不同類型肺結(jié)節(jié)的生長(zhǎng)曲線分析
發(fā)布時(shí)間：2018-12-13 18:42
【摘要】：背景與目的計(jì)算機(jī)斷層掃描(computed tomography,CT)隨訪評(píng)估肺內(nèi)結(jié)節(jié)的生長(zhǎng)特性是臨床判斷結(jié)節(jié)良惡性的常用策略。不同生物學(xué)行為的肺結(jié)節(jié)可能具有不同的生長(zhǎng)速度和生長(zhǎng)模式。本研究的目的是繪制不同類型肺結(jié)節(jié)的體積生長(zhǎng)曲線,了解其生長(zhǎng)方式,為判斷結(jié)節(jié)性質(zhì)并制定肺結(jié)節(jié)隨訪方案提供依據(jù)。方法應(yīng)用三維分析軟件對(duì)111例接受2次及以上CT檢查的肺結(jié)節(jié)(實(shí)性結(jié)節(jié)54例、亞實(shí)性結(jié)節(jié)57例)的影像資料進(jìn)行回顧性分析。35例惡性及5例良性結(jié)節(jié)經(jīng)病理或組織學(xué)確認(rèn),其余71例經(jīng)兩年隨訪無(wú)顯著生長(zhǎng),經(jīng)專家會(huì)診確認(rèn)為肺癌低危結(jié)節(jié)。所有結(jié)節(jié)按密度及性質(zhì)分組:實(shí)性良性/低危結(jié)節(jié)、實(shí)性惡性結(jié)節(jié)、亞實(shí)性良性/低危結(jié)節(jié)、亞實(shí)性惡性結(jié)節(jié)。以隨訪間隔時(shí)間(d)為X軸,以隨訪結(jié)節(jié)的三維體積(mm3)和三維體積對(duì)數(shù)為Y軸,繪制體積線性及指數(shù)性生長(zhǎng)曲線,由研究者主觀觀察曲線的形態(tài)。應(yīng)用卡方檢驗(yàn)比較不同性質(zhì)肺結(jié)節(jié)的生長(zhǎng)曲線的差異。結(jié)果實(shí)性惡性結(jié)節(jié)中12例(66.7%)生長(zhǎng)曲線快速上升,3例(16.7%)先平緩-后上升,2例(11.1%)緩慢上升,1例(5.56%)平直。亞實(shí)性惡性結(jié)節(jié)中8例(47.1%)呈快速上升型,4例(23.5%)緩慢上升,3例(17.6%)平直,2例(11.8%)為先下降-后上升型。實(shí)性良性/低危結(jié)節(jié)中5例(13.9%)呈下降型,17例(47.2%)平直,8例(21.6%)緩慢上升,6例(16.7%)呈波浪型。亞實(shí)性良性/低危結(jié)節(jié)中4例(10%)呈下降型,21例(52.5%)平直,9例(22.5%)緩慢上升,6例(15%)呈波浪型。良性/低危結(jié)節(jié)與惡性結(jié)節(jié)生長(zhǎng)曲線分布存在顯著性差異(χ2=42.4,P0.01)。結(jié)論肺癌生長(zhǎng)曲線具有異質(zhì)性,快速上升是惡性肺結(jié)節(jié)的特征性生長(zhǎng)曲線,但部分可在一定時(shí)期內(nèi)表現(xiàn)為平直、緩慢上升甚至下降。緩慢生長(zhǎng)不能排除肺癌可能,尤其是亞實(shí)性結(jié)節(jié)。
[Abstract]:Background & objective to evaluate the growth characteristics of pulmonary nodules by computed tomography (computed tomography,CT) follow-up is a common strategy in clinical diagnosis of benign and malignant nodules. Pulmonary nodules with different biological behaviors may have different growth rates and patterns. The purpose of this study was to draw the volume growth curves of different types of pulmonary nodules, to understand their growth patterns, and to provide evidence for judging the nature of nodules and making follow-up plans for lung nodules. Methods the imaging data of 111 cases of pulmonary nodules (54 solid nodules and 57 subsolid nodules) which underwent CT examination twice or more were analyzed retrospectively. 35 cases of malignant nodules and 5 cases of benign nodules were confirmed by pathology or histology. The other 71 cases were diagnosed as low risk nodules of lung cancer after two-year follow-up. All nodules were classified according to density and nature: solid benign / low risk nodules, solid malignant nodules, subsolid benign / low risk nodules, subsolid malignant nodules. The linear and exponential growth curves were drawn using (d) as X axis and mm3 and logarithm of 3D volume as Y axis. The shape of the curve was observed subjectively. Chi-square test was used to compare the difference of growth curves among different types of pulmonary nodules. In 12 cases (66.7%), the growth curve of fruit bearing malignant nodules increased rapidly, 3 cases (16.7%) were flat first and then increased, 2 cases (11.1%) slowly increased, and 1 case (5.56%) was straight. Among the subsolid malignant nodules, 8 cases (47.1%) showed a rapid upward pattern, 4 cases (23.5%) slowly increased, 3 cases (17.6%) were flat, and 2 cases (11.8%) showed the first descending and then ascending type. In 5 cases (13.9%) of solid benign / low risk nodules, 17 cases (47.2%) were flat, 8 cases (21.6%) were slowly ascending, and 6 cases (16.7%) were wavy. Of the subsolid benign / low risk nodules, 4 cases (10%) showed descending type, 21 cases (52.5%) were flat, 9 cases (22.5%) increased slowly, and 6 cases (15%) were wavy. There was significant difference in the distribution of growth curve between benign and low risk nodules and malignant nodules (蠂 2 / 42.4 P 0.01). Conclusion the growth curve of lung cancer is heterogeneity, and the rapid rise is the characteristic growth curve of malignant pulmonary nodules, but some of the growth curves can be flat, slowly rising or even decreasing in a certain period of time. Slow growth does not rule out lung cancer, especially subsolid nodules.
