Differential diagnoses of solitary pulmonary nodule in patients with extrapulmonary malignant tumor:CT and pathologic correlation
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF RADIOLOGY
- Issue:
- 8
- DOI:
- 10.3760/j.issn:1005-1201.2004.08.009
- Key Word:
- 硬币病变,肺;肿瘤转移;诊断,鉴别;体层摄影术,X线计算机;病理学
Abstract： 目的用多因素回顾性研究的方法,探讨肺外恶性肿瘤患者肺内直径＜3 cm的孤立性结节(ETM-SPN)定性诊断的可能性,并评价CT的鉴别诊断价值.方法搜集经证实的直径＜3 cm的ETM-SPN病例83例,通过对性别、年龄、吸烟史、肺内外病灶的平均时间间隔、肺内结节的CT形态学特征,以及肺外肿瘤病理类型与肺结节性质的关系等行多因素分析,探讨ETM-SPN定性诊断的相关因素.结果83例肺部结节中孤立性转移瘤、原发性支气管肺癌、良性病灶分别为43、33和7例.平均年龄为(57.43±15.33)岁,男女之比为1.59:1.原发性支气管肺癌和孤立性转移瘤组的平均年龄和男女之比分别为(62.48±11.96)岁、1.20:1和(54.10±16.49)岁(t=3.34,P＜0.05)、2.31:1(x2=0.0209,P＞0.05).各组吸烟率间,原发性支气管肺癌组(39.3%,11/17)与孤立性转移瘤组(35.9%,14/39)和非原发性肺癌组(33.3%,15/45)间差异均无显著意义(χ2=0.640,P＞0.05;χ2=0.931,P＞0.05).原发性肺癌组和孤立性转移瘤组的肺内外肿瘤确诊的平均时间间隔分别为(65.62±13.45)个月和(22.83±4.19)个月,两组间差异有显著性意义(Wilcoxon秩和检验,U=2.796,P＜0.01).肺外肿瘤为鳞癌(10例)和腺癌(58例)者,其肺内病灶原发性肺癌、孤立性转移瘤比例分别为7:3和24:34,差异无显著性意义(χ2=1.781,P＞0.05).CT形态学特征分析结果,原发性肺癌和孤立性转移瘤两组间"毛刺"和"光整"的显示率差异有显著性意义(χ2=8.562,P＜0.01;χ2=15.220,P＜0.001);而"分叶"显示率差异无显著性意义(χ2=2.054,P＞0.05).原发性肺癌组和孤立性转移瘤组肺结节平均最大径分别为(2.86±1.18)cm和(2.62±1.31)cm,两组间差异无显著性意义(t=1.29,P＞0.05).CT和手术病理对照分析37例经肺门和纵隔淋巴结清扫术的病例,结果原发性肺癌和孤立性转移瘤组淋巴结癌细胞浸润率间差异无显著性意义(χ2=2.801,P＞0.05).结论直径＜3 cm的ETM-SPN的定性诊断,主要应结合患者的年龄、两瘤时间间隔和肺内病灶的CT形态学特征,而与性别、吸烟史、是否有肺门纵隔淋巴结转移,以及肺外肿瘤的病理类型无显著相关性.
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