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目的:探讨低剂量CT在筛查及鉴别疑似肺癌患者中的应用价值。方法:回顾性分析2015年1月~2016年10月我院接诊的18例疑似肺癌患者影像学资料,均在我院行胸部数字化X线及低剂量CT(LDCT)筛查,分析肺癌影像特征,并以病理结果为准,评价LDCT与X线诊断肺癌的效能,根据病变密度分为非实性结节与部分实性结节,根据病理结果将部分实性结节分为浸润前+微浸润性病变组,另一组为浸润性病变组,分析LDCT的鉴别要点及鉴别准确性。结果:本组18例疑似肺癌患者中共发现肺结节与肿块(>3cm)20个,平均大小(2.10±0.01)cm,其中非实性、部分实性、实性分别占15.00%、65.00%、20.00%;18例中,15例证实为肺癌,其中12例发现癌结节13个,中央型3个、周围型10个,平均大小(1.61±0.02)cm;LDCT对肺癌的阳性检出率73.33%明显高于胸部X线33.33%;浸润前病变+微浸润性病变组病变大小、实性成分百分比及毛刺征、分叶征、胸膜牵拉征发生率明显低于浸润性病变组;多因素Logistics回归分析显示病灶直径、实性成分比例为鉴别浸润前及微浸润性病变与浸润性病变的独立危险因素,两者联合诊断时ROC曲线下面积为0.861,95%可信区间:0.761,0.956。结论:低剂量CT在筛查及鉴别疑似肺癌患者中具有较高应用价值,病灶较小结合实性部分少是将浸润前及微浸润性病变从浸润性病变中鉴别出的诊断点。
Objective: To investigate the value of low-dose CT in the screening and identification of suspected lung cancer patients. Methods: The imaging data of 18 patients with suspected lung cancer admitted from January 2015 to October 2016 in our hospital were retrospectively analyzed. All patients underwent digital radiography and LDCT screening in our hospital. The lung cancer images According to pathological results, some solid nodules were divided into non-solid nodules and some solid nodules according to pathological density, Microinvasive lesions group, another group of infiltrative lesions group, analysis of the key points of LDCT identification and identification accuracy. Results: There were 20 pulmonary nodules and masses (> 3cm) in average size (2.10 ± 0.01) cm in the 18 patients with suspected lung cancer, of which 15.00% were non-solid and some were solid and solid, accounting for 65.00% , 20.00%. Of the 18 cases, 15 were confirmed as lung cancer, of which 13 were cancerous nodules in 12 cases, 3 were central type and 10 were peripheral type with an average size of (1.61 ± 0.02) cm. LDCT was positive for lung cancer The rate of 73.33% was significantly higher than that of chest X-ray 33.33%. The size of lesion, percentage of solid component, spiculation, lobulation and pleural traction in infiltrative lesion and microinvasive lesion were significantly lower than those in infiltrative lesion. Multi-factor Logistic regression analysis showed that lesion diameter and solid component ratio were independent risk factors for differentiating preinvasive and micro-infiltrative and infiltrative lesions. The area under the ROC curve for combined diagnosis was 0.861, 95% confidence interval: 0.761 , 0.956. Conclusion: Low-dose CT has a high value in the screening and identification of suspected lung cancer patients. The smaller the lesion combined with the less solid part is the diagnosis point of differentiating invasive and micro-invasive lesions from infiltrative lesions.