胸部CT影像学特征评分系统对评估经支气管镜活检诊断准确度的应用价值

doi:10.19871/j.cnki.xfcrbzz.2025.01.007

新发传染病电子杂志 ›› 2025, Vol. 10 ›› Issue (1): 32-38.doi: 10.19871/j.cnki.xfcrbzz.2025.01.007

胸部CT影像学特征评分系统对评估经支气管镜活检诊断准确度的应用价值

徐宇翔^1,2, 叶涛生², 刘伟坚², 李金沛², 曾旋², 黄河^1,3

1.广州医科大学研究生院,广东广州 510120;
2.深圳市第三人民医院呼吸内镜室,国家感染性疾病临床研究中心,广东深圳 518112;
3.深圳市第二人民医院呼吸与危重症医学科,广东深圳 518016

收稿日期:2024-07-21 出版日期:2025-02-28 发布日期:2025-03-31
通讯作者: 黄河,Email：1192952125@qq.com
基金资助:
深圳市科技计划项目（JCYJ20180228162336873）

Application value of chest CT imaging feature scoring system in evaluating the diagnostic accuracy of bronchoscopic biopsy

Xu Yuxiang^1,2, Ye Taosheng², Liu Weijian², Li Jinpei², Zeng Xuan², Huang He^1,3

1. Guangzhou Medical University, Guangdong Guangzhou 510120, China;
2. Department of Respiratory Endoscopy, The Forth Department of Pulmonary Diseases, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Guangdong Shenzhen 518112, China;
3. Pulmonary and Critical Care Medicine, The Second People's Hospital of Shenzhen, Guangdong Shenzhen 518016, China

Received:2024-07-21 Online:2025-02-28 Published:2025-03-31

摘要/Abstract

摘要： 目的探究影响支气管镜肺活检准确性的因素,以及基于胸部CT影像学特征的评分系统在经支气管镜活检诊断中的应用价值,从而构建经支气管镜活检诊断准确率的预测模型及简易评分系统。方法回顾性分析2019年1月至2023年6月在深圳市第三人民医院住院肺部病变查因、行薄层CT及行经支气管镜活检成功的454例患者,根据患者病理诊断与临床诊断是否吻合分为阳性组（323例）和阴性组（131例）,比较两组的基本临床特征、病理分类及胸部CT征象。基于胸部CT影像征象构建Logistic预测模型,评估经支气管镜活检的准确性。结果本研究454例患者中活检组织病理诊断与临床诊断相吻合即阳性组323例,经支气管镜活检准确率总体为71.15%。阳性组与阴性组患者病灶大小、支气管分级、有无支气管充气征及病灶形态特征等胸部CT影像学特征均有统计学差异（P< 0.05）,其中支气管分级和有无支气管充气征是预测活检准确度的影响因素;根据支气管分级及有无支气管充气征构建Logistic预测模型,其ROC曲线下面积0.787(95%CI 0.737~0.836,P<0.001),最后建立的简易评分公式ROC曲线下面积0.735(95%CI 0.684~0.786, P<0.001)。结论支气管分级和支气管充气征是预测经支气管镜活检准确度的影响因素;基于胸部CT影像学特征的评分系统在经支气管镜活检诊断中具有良好的临床应用价值。

关键词: 胸部计算机断层扫描, 影像学特征, 支气管镜活检, 评分系统

Abstract: Objective The study is to examine the various factors that influence the precision of bronchoscopic lung biopsy and explore the diagnostic utility of a scoring system grounded on chest CT imaging characteristics. This will enable the development of a predictive model for assessing the diagnostic accuracy of transbronchoscopic biopsy, ultimately leading to the establishment of a streamlined scoring system. Method A retrospective analysis was conducted on 454 patients admitted to the Third People's Hospital of Shenzhen from January 2019 to June 2023, who were diagnosed with pulmonary lesions, underwent thin-layer CT scanning, and underwent successful bronchoscopy biopsy. The patients were divided into a positive group (323 cases) and a negative group (131 cases) based on whether their pathological diagnosis matched their clinical diagnosis. The basic clinical characteristics, pathological classification, and chest CT signs of the two groups were compared. Constructing a logistic prediction model based on chest CT imaging features to evaluate the accuracy of bronchoscopic biopsy. Result Among 454 patients in this study. The pathological diagnosis of biopsy tissue matched the clinical diagnosis, with 323 cases in the positive group. The overall accuracy rate of bronchoscopy biopsy was 71.15%. Statistically significant differences were observed between the positive and negative groups regarding CT imaging characteristics of the chest, including lesion size, bronchial grading, presence or absence of the bronchial insufflation sign, and morphological characteristics of the lesion (P<0.05). Notably, bronchial grading and the presence or absence of the bronchial insufflation sign emerged as predictive factors for biopsy accuracy. A logistic prediction model was developed based on these two factors, yielding an area under the ROC curve of 0.787 (95%CI 0.737-0.836, P<0.001). Additionally, a simplified scoring formula was established, resulting in an area under the ROC curve of 0.735 (95%CI 0.684-0.786, P<0.001). Conclusion Bronchial grading and the bronchial insufflation sign serve as predictive imaging factors for the precision of transbronchoscopic biopsy, while a scoring system derived from chest CT imaging characteristics demonstrates effective clinical utility in diagnosing transbronchoscopic biopsy.

Key words: Chest computed tomography, Imaging signs, Bronchoscopic biopsy, Scoring system

中图分类号:

R445

徐宇翔, 叶涛生, 刘伟坚, 李金沛, 曾旋, 黄河. 胸部CT影像学特征评分系统对评估经支气管镜活检诊断准确度的应用价值[J]. 新发传染病电子杂志, 2025, 10(1): 32-38.

Xu Yuxiang, Ye Taosheng, Liu Weijian, Li Jinpei, Zeng Xuan, Huang He. Application value of chest CT imaging feature scoring system in evaluating the diagnostic accuracy of bronchoscopic biopsy[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(1): 32-38.

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胸部CT影像学特征评分系统对评估经支气管镜活检诊断准确度的应用价值

Application value of chest CT imaging feature scoring system in evaluating the diagnostic accuracy of bronchoscopic biopsy

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