Diagnostic efficacy of three-phase dynamic CT enhanced scanning combined with ultrasonic bronchoscopy in patients with peripheral lung cancer
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摘要:
目的 研究三期动态CT增强扫描联合超声支气管镜对周围型肺癌患者的诊断效能。 方法 本研究为回顾性研究，将2018年1月~2020年1月在我院确诊的82例周围型肺癌患者设为观察组，另选取同期在我院进行健康体检的志愿者82例作为对照组。所有患者均采取三期动态CT增强扫描以及超声支气管镜检查，比较两组患者的CT值以及CT净增强值，分析单独检测以及联合检测对周围型肺癌的诊断效能。 结果 观察组的CT值、强化峰值以及CT净增强值均高于对照组（P < 0.05）；Ⅲ~Ⅳ期患者的CT值、强化峰值以及CT净增强值均高于Ⅰ~Ⅱ期（P < 0.05）；不同病理分期患者的CT值、强化峰值以及CT净增强值之间的差异有统计学意义（P < 0.05）；联合诊断的特异性高于单独检测（P < 0.05）；联合诊断的曲线下面积高于单独检测（P < 0.05）。 结论 采用三期动态CT增强扫描联合超声支气管镜对周围性肺癌患者具有很好的诊断效能，适宜推广应用。 -
关键词:
- 三期动态CT增强扫描 /
- 超声支气管镜 /
- 周围型肺癌 /
- 联合诊断
Abstract:Objective To explore the diagnostic efficacy of three-phase dynamic CT enhanced scanning combined with ultrasound bronchoscopy in patients with peripheral lung cancer. Methods A retrospective study was conducted in 82 patients (observation group) with peripheral lung cancer diagnosed in our hospital from January 2018 to January 2020. In addition, 82 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. All patients received three-phase dynamic CT enhanced scanning and ultrasound bronchoscopy, and the CT value and net enhanced CT value of patients in the two groups were compared. The diagnostic efficacy of single detection and combined detection for peripheral lung cancer was analyzd. Results CT value, enhancement peak value and net enhancement value of CT in observation group were significantly higher than those in control group (P < 0.05). CT value, enhancement peak value and net enhancement value of CT in stage Ⅲ-Ⅳ were significantly higher than those in stage Ⅰ-Ⅱ (P < 0.05). There were statistically significant differences in CT value, enhancement peak value and net enhancement value of CT in patients with different pathological stages (P < 0.05). The specificity of combined diagnosis was significantly higher than that of single detection (P < 0.05). The area under the curve of combined diagnosis was significantly higher than that of single detection (P < 0.05). Conclusion Three-phase dynamic CT enhanced scanning combined with ultrasound bronchoscopy has good diagnostic efficacy in patients with peripheral lung cancer and is suitable for application -
图 1 两组三期动态CT增强指标比较
A: 左下肺腺癌1期肺窗; B: 左下肺腺癌1期纵膈窗; C: 右上肺腺癌2期肺窗; D: 右上肺腺癌2期纵隔窗; E: 右上肺腺癌3期肺窗; F: 右上肺腺癌3期纵隔窗; G: 右上肺腺癌4期肺窗; H: 右上肺腺癌4期纵隔窗; I: 正常肺窗199; J: 正常纵膈窗199.
Figure 1. Comparison of three-phase dynamic CT enhancement indexes between the two groups.
表 1 两组一般资料比较
Table 1. Comparison of baseline data between the two groups (n=82)
组别 性别(男/女, n) 年龄(岁, Mean±SD) BMI(kg/m2, Mean±SD) 观察组 49/33 55.29±2.56 24 56±2.33 对照组 45/37 55.12±2.67 24.71±1.88 t/χ2 0.399 0.416 0.454 P 0.528 0.678 0.651 
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表 2 两组三期动态CT增强指标比较
Table 2. Comparison of three phase dynamic CT enhancement indexes between the two groups (Hu, n=82, Mean±SD)
组别 CT值 强化峰值 CT净增强值 观察组 29.15士7.05 78.10±16.33 27. 42±10.01 对照组 5.18士1.64 5.36±4.56 1.55±0.32 t 29.988 38.850 23.39 1 P ＜0.001 ＜0.001 ＜0.001
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表 3 不同病理状态的三期动态CT增强指标比较
Table 3. Comparison of three-phase dynamic CT enhancement indexes in different pathological states (Hu, Mean±SD)
组别 CT值 强化峰值 CT净增强值 TNM分期 Ⅰ~Ⅱ期(n=24) 24.33±7.13 71.25±15.11 22.03±5.06 Ⅲ~Ⅳ期(n=58) 34.73±7.13 86.03±15.09 33.65±5.09 t 6.010 4.032 9.445 P ＜0.001 ＜0.001 ＜0.001 病理分型 腺癌(n=35) 21.03±3.31 71.44±5.01 21.03±5.11 鳞癌(n=27) 25.63±5.22 75.29±5.15 25.26±5.13 小细胞癌(n=20) 45.11±11.41 93.55±5.12 41.51±4.14 F 11.265 16.558 20.674 P ＜0.001 ＜0.001 ＜0.001
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表 4 联合诊断效能分析
Table 4. Effectiveness analysis of joint diagnosis
诊断方法 真阳例数(n) 假阳例数(n) 真阴例数(n) 假阴例数(n) 准确率(%) 敏感度(%) 特异性(%) 阳性预测值(%) 阴性预测值(%) 三期动态CT增强 75 18 64 7 84.76 91.46 46.04 80.65 90.14 超声支气管镜检 79 12 70 3 90.85 96.34 46.98 86.81 95.89 联合检测 70 4 78 12 90.24 85.37 52.70 94.59 86.67
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表 5 ROC曲线分析
Table 5. ROC curve analysis
诊断方法 标准误 曲线下面积 曲线下面积（95% CI） P 三期动态CT增强 11.231 0.775 0.520~0.872 0.017 超声支气管镜检 9.252 0.603 0.600~0.746 ＜0.001 联合检测 10.263 0.892 0.654~0.912 ＜0.001
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