【作者單位】： 天津醫(yī)科大學(xué)總醫(yī)院醫(yī)學(xué)影像科;貴州省人民醫(yī)院核醫(yī)學(xué)科;天津醫(yī)科大學(xué)總醫(yī)院病理科;
【基金】：國(guó)家自然科學(xué)基金面上項(xiàng)目(No.81171345) 中央補(bǔ)助地方公共衛(wèi)生專項(xiàng)資金肺癌早診早治項(xiàng)目 2012年高等學(xué)校博士學(xué)科點(diǎn)專項(xiàng)科研基金(No.20121202110005)資助~~
【分類號(hào)】：R734.2
，
本文編號(hào)：2377033
[Abstract]:Background & objective to evaluate the growth characteristics of pulmonary nodules by computed tomography (computed tomography,CT) follow-up is a common strategy in clinical diagnosis of benign and malignant nodules. Pulmonary nodules with different biological behaviors may have different growth rates and patterns. The purpose of this study was to draw the volume growth curves of different types of pulmonary nodules, to understand their growth patterns, and to provide evidence for judging the nature of nodules and making follow-up plans for lung nodules. Methods the imaging data of 111 cases of pulmonary nodules (54 solid nodules and 57 subsolid nodules) which underwent CT examination twice or more were analyzed retrospectively. 35 cases of malignant nodules and 5 cases of benign nodules were confirmed by pathology or histology. The other 71 cases were diagnosed as low risk nodules of lung cancer after two-year follow-up. All nodules were classified according to density and nature: solid benign / low risk nodules, solid malignant nodules, subsolid benign / low risk nodules, subsolid malignant nodules. The linear and exponential growth curves were drawn using (d) as X axis and mm3 and logarithm of 3D volume as Y axis. The shape of the curve was observed subjectively. Chi-square test was used to compare the difference of growth curves among different types of pulmonary nodules. In 12 cases (66.7%), the growth curve of fruit bearing malignant nodules increased rapidly, 3 cases (16.7%) were flat first and then increased, 2 cases (11.1%) slowly increased, and 1 case (5.56%) was straight. Among the subsolid malignant nodules, 8 cases (47.1%) showed a rapid upward pattern, 4 cases (23.5%) slowly increased, 3 cases (17.6%) were flat, and 2 cases (11.8%) showed the first descending and then ascending type. In 5 cases (13.9%) of solid benign / low risk nodules, 17 cases (47.2%) were flat, 8 cases (21.6%) were slowly ascending, and 6 cases (16.7%) were wavy. Of the subsolid benign / low risk nodules, 4 cases (10%) showed descending type, 21 cases (52.5%) were flat, 9 cases (22.5%) increased slowly, and 6 cases (15%) were wavy. There was significant difference in the distribution of growth curve between benign and low risk nodules and malignant nodules (蠂 2 / 42.4 P 0.01). Conclusion the growth curve of lung cancer is heterogeneity, and the rapid rise is the characteristic growth curve of malignant pulmonary nodules, but some of the growth curves can be flat, slowly rising or even decreasing in a certain period of time. Slow growth does not rule out lung cancer, especially subsolid nodules.
【作者單位】： 天津醫(yī)科大學(xué)總醫(yī)院醫(yī)學(xué)影像科;貴州省人民醫(yī)院核醫(yī)學(xué)科;天津醫(yī)科大學(xué)總醫(yī)院病理科;
【基金】：國(guó)家自然科學(xué)基金面上項(xiàng)目(No.81171345) 中央補(bǔ)助地方公共衛(wèi)生專項(xiàng)資金肺癌早診早治項(xiàng)目 2012年高等學(xué)校博士學(xué)科點(diǎn)專項(xiàng)科研基金(No.20121202110005)資助~~
【分類號(hào)】：R734.2
，
本文編號(hào)：2377033
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