| Objective:Through the evaluation of which use signs in Spiral CT images to diagnosis hollow lung cancer,we discuss the value of signs in Spiral CT images joint test to improve the value of Spiral CT in hollow lung cancer.Methods:(1)Object of study and epidemiological methods: Gather 393 patients who were diagnosed isolated lung cavity by our hospital from June,2008 to September,2016.In these cases,285 patients are men,their age between 41 and 75,and their average age is 53;108 patients are women,their age between 44 and 82,and their average age is 57.Meanwhile,there are 227 cancerous cavities and 166 non-cancerous cavities.All isolated and hollow cases were diagnosed by pathology?laboratory and clinic.Divide all cases into two groups.There are 227 cancerous cavities in test group and 166 non-cancerous cavities in control group.Use signs in images of deep lobes and short burr separately and jointly,to diagnose and evaluate two groups.Evaluate the authenticity,reliability and profit of using deep lobes and short burr to diagnose cancerous cavity.Scanning Method:Use GE high-speed 64-slice Spiral CT scanner,Scanning parameters: 100~120kV,120~130mA,pitch 1mm,thickness 5mm,layer distance 5mm,the width of lung window is 1400~1600HU and its window level is-600 HU,the width of mediastinal window is 400 HU and its window level is 40 HU,the matrix is 512×512.All the objects in study are treated with spiral scanning,and demolished to 1.25 mm.Then send them to AW4.6 post-processing station to carry on multiplanar reconstruction(MPR),in order to make isolated lung cavity present three-dimensional morphological features in multiple planes.Analyze and judge signs of deep lobes and short burr in Spiral CT images.Judgment Standard: the radian of lobulation is considered as the standard of lobes,if chord distance/chord length >2/5,it is deep lobes.Short burr is that the edge of the tumor has spine protrusion in different degree and the length is less than 5mm.The judgment of signs in images is diagnosed by two attending physicians.The two physicians diagnose according to the judgment standard,and they use blindness in image post-processing and diagnosis.If the diagnostic results are different,the two physicians need to request deputy director or director to diagnose.Each case that presents deep lobes and short burr,is recorded by diseases and analyzed statistically.Results:In 227 cancerous cavity lesions,116 patients only present deep lobes,38 patients only present short burr,54 patients present deep lobes and short burr simultaneously,19 patients don't present deep lobes or short burr.In cancerous cavity,the appearance rate of deep lobes is 170/227(74.9%),the appearance rate of short burr is 92/227(40.5%).In 116 non-cancerous cavity lesions,there are 50 silicosis cavity,36 hollow tuberculosis,21 chronic lung abscess and 9 mold disease cavity.In non-cancerous cavity,the appearance rate of deep lobes is 35/166(21.1%),the appearance rate of short burr is 9/166(5.4%).Analyzing authenticity,for deep lobes,the sensitivity is 74.9%,the specificity is 78.9%,the missed rate is 57/227(25.1%),the misdiagnosis rate is 35/166(21.1%),the rough consistency is 301/393(76.6%)and the adjust consistency is 76.6%.Besides,the Jorden index is 53.8%,the positive likelihood ratio is 3.55 and the negative likelihood ratio is 0.32.For short burr,the sensitivity is 40.5%,the specificity is 94.6%,the missed rate is 135/227(59.5%),the misdiagnosis rate is 9/166(5.4%),the rough consistency is 249/393(63.4%)and the adjust consistency is 70.0%.Instead,the Jorden index is 35.1%,the positive likelihood ratio is 7.48 and the negative likelihood ratio is 0.63.For parallel test,the sensitivity is 91.6%,the specificity is 74.7%,the missed rate is 19/227(8.4%),the misdiagnosis rate is 42/166(25.3%),the rough consistency is 332/393(84.5%)and the adjust consistency is 84.1%.In addition,the Jorden index is 66.3%,the positive likelihood ratio is 3.62 and the negative likelihood ratio is 0.11.For series test,the sensitivity is 23.8%,the specificity is 98.8%,the missed rate is 173/227(76.2%),the misdiagnosis rate is 2/166(1.2%),the rough consistency is 218/393(55.5%)and the adjust consistency is 66.9%.In addition,the Jorden index is 22.6%,the positive likelihood ratio is 19.74 and the negative likelihood ratio is 0.77.Analyzing reliability,in the process of the two diagnostic physicians' judgment,there are 197 cases judged as deep lobes by both of them,141 judged as non-deep lobes by both,31 judged as deep lobes by physician A and 24 judged as deep lobes by physician B.As for short burr,there are 184 cases confirmed by both of them,134 confirmed as non-short burr by both,65 confirmed by physician A and 10 confirmed by physician B.In the aspect of judging deep lobes,the coincidence rate of two physicians is 338/393(86.0%),the value of Kappa is 0.71;for short burr,the coincidence rate is 318/393(81.0%),the value of Kappa is 0.63.Analyzing profit,for deep lobes,the positive predictive value is 170/205(82.9%),the negative predictive value is 131/188(69.7%);for short burr,the positive predictive value is 92/101(91.1%),the negative predictive value is 157/292(53.8%);for parallel test,the positive predictive value is 208/250(83.2%),the negative predictive value is 124/143(86.7%);for series test,the positive predictive value is 54/56(96.4%),the negative predictive value is 164/337(48.7%).Conclusion:1.According to ?2= 88.902,?2(0.05,1)= 7.88(p<0.05),the probability of deep lobes' appearance in cancerous cavity is higher obviously than in non-cancerous cavity,and the difference is significant.2.According to ?2=68.208,?2(0.05,1)= 7.88(p<0.05),the probability of short burr's appearance in cancerous cavity is higher obviously than in non-cancerous cavity,and the difference is significant.3.According to ?2(0.1,1)=23.221,?2=3.64(p<0.1),in cancerous cavity,there is significant difference between the probability of deep lobes' appearance and short burr's appearance,and the probability of deep lobes' appearance is higher than short burr's appearance.4.The relationship between hollow lung cancer and deep lobes and short burr is medium-intensity association.The value of RR(Relative risk)of deep lobes is 2.74,the value of OR(Odds ratio)is 11.16,the confidence interval of OR is(7.1,17.5);the value of RR of short burr is 1.97,the value of OR is 11.9,the confidence interval of OR is(6.4,22.1).5.Parallel test for cavity lesions in patients is sensitive.It reduces missed rate obviously and maintains a low misdiagnosis rate.Meanwhile,its consistency and positive likelihood ratio are high but negative likelihood ratio is very low.Furthermore,compared with the first two,the sensitivity of parallel diagnosis is obviously higher,the specificity is slightly lower.In ROC curve(receiver operating characteristic curve),the demarcation point of parallel diagnosis is located on the shoulder of the ROC curve,and compared with both are diagnosed separately,the area under ROC curve is larger,so its authenticity is better.Besides,it's helpful to reduce missed diagnosis effectively and maintain relatively high specificity.6.It's quite credible to choose deep lobes and short burr to diagnose.Two diagnostic physicians use signs in images of deep lobes and short burr to diagnose specimen,and the former coincidence rate is 86%,the value of Kappa is 0.71,the later coincidence rate is 81%,the value of Kappa is 0.63.According to the standard that is proposed by Kanidis and Koch,the two results are both high consistency and reproducibility.7.As for parallel test for cavity lesions in patients,while its negative predictive value rises apparently,it maintains a high positive predictive value.It means the profit is great. |
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