乳腺癌患者肺内孤立性结节CT征象：肺原发性腺癌和转移性乳腺癌的鉴别

doi:10.19401/j.cnki.1007-3639.2018.06.003

中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (6): 411-418.doi: 10.19401/j.cnki.1007-3639.2018.06.003

乳腺癌患者肺内孤立性结节CT征象：肺原发性腺癌和转移性乳腺癌的鉴别

王升平¹，付怡¹，刘权¹，叶挺²，孙向洁³，李媛³，莫淼⁴，顾雅佳¹，彭卫军¹

1. 复旦大学附属肿瘤医院放射诊断科，复旦大学上海医学院肿瘤学系，上海 200032 ；
2. 复旦大学附属肿瘤医院胸外科，复旦大学上海医学院肿瘤学系，上海 200032 ；
3. 复旦大学附属肿瘤医院病理科，复旦大学上海医学院肿瘤学系，上海 200032 ；
4. 复旦大学附属肿瘤医院肿瘤预防部，复旦大学上海医学院肿瘤学系，上海 200032

出版日期:2018-06-30 发布日期:2018-07-20
通信作者: 彭卫军 E-mail: cjr.pengweijun@vip.163.com

Computed tomography features of solitary pulmonary nodules in breast cancer patients: differential diagnosis between primary lung adenocarcinoma and metastatic pulmonary breast cancer

WANG Shengping¹, FU Yi¹, LIU Quan¹, YE Ting², SUN Xiangjie³, LI Yuan³, MO Miao⁴, GU Yajia¹, PENG Weijun¹

1. Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 2. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 3. Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 4. Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Department of Oncology,
Shanghai Medical College, Fudan University, Shanghai 200032, China

Published:2018-06-30 Online:2018-07-20
Contact: PENG Weijun E-mail: cjr.pengweijun@vip.163.com

摘要/Abstract

摘要： 背景与目的：乳腺癌患者CT上表现为孤立性的肺结节（solitary pulmonary nodule，SPN）可能是原发性肺癌（primary lung cancer，PLC）也可能是乳腺癌肺转移（metastatic pulmonary breast cancer，MBC），明确诊断对于患者的个性化诊疗具有重要意义。该研究回顾性分析CT上表现为SPN的PLC和MBC的高分辨率CT（high resolution CT，HRCT）特征，探讨其诊断价值。方法：回顾性分析2007年10月—2013年9月经胸外科手术获得病理证实的116例乳腺癌患者的孤立性肺结节，通过Logistic回归模型和受试者工作特征（receiver operating characteristic，ROC）曲线分析结节CT征象鉴别MBC和PLC。结果：116例结节中，PLC为77例（66.4%），MBC为39例（33.6%）。MBCs与PLCs在圆形或椭圆形、亚实性结节、分叶征、毛刺征、空泡征、支气管充气征、胸膜凹陷征、结节最大径及实性成分体积比等征象上差异有统计学意义。多变量分析显示，毛刺征、支气管充气征和非实性成分体积比≥24%是PLC的独立预测因子，相应的比值比（odds ratio，OR）分别为0.219（95%CI：0.069~0.638）、0.061（95%CI：0.009~0.240）和0.972（95%CI：0.951~0.990）。该多因素回归模型对PLC与MBC的鉴别具有良好的性能，ROC曲线的曲线下面积（area under curve，AUC）为0.903（95%CI：0.838~0.969），准确率为86.2%，灵敏度为88.3%，特异度为82.1%。结论：乳腺癌患者孤立性肺结节中原发性肺腺癌概率高。实性成份体积比＜24%、有支气管充气征和有毛刺征等CT征象提示原发性肺癌的可能大。

关键词: 孤立性肺结节, 肺腺癌, 乳腺癌肺转移, X线断层成像, 鉴别诊断

Abstract: Background and purpose: Solitary pulmonary nodule (SPN) detected by computed tomography (CT) in breast cancer patients may be primary lung cancer (PLC) or metastatic pulmonary breast cancer (MBC), and definitive diagnosis of nodule is very important for personalized medical care of patients. In this study, we retrospectively analyzed high resolution CT (HRCT) features of MBC and PLC shown as SPN in breast cancer patients and evaluated their diagnostic values. Methods: From Oct. 2007 to Jun. 2014 , data of 116 patients with 116 SPNs confirmed by pathology were assessed with respect to preoperative CT findings retrospectively. We reviewed CT signs of nodules to differentiate MBCs and PLCs by using multivariate logistic regression model and receiver operating characteristic (ROC) curve. Results: Of the 116 SPNs, 77 (66.4%) were PLC and 39 were (33.6%) MBC. There were statistically significant differences in round or oval shape, sub-solid nodule, spiculation, lobulation, bubble lucency, air bronchogram, pleural tag, maximum diameter of nodule and portion of the solid volume component between MBCs and PLCs. Multivariate analysis showed that spiculation, presence of air bronchogram and portion of the solid volume component >24% were statistically significant independent predictors of PLCs, with the corresponding odds ratio (OR) being 0.219 (95%CI: 0.069-0.638), 0.061 (95%CI: 0.009-0.240) and 1.029 (95%CI: 1.010-1.052), respectively. This multivariate regression model had a good performance in differentiating PLC from MBC, with an area under the ROC curve (AUC) of 0.903 (95%CI: 0.838-0.969), an accuracy of 86.2%, a sensitivity of 88.3% and a specificity of 82.1%. Conclusion: In all SPNs of breast cancer patients, the probability of PLC is higher than that of MBC. Less solid component, absence of spiculation and air bronchogram are highly indicative of PLCs.

Key words: Solitary pulmonary nodule, Metastatic pulmonary breast cancer, Primary lung adenocarcinoma, X-ray computed tomography, Differential diagnosis

王升平,付怡,刘权,等. 乳腺癌患者肺内孤立性结节CT征象：肺原发性腺癌和转移性乳腺癌的鉴别[J]. 中国癌症杂志, 2018, 28(6): 411-418.

WANG Shengping, FU Yi, LIU Quan, et al. Computed tomography features of solitary pulmonary nodules in breast cancer patients: differential diagnosis between primary lung adenocarcinoma and metastatic pulmonary breast cancer[J]. China Oncology, 2018, 28(6): 411-418.

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乳腺癌患者肺内孤立性结节CT征象：肺原发性腺癌和转移性乳腺癌的鉴别

Computed tomography features of solitary pulmonary nodules in breast cancer patients: differential diagnosis between primary lung adenocarcinoma and metastatic pulmonary breast cancer

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