高分辨CT增强扫描联合循环肿瘤细胞检测对磨玻璃样病变患者早期肺癌的诊断价值探究
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摘要
目的探讨高分辨CT增强扫描联合循环肿瘤细胞(circulating tumor cell,CTC)检测对磨玻璃样病变(ground glass opacity,GGO)患者早期肺癌的诊断价值。方法选择西安市中心医院2015年1月至2017年12月经高分辨CT检查发现的GGO患者为研究对象,所有患者均经病理学检查确诊。采用飞利浦Brilliance 16排螺旋CT进行高分辨增强扫描,同时对所有患者进行CTC检测,分析良/恶性病变患者的CT征象,对比高分辨CT增强扫描、CTC检测及联合检查诊断早期肺癌的特异度、灵敏度、诊断符合率、阳性预测值、阴性预测值。结果 67例患者中41例为单纯GGO结节,26例为混合GGO结节;根据病理检查结果显示,67例患者中共有39例为恶性病变,28例为良性病变。恶性病变患者毛刺、分叶、胸膜凹陷征的CT征象的发生率均显著高于良性病变(P_均<0.05)。高分辨CT增强扫描诊断早期肺癌的灵敏度、特异度、诊断符合率、阳性预测值、阴性预测值均显著低于CTC检测及联合检查(P_均<0.05);联合检查的特异度、灵敏度、诊断符合率、阳性预测值、阴性预测值均高于CTC检测,但差异均无显著性(P_均> 0.05)。结论高分辨CT增强扫描和CTC检测对GGO均有较高的诊断价值,能有效鉴别病变的良/恶性,二者联合应用能显著提高诊断的特异度和灵敏度,为早期发现、诊断、治疗肺癌提供参考依据。
Objective To investigate the diagnostic value of high resolution CT enhanced scan combined with circulating tumor cell(CTC) detection in early lung cancer with lung ground glass opacity(GGO). Method From January 2015 to December 2017, 67 patients with GGO were examined by high resolution CT in Xi'an Central Hospital. All patients were confirmed by pathological examination. Phillips Brilliance 16-slice spiral CT was used to perform high-resolution contrast-enhanced scan, and CTC was performed in all patients. The CT signs of benign and malignant lesions were analyzed. The specificity, sensitivity, diagnostic coincidence rate, positive predictive value and negative predictive value of high resolution CT, CTC and combined detection for early lung cancer were compared. Result In 67 cases, 41 cases of simple GGO lesion and 26 cases were mixed GGO lesions. According to the results of pathological examination, 39 cases were malignant and 28 cases were benign. The incidence of burr, lobulation and pleural indentation in malignant lesions was significantly higher than that in benign lesions(P_(all)< 0.05). The specificity, sensitivity, diagnostic coincidence rate, positive predictive value and negative predictive value of high resolution CT were significantly lower than those of CTC detection and combined examination(P_(all)< 0.05), and the indexes of combined examination were higher than those of CTC detection, but the differences were not significant(P_(all)> 0.05). Conclusion High resolution CT enhanced scan and CTC detection are of high diagnostic value for GGO, and can effectively differentiate benign and malignant lesions. At the same time, the combination of the two method can significantly improve the specificity and sensitivity of diagnosis, and provide a reference for early detection, diagnosis and treatment of lung cancer.
Objective To investigate the diagnostic value of high resolution CT enhanced scan combined with circulating tumor cell(CTC) detection in early lung cancer with lung ground glass opacity(GGO). Method From January 2015 to December 2017, 67 patients with GGO were examined by high resolution CT in Xi'an Central Hospital. All patients were confirmed by pathological examination. Phillips Brilliance 16-slice spiral CT was used to perform high-resolution contrast-enhanced scan, and CTC was performed in all patients. The CT signs of benign and malignant lesions were analyzed. The specificity, sensitivity, diagnostic coincidence rate, positive predictive value and negative predictive value of high resolution CT, CTC and combined detection for early lung cancer were compared. Result In 67 cases, 41 cases of simple GGO lesion and 26 cases were mixed GGO lesions. According to the results of pathological examination, 39 cases were malignant and 28 cases were benign. The incidence of burr, lobulation and pleural indentation in malignant lesions was significantly higher than that in benign lesions(P_(all)< 0.05). The specificity, sensitivity, diagnostic coincidence rate, positive predictive value and negative predictive value of high resolution CT were significantly lower than those of CTC detection and combined examination(P_(all)< 0.05), and the indexes of combined examination were higher than those of CTC detection, but the differences were not significant(P_(all)> 0.05). Conclusion High resolution CT enhanced scan and CTC detection are of high diagnostic value for GGO, and can effectively differentiate benign and malignant lesions. At the same time, the combination of the two method can significantly improve the specificity and sensitivity of diagnosis, and provide a reference for early detection, diagnosis and treatment of lung cancer.
引文
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[15]Lee KH,Goo JM,Park SJ,et al.Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules[J].J Thorac Oncol,2014,9(1):74-82.
