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目的探索一种常规术前CT检查评估胸膜受侵的简单、无创技术。材料与方法本项回顾性研究经机构审查委员会批准,并签署关于初次级随访CT检查的知情同意书。评估术前CT表现(169例疑有胸膜受侵的病人)和手术切除后的病理诊断。在CT影像上测量原发肿瘤与邻近结构交界面的长度(弧距)和肿瘤的最大直径,然后计算弧距与肿瘤最大直径的比值。采用受试者操作特征(ROC)曲线分析该比值。结果应用国际抗癌联合会TNM分期系统,根据弧距与肿瘤最大直径比值的中位数将胸膜侵犯分级如下:pl1为0.206(第1—第3个百分位数:0~0.486);pl2为0.638(第1—第3个百分位数:0.385~0.830);pl3为1.092(第1—第3个百分位数,1.045~1.214)(组间P<0.001)。基于ROC曲线的分析,弧距与肿瘤最大直径之比为0.9是胸膜受侵的临界值。当比值>0.9时,胸膜受侵的敏感度、特异度及ROC曲线下面积分别为89.7%、96.0%和0.976,较应用常规标准测量值的敏感度和特异度(诊断医师A和B:分别为46.7%和74.2%,91.3%和84.8%)有所提高。结论应用弧距与肿瘤最大直径比值诊断T3或T4期肺癌可达到比应用常规标准更高的性能等级。弧距与肿瘤最大直径比值的测量是一种评估胸膜受侵的简单无创技术。
Objective To explore a simple, noninvasive technique for assessing pleural invasion by routine preoperative CT. Materials and Methods This retrospective study was approved by the Institutional Review Board and signed an informed consent form for initial follow-up CT examination. Preoperative CT findings were assessed (169 patients with suspected pleural invasion) and pathological diagnosis after surgical resection. The length (arc distance) of the interface between the primary tumor and the adjacent structures and the maximum diameter of the tumor were measured on the CT image. The ratio of the arc distance to the maximum diameter of the tumor was then calculated. The ratio was analyzed using receiver operating characteristic (ROC) curves. Results According to the TNM staging system of the International Union Against Cancer, the pleural invasion was graded according to the median of the ratio of the arc distance to the maximum diameter of the tumor as follows: pl1 was 0.206 (1st-3rd percentile: 0-0.486); pl2 Was 0.638 (1st-3rd percentile: 0.385-0.830); pl3 was 1.092 (1st-3rd percentile, 1.045-1.214) (P <0.001 for groups). Based on the analysis of the ROC curve, the ratio of the arc distance to the maximum tumor diameter of 0.9 was the critical value for pleural invasion. The sensitivity, specificity, and area under the ROC curve for pleural invasion were 89.7%, 96.0%, and 0.976, respectively, when the ratio was> 0.9, compared with the sensitivity and specificity of routine standard measurements (Diagnostic Physician A and B respectively 46.7% and 74.2%, 91.3% and 84.8% respectively). Conclusion It is possible to achieve a higher level of performance than the conventional standard when diagnosing T3 or T4 lung cancer using the arc-to-tumor maximum diameter ratio. The measurement of the arc-to-tumor maximal diameter ratio is a simple, noninvasive technique for assessing pleural invasion.