Establishment And Diagnostic Value Of Chest CT Scan Scoring System For Malignant Pleural Effusion

Objective The features of chest computed tomography(CT)were analyzed in 518 patients with pleural effusion in the 940 th hospital of joint logistics support force of chinese people's liberation army(fomer Lanzhou general hospital of chinese people's liberation army).According to the characteristics of patients with malignant pleural effusion,the CT scoring system of malignant pleural effusion was established by Logistic regression analysis,and the ROC curve was drawn to verify its predictive diagnostic value.The aim is provide an early,simple and meaningful method for the differential diagnosis between the benign and malignant pleural effusion.Methods According to the gold diagnostic standard of benign and malignant pleural effusion,370 cases of benign pleural effusion and 148 cases of malignant pleural effusion were analyzed retrospectively.The information of the patients were collected and the CT signs of chest scan were observed,including the unilateral or bilateral pleural effusion in CT images,pleural nodules,pleural uniformity,pleural thickening,mediastinal pleural thickening,pleural fat shadow change,pleural effusion encapsulation,pericardial effusion volume,mean CT value of pleural effusion density,mean standard deviation(SD)of CT density,etc.For the result,the meaningful variables of single factor Logistic regression analysis enter the multivariate analysis to estimate various risk factors.Finally,the model of CT scoring system for chest scan of malignant pleural effusion was established,and the ROC curve was drawn.This model is valuable in the diagnosis of malignant pleural effusion.Results 1.370 patients with benign pleural effusion aged from 14 to 90 years,median age is 61 years and range interquartile is 27.25 years,male:female ? 2:1;There are 170(45.95%)para-pneumonic effusion patients and 129(34.86%)tuberculous pleural effusion patients,and 71 cases(about 19.19%)caused by other reasons such as cardiac disease.148 cases malignant pleural effusion patients aged from 18 to 90 years,median age is 61 years and range interquartile is 19 years;male:female?1.4:1;There are 92(62.16%)patients with lung cancer and 22(14.86%)patients with malignant pleural mesothelioma,12(8.11%)patients with breast cancer,22(14.87%)patients with other tumors such as digestive tract tumor,reproductive system tumor,mediastinal and other part of tumor.Among which 67(45.27%)patients have tumor metastases such as liver metastasis and bone metastasis,adrenal metastasis,gastrointestinal metastasis and craniocerebral metastasis.2.Single factor Logistic regression analysis showed that unilateral pleural effusion(P=0.006)?pleural nodules(P=0.000)?pleural uniformity(P=0.000)?mediastinal pleural thickening(P=0.000)? pleural fat shadow < 0.25mm(P=0.000)? pleural encapsulation(P=0.000)? volumn of pleural effusion(P=0.000)? noncalcified mediastinal lymphadenomegaly(P=0.000)?cardiac shadow enlargement(P=0.001)?pleural density mean CT value(P=0.005)?mean standard deviation(SD)of pleural effusion density(P=0.001)is the related factors of diagnosis in malignant pleural effusion.3.The results of multivariate Logistic regression analysis showed that pleural nodules(P=0.000)?pleural uniformity(P=0.000)?mediastinal pleural thickening(P=0.000)? pleural encapsulation(P=0.000)and pleural effusion volume(P=0.006)is the risk factors of malignant pleural effusion and entered the model.4.The establishment of chest CT scan scoring system model: Y=X1×pleural nodules+X2×pleural uniformity+X3×mediastinal pleural thickening+X4×pleural effusion wrapped+X5×pleural effusion volume.(According to the value of partial regression index in multivariate logistic regression analysis,if there is no pleural nodule,X1 is 0,if 5mm > pleural nodules > 0mm,X1 is 2,if pleural nodules?5mm,X1 is 4;If pleural is uniform,X2 is-3,uneven is 0;Mediastinal pleural is thickened,the value of X3 is 4,if the mediastinal pleura is not thickened,the value is 0;when the pleural effusion is wrapped,the X4 is-3,otherwise is 0;when the volume of pleural effusion is small,medium or large,the value of X5 is 0,1,3 respectively.)5.The sensitivity?specificity?diagnostic accuracy?positive predictive value and negative predictive value of malignant pleural effusion predictive scorning model were 89.86%,96.49%,94.59%,91.10 % and 95.97%,respectively.Conclusion 1.Chest CT features of pleural effusion have significant diagnostic meaning for MPE.2.The pleural nodules?mediastinal pleural thickening?pleural effusion volumn were risk factors of diagnosis in MPE.Pleural homogeneity and pleural effusion encapsulation were protective factors of diagnosis in MPE.These five features can be used to establish a scoring model for the diagnosis of malignant pleural effusion.3.The malignant pleural effusion CT scorning model is a safe,effective and high diagnostic method with good fitting degree and great accuracy,which has a high guiding value in diagnosis of MPE.