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小型肺腺癌における3D-CTを利用したコンソリデーション部と病理学的悪性度との比較

佐伯, 祐典 筑波大学 DOI:10.15068/0002002092

2021.12.02

概要

Objectives:
T factor depends on consolidation diameter in lung adenocarcinoma according to WHO clas- sification. Adenocarcinoma with short consolidation diameter could be indicated for sublobar resection. However, measurement of consolidation diameter under lung window in 2D-CT could be problematic. We evaluated the relationship between consolidation lesion under mediastinal window in 3D-CT and pathological invasiveness.

Methods:
95 patients who underwent surgical resection of lung adenocarcinoma that are less than 20mm in diameter and has consolidation were analyzed retrospectively, in our Hospital from 2010 to 2016. The diameter, volume and CT value of consolidation were analyzed using thin slice CT and 3D-CT. We assumed that the integration of CT value correlates with pathological invasive- ness and defined the modified CT value by adding 1000 to original value to avoid the offset in integration. Multiple logistic regression analyses were performed for prediction of pathological invasiveness. The diameter, volume and the integration of modified CT values of consolidation were compared with pathological invasiveness: non-invasive (preinvasive lesion and minimally invasive) adenocarcinoma group and invasive adenocarcinoma group. Receiver operator char- acteristic curves were constructed for analysis of the diagnostic values. The cutoff values were set so that the specificity was 97% or more.

Results:
26 non-invasive adenocarcinomas and 69 invasive adenocarcinomas were evaluated. The diam- eter, volume and integration of modified CT values of invasive group were significantly greater than those of non-invasive group (p<0.001). The sensitivity, specificity and area under the curve (AUC) of consolidation diameter, consolidation volume and the integration of modified CT value were 46.2%, 97.1% 0.820, 57.7%, 97.1% 0.868, and 57.7%, 97.1% 0.871 respectively. The cut off values of the diameter, volume and the integration of modified CT values of consolidation were obtained at 5mm, 75mm3, and 80000, respectively.

Conclusions:
Higher AUCs were obtained in consolidation volume and the integration of modified CT values compared to consolidation diameter.

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