瘤的分期及侵袭性的价值。方法回顾性分析经手术病理证实的胸腺瘤79例,根据Masaoka-Koga分期将胸腺瘤分组:A组为(Ⅰ+Ⅱ期)44例,B组(Ⅲ+Ⅳ期)35例,分析两组肿瘤分布、最大横径、形态、密度、内部钙化及与周围组织器官关系等CT特征,预测胸腺瘤的分期及对周围组织的侵袭程度,与Masaoka-Koga病理分期比较。结果两组肿瘤分布无差异(P=0.418),两组最大横径、形态、密度、内部钙化均不同,P值分别为0.000,0.000,0.001,0.002。CT对胸腺瘤侵袭纵隔脂肪、纵隔胸膜、心包、临近肺组织及大血管的阳性预测值分别为83.67%、76.92%、71.43%、66.67%、80%,阴性预测值分别为80%、96.22%、96.55%、94.83%、97.3%。结论 CT能较好的判断胸腺瘤的侵袭性,区分Ⅰ/Ⅱ期与Ⅲ/Ⅳ期胸腺瘤,从而确定术前需要新辅助治疗的患者,提高手术切除率及肿瘤切除完整性,改善预后。
Objective To investigate the value of CT in predicting the staging and invasiveness of thymoma. Methods A retrospective analysis of 79 cases of thymoma confirmed by surgery and pathology was performed according to the Masaoka-Koga criteria. Thymoma was divided into group A (44 cases in stage I + II) and 35 cases in group B (stage Ⅲ + Ⅳ) Tumor distribution, maximum diameter, shape, density, internal calcification and the relationship with the surrounding tissue and other CT features of the thymoma prognosis and surrounding tissue invasion degree, and Masaoka-Koga pathological staging compared. Results There was no difference in tumor distribution between the two groups (P = 0.418). The maximum diameter, shape, density and internal calcification of the two groups were different. The P values were 0.000, 0.000, 0.001 and 0.002 respectively. The positive predictive value of CT for invasion of mediastinal fat, mediastinal pleura, pericardium, adjacent lung tissue and large blood vessels of thymoma was 83.67%, 76.92%, 71.43%, 66.67% and 80% respectively, and the negative predictive values were 80% and 96.22% , 96.55%, 94.83%, 97.3%. Conclusion CT can determine the invasiveness of thymoma and differentiate stage Ⅰ / Ⅱ thymoma from stage Ⅲ / Ⅳ thymoma, so as to determine the patients needing neoadjuvant therapy before surgery, to improve the resection rate and tumor resection completeness and improve the prognosis.