The Evaluation Of 3D Printing Technology In The Diagnosis And Treatment Of Early GGO Lung Cancer

Background Lung cancer is the highest mortality and morbidity cancer in the world.Improving the detection rate of early lung cancer and the early precision surgery are the key factors to control lung cancer mortality.CT,sputum examination and serum tumor markers are the common methods of the early diagnosis of lung cancer.However,the sensitivity and accuracy of the detection of early lung cancer with ground-glass opacity(GGO)by conventional means are low.Thoracoscopic segmental resection of lung is considered to be the best surgical treatment for early stage lung cancer.However,due to the anatomical variation of the lung segment,it is difficult to accurately estimate the shape and charactor of the tumor and surroundings by two-dimensional imaging of thoracoscopy.It is difficult and takes a lot of risk to operate resection surgery under thoracoscopy.Besides,only two-dimensional field of view can be displayed through the endoscope in the minimally invasive thoracoscopic surgery with no tactile feedback,which enhances the difficulty of surgery and often leads to excessive resection.In recent years,3D printing technology has been widely used in the medical field,but it is rarely used in thoracic surgery.3D printing technology includes digital models(3D reconstruction) and solid models.In this study,we investigate the value of 3D printing in the diagnosis of early GGO lung cancer and its value in the thoracoscopic accurate segmental resection for early GGO lung cancer.Objective To explore the diagnostic value of CT three-dimensional reconstruction(3D imaging)technique for early lung cancer with GGO and the application of 3D printing based on three-dimensional reconstruction technique for thoracoscopic lung cancer surgery.Methods 52 patients with GGO who had surgery in the First Affiliated Hospital of Zhengzhou University were collected(36 patients with pathologically lung adenocarcinoma,staged T1M0N0;16 patients with pathologically benign lesions)in the study.All patients accepted 64-slice spiral CT enhanced scan and 3D reconstruction by image post-processing workstation before surgery,including 18 cases of pure ground glass nodules(p GGO)and 34 cases of partial solid nodules(m GGO).The imaging performance of three-dimensional images and axial images in malignant GGO was retrospectively analyzed,as well as the diagnostic efficacy between axial images and 3D images on benign and malignant tumors,and the diagnostic value of three-dimensional reconstruction in early lung cancer.We obtained the solid models via the 3D reconstructed images,including lymph nodes,bronchus,arteries and veins in and around the lesions.The value of models on preoperative planning,intraoperative guidance,and optimization of the surgical procedure was also assessed.Results 1.Among the 36 cases of malignant GGO,64-slice CT enhanced scan three-dimensional reconstruction was superior to axial imaging in the detection of malignant tumor signs(lobulation sign,burr sign,vascular bundle sign).The 64-slice CT enhanced scan showed that the detection rate of GGO early lung cancer lobulation sign was 61.1%(22/36),the detection rate of burr sign was 55.6%(20/36),and the detection rate of vascular bundle sign was 30.6%(11/36).The 64-slice CT enhanced scan 3D reconstruction examination showed that the detection rate of lobulation sign in early lung cancer with GGO was 94.4%(34/36),and the detection rate of burr sign was 94.4%(34/36).The detection rate was 72.2%(26/36);the lobulation sign was P=0.041<0.05,the burr sign was P=0.018<0.05,and the vascular bundle sign was P=0.001<0.05,which were statistically significant.2.The diagnostic efficiency of 64-slice CT enhanced scan 3D reconstruction is also significantly better than axial imaging.The sensitivity of 64-slice CT enhanced scan test is 61.1%(22/36),the specificity is 62.5%(10/16)and the accuracy is 61.5%(32 /52).The sensitivity of 64-slice CT enhanced scan 3D reconstruction test was 94.4%(34/36),the specificity is 87.5%(14/16)and the accuracy is 92.3%(48/52).The diagnostic efficiency of 64-slice CT enhanced scan 3D reconstruction(sensitivity,specificity,accuracy)was significantly better than that of axial imaging(P < 0.05),all of which were statistically significant.3.It is confirmed during operation that the 3D printed model and the real object is extremely similar.The similarity degree between intraoperative lesions including the adjacent vessels,bronchus,lymph nodes and 3D printed models is more than 90%;Conclusion 1.3D printing technology has certain value in the diagnosis of early GGO lung cancer.2.3D printing technology can assist in the surgical treatment of thoracoscopic accurate segmental resection for early lung cancer.