不同病理类型囊腔样肺癌的多排螺旋CT诊断

目的:分析不同病理类型囊腔样肺癌的多排螺旋CT(Multi-Detector Computed Tomography,MDCT)影像表现,以提高对该病的认识及早期诊断水平。方法:回顾性分析28例经病理证实的囊腔样肺癌的一般资料和MDCT表现,并分析不同病理类型的影像特征包括病灶大小、部位、形态分型、磨玻璃征、形态和边缘、瘤-肺界面、与支气管关系、囊腔内残留血管分隔、胸膜凹陷征、合并肺大泡等及其相关性。结果:28例囊腔样肺癌包括18例腺癌,3例微浸润腺癌,6例鳞癌,1例腺鳞癌。患者的平均发病年龄腺癌(60.56±8.03)和鳞癌(66.00±7.93岁)高于微浸润腺癌组(49.33±16.17岁)(F=3.449,P=0.048)。平均病灶大小腺癌(1.99±0.69 cm)和鳞癌(2.45±0.87 cm)大于微浸润腺癌(0.73±0.23 cm)(F=5.980,P=0.008)。磨玻璃征主要见于腺癌(14例,77.8%)或微浸润腺癌(3例,100.0%),与鳞癌(1例,16.7%)之间比较有统计学差异(P=0.012)。鳞癌(5例)与腺癌(2例)相比更容易显示支气管截断(P=0.003)。对不同病理类型囊腔样肺癌的其他影像特征之间比较无统计学差异(P0.05)。结论:不同病理类型囊腔样肺癌具有一定的典型CT影像特征,如磨玻璃征可高度提示腺癌或微浸润腺癌,鳞癌更容易出现支气管截断征象或肺门侧软组织影。对于不典型病灶,影像动态随访对确诊很重要。

Multi-Detector Computed Tomography Diagnosis of the Different Pathological Types of Cystic Lung Cancer

ABSTRACT Objective: To analyze multi-detector computed tomography(MDCT) findings of different pathological types of cystic lung cancer(CLC) in order to improve recognition and early diagnosis of CLC. Methods: Twenty-eight cases with pathologically proved CLC were retrospectively collected and general clinical data and MDCT findings of these patients were analyzed. Then imaging features of these CLC were further interpreted which including lesion size, location, morphological classification, ground-glass opacity sign, shape, margin, tumor-lung interface, relationship of tumor and bronchus, residual vessel sepatation in the airspace, pleural indentation and associated bullae. Results: Of 28 cases of CLC, there were 18 cases of adenocarcinomas, three cases of microinvasive adenocarcinomas, six cases of squamous carcinomas and one adenosquamous carcinoma. The average age of patients in the adenocarcinoma cases and the squamous cell carcinoma cases were 60.56±8.03 and 66.00±7.93 years old respectively, which was higher than the microinvasive adenocarcinoma cases (49.33±16.17 years old) (F=3.449, P=0.048). For the lesion size, the cases of adenocarcinoma (1.99±0.69 cm) and squamous cell carcinoma (2.45±0.87 cm) were larger than that of the cases of microinvasive adenocarcinoma (0.73±0.23 cm) (F=5.980, P=0.008). Ground-glass sign was mainly found in adenocarcinoma (14 cases, 77.8 %) and microinvasive adenocarcinoma (3 cases, 100.0 %), however, only one case(16.7 %) of squamous cell carcinoma showed this sign (P=0.012). Five cases of squamous cell carcinoma showed bronchial cut-off sign, which was more common than in the adenocarcinoma(2 cases)(P=0.003). There were no significant differences for other imaging features in different pathological types of CLC(P>0.05). Conclusion: For the different pathological type of CLC, there are relatively typical CT imaging findings. For example, the ground-glass opacity were frequent observed in adenocarcinoma or microinvasive adenocarcinoma while the bronchial truncation sign and soft tissue shadow were common in squamous cell carcinoma. It is important to do dynamic follow-up CT for atypical lesions of CLC.