■亚实性结节(SSN)的固体成分与肺腺癌的侵袭性密切相关,其准确评估对于选择治疗方法至关重要。因此,这项研究旨在评估在多平面容积再现(MPVR)上测量的SSN中固体成分尺寸的准确性,并将其与病理上侵入性成分的尺寸进行比较。
■使用胸部体模进行了一项初步研究,以确定SSN内固体成分的最佳MPVR阈值,然后通过回顾性纳入2020年10月至2021年10月经病理证实的单发SSN患者进行临床验证。测量MPVR上的放射学肿瘤大小以及MPVR(RSSm)和肺窗口(RSSl)上的实体成分大小。在病理切片上测量肿瘤的大小和侵袭,和入侵,纤维化,并记录SSN内的炎症。计算机断层扫描(CT)和病理学之间的测量差异,分析了观察者间和测量间的协议。进行接收器工作特性(ROC)分析和Bland-Altman图评估MPVR的诊断效率。
■总共142名患者(平均年龄,54±11岁,39名男性)回顾性纳入临床研究,有26个原位腺癌,92例微创腺癌(MIA),和24例侵袭性腺癌(IAs)。RSSl明显小于病理侵袭大小,具有公平的测量间一致性[组内相关系数(ICC)=0.562,P<0.001]和中等的观察者间一致性(ICC=0.761,P<0.001)。RSSm明显大于病理侵袭大小,具有优异的测量间一致性(ICC=0.829,P<0.001)和优异的观察者间一致性(ICC=0.952,P<0.001)。ROC分析表明,RSSm区分原位腺癌与MIA和IAMIA的截断值分别为1.85和6.45mm(敏感性:93.8%和95.5%,特异性:85.7%和88.2%,95%置信度内部:0.914-0.993和0.900-0.983),分别。MPVR预测侵袭的阳性预测值和阴性预测值分别为92.8%和100%,分别。
■使用MPVR预测SSN的侵入程度具有较高的准确性和良好的观察者间一致性,优于肺窗口测量,有助于临床决策。
UNASSIGNED: The solid component of subsolid nodules (SSNs) is closely associated with the invasiveness of lung adenocarcinoma, and its accurate assessment is crucial for selecting treatment method. Therefore, this study aimed to evaluate the accuracy of solid component size within SSNs measured on multiplanar volume rendering (MPVR) and compare it with the dimensions of invasive components on pathology.
UNASSIGNED: A pilot study was conducted using a chest phantom to determine the optimal MPVR threshold for the solid component within SSN, and then clinical validation was carried out by retrospective inclusion of patients with pathologically confirmed solitary SSN from October 2020 to October 2021. The radiological tumor size on MPVR and solid component size on MPVR (RSSm) and on lung window (RSSl) were measured. The size of the tumor and invasion were measured on the pathological section, and the invasion, fibrosis, and inflammation within SSNs were also recorded. The measurement difference between computed tomography (CT) and pathology, inter-observer and inter-measurement agreement were analyzed. Receiver operating characteristic (ROC) analysis and Bland-Altman plot were performed to evaluate the diagnostic efficiency of MPVR.
UNASSIGNED: A total of 142 patients (mean age, 54±11 years, 39 men) were retrospectively enrolled in the clinical study, with 26 adenocarcinomas in situ, 92 minimally invasive adenocarcinomas (MIAs), and 24 invasive adenocarcinomas (IAs). The RSSl was significantly smaller than pathological invasion size with fair inter-measurement agreement [intraclass correlation coefficient (ICC) =0.562, P<0.001] and moderate interobserver agreement (ICC =0.761, P<0.001). The RSSm was significantly larger than pathological invasion size with the excellent inter-measurement agreement (ICC =0.829, P<0.001) and excellent (ICC =0.952, P<0.001) interobserver agreement. ROC analysis showed that the cutoff value of RSSm for differentiating adenocarcinoma in situ from MIA and MIA from IA was 1.85 and 6.45 mm (sensitivity: 93.8% and 95.5%, specificity: 85.7% and 88.2%, 95% confidence internal: 0.914-0.993 and 0.900-0.983), respectively. The positive predictive value-and negative predictive value of MPVR in predicting invasiveness were 92.8% and 100%, respectively.
UNASSIGNED: Using MPVR to predict the invasive degree of SSN had high accuracy and good inter-observer agreement, which is superior to lung window measurements and helpful for clinical decision-making.