Analysis of the value of enhanced CT combined with texture analysis in the differential diagnosis of pulmonary sclerosing pneumocytoma and atypical peripheral lung cancer: a feasibility study

Chenglong Luo,Rui Wang,Songwei Yue,Jianbo Gao,Yiman Song,Yiyang Liu,Changmao Ding

doi:10.1186/s12880-022-00745-1

Chenglong Luo, Rui Wang + Show 5 more

Open Access

https://doi.org/10.1186/s12880-022-00745-1

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Abstract

BackgroundAs a rare benign lung tumour, pulmonary sclerosing pneumocytoma (PSP) is often misdiagnosed as atypical peripheral lung cancer (APLC) on routine imaging examinations. This study explored the value of enhanced CT combined with texture analysis to differentiate between PSP and APLC.MethodsForty-eight patients with PSP and fifty patients with APLC were retrospectively enrolled. The CT image features of the two groups of lesions were analysed, and MaZda software was used to evaluate the texture of CT venous phase thin-layer images. Independent sample t-test, Mann–Whitney U tests or χ2 tests were used to compare between groups. The intra-class correlation coefficient (ICC) was used to analyse the consistency of the selected texture parameters. Spearman correlation analysis was used to evaluate the differences in texture parameters between the two groups. Based on the statistically significant CT image features and CT texture parameters, the independent influencing factors between PSP and APLC were analysed by multivariate logistic regression. Extremely randomized trees (ERT) was used as the classifier to build models, and the models were evaluated by the five-fold cross-validation method.ResultsLogistic regression analysis based on CT image features showed that calcification and arterial phase CT values were independent factors for distinguishing PSP from APLC. The results of logistic regression analysis based on CT texture parameters showed that WavEnHL_s-1 and Perc.01% were independent influencing factors to distinguish the two. Compared with the single-factor model (models A and B), the classification accuracy of the model based on image features combined with texture parameters was 0.84 ± 0.04, the AUC was 0.84 ± 0.03, and the sensitivity and specificity were 0.82 ± 0.13 and 0.87 ± 0.12, respectively.ConclusionEnhanced CT combined with texture analysis showed good diagnostic value for distinguishing PSP and APLC, which may contribute to clinical decision-making and prognosis evaluation.

Highlights

As a rare benign lung tumour, pulmonary sclerosing pneumocytoma (PSP) is often misdiagnosed as atypical peripheral lung cancer (APLC) on routine imaging examinations
The results suggest that PSP was mostly round or oval in shape, and internal calcification was more common, while the incidence of the lobular sign in APLC lesions was higher than that of PSP, and the above differences were statistically significant (P < 0.05)
Compared with APLC, PSP lesions were mainly enhanced with a higher degree of enhancement; the difference in computer tomography (CT) values between the two groups of lesions in the arterial and venous phases was statistically significant (P < 0.05)

Summary

Introduction

As a rare benign lung tumour, pulmonary sclerosing pneumocytoma (PSP) is often misdiagnosed as atypical peripheral lung cancer (APLC) on routine imaging examinations. PSP lacks characteristic imaging findings, and without obvious malignant signs such as burr signs and pleural depression, it can be confused with atypical peripheral lung cancer (APLC) [4,5,6]. Surgical resection is the first choice for the treatment of PSP; there is no need for additional radiotherapy and chemotherapy, and the cure rate is good. Careful evaluation and staging of the lesions are needed before surgical resection, and the accurate distinction between PSP and APLC before surgery is of great significance for the selection of appropriate surgery and treatment options

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