[16]陈昌南,潘岐作,陈婵娟,等.非小细胞肺癌循环肿瘤细胞CTC监测与影像CT同步比较分析的临床研究[J].心理医生,2017,23(28):113-114.
[17]Pedersen JH,Saghir Z,Wille MM,et al.Ground-Glass Opacity Lung Nodules in the Era of Lung Cancer CT Screening:Radiology,Pathology,and Clinical Management[J].Oncology(Williston Park),2016,30(3):266-274.
[18]Hwang IP,Park CM,Park SJ,et al.Persistent Pure GroundGlass Nodules Larger Than 5 mm:Differentiation of Invasive Pulmonary Adenocarcinomas From Preinvasive Lesions or Minimally Invasive Adenocarcinomas Using Texture Analy sis[J].Invest Radiol,2015,50(11):798-804.
[19]Mascalchi M,Maddau C,Sali L.Circulating tumor cells and microemboli can differentiate malignant and benign pulmonary lesions[J].J Cancer,2017,8(12):2223-2230.
[20]李发凯,陆远,王媛,等.循环肿瘤细胞检测在肺癌临床诊疗及预后判断中的应用进展[J].山东医药,2018,58(6):101-104.
[2]张增利,施敏骅.肺癌早期筛查的研究进展[J].中国医学前沿杂志(电子版),2018,10(7):32-36.
[3]崔刚,谭彦芳.高分辨率CT对肺孤立性磨玻璃样病变的鉴别诊断价值[J].中外医疗,2018,37(9):184-186.
[4]陆龙,李军.64排螺旋CT发现及随访肺磨玻璃样结节对早期肺癌的诊断价值[J].影像研究与医学应用,2017,1(11):41-42.
[5]段新春,刘志东,许绍发.循环肿瘤细胞在早期肺癌诊疗中的研究进展[J].中国肺癌杂志,2017,20(10):703-709.
[6]凌淑荣,游正坤,陈欣.高分辨胸部CT对肺部磨玻璃结节及早期肺癌的筛查价值[J].中国临床保健杂志,2017,20(3):299-300.
[7]Lv YG,Bao JH,Xu DU,et al.Characteristic analysis of pulmonary ground-glass lesions with the help of 64-slice CT technology[J].Eur Rev Med Pharmacol Sci,2017,21(14):3212-3217.
[8]姜格宁,谢冬.表现为磨玻璃样影的早期肺癌[J].中华外科杂志,2015,53(10):790-793.
[9]Son JY,Lee HY,Kim JH,et al.Quantitative CT analysis of pulmonary ground-glass opacity nodules for distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma:the added value of using iodine mapping[J].Eur Radiol,2016,26(1):43-54.
[10]Shewale JB,Nelson DB,Rice DC,et al.Natural History of Ground-Glass Lesions Among Patients With Previous Lung Cancer[J].Ann Thorac Surg,2018,105(6):1671-1677.
[11]Bankier AA,Macmahon H,Goo JM,et al.Recommendations for Measuring Pulmonary Nodules at CT:A Statement from the Fleischner Society[J].Radiology,2017,285(2):584-600.
[12]明星,吴非.肺磨玻璃结节CT征象对早期肺腺癌的诊断价值[J].国际医学放射学杂志,2017,40(1):37-40.
[13]袁焕初,郑晓林,邹玉坚,等.肺磨玻璃样病变高分辨率CT的质地分析及其对早期肺癌的诊断价值[J].临床放射学杂志,2018,37(2):252-256.
[14]张金英,戚元刚,黄勇.肺部纯磨玻璃密度结节高分辨率CT征象与病理组织学的关系[J].山东医药,2018,58(1):89-91.
[15]Lee KH,Goo JM,Park SJ,et al.Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules[J].J Thorac Oncol,2014,9(1):74-82.
[16]陈昌南,潘岐作,陈婵娟,等.非小细胞肺癌循环肿瘤细胞CTC监测与影像CT同步比较分析的临床研究[J].心理医生,2017,23(28):113-114.
[17]Pedersen JH,Saghir Z,Wille MM,et al.Ground-Glass Opacity Lung Nodules in the Era of Lung Cancer CT Screening:Radiology,Pathology,and Clinical Management[J].Oncology(Williston Park),2016,30(3):266-274.
[18]Hwang IP,Park CM,Park SJ,et al.Persistent Pure GroundGlass Nodules Larger Than 5 mm:Differentiation of Invasive Pulmonary Adenocarcinomas From Preinvasive Lesions or Minimally Invasive Adenocarcinomas Using Texture Analy sis[J].Invest Radiol,2015,50(11):798-804.
[19]Mascalchi M,Maddau C,Sali L.Circulating tumor cells and microemboli can differentiate malignant and benign pulmonary lesions[J].J Cancer,2017,8(12):2223-2230.
[20]李发凯,陆远,王媛,等.循环肿瘤细胞检测在肺癌临床诊疗及预后判断中的应用进展[J].山东医药,2018,58(6):101-104.