肺外恶性肿瘤患者肺内孤立性结节的鉴别诊断(附103例报告)

Differential diagnoses of solitary pulmonary nodules in 103 patients with extrapulmonary malignant tumor

目的 :探讨肺外恶性肿瘤患者肺内孤立性病灶 (EPM- SPN)定性诊断的可能性 ,评价 CT对此类病变鉴别诊断的价值。方法 :收集经证实的 EPM- SPN病例 10 3例 ,通过对年龄、性别、吸烟史、肺内外病灶的平均时间间隔、肺内结节或肿块的 CT形态学特征等多因素分析 ,探讨 EPM- SPN定性诊断的相关因素。 结果 :10 3例病例中原发性支气管肺癌、孤立性转移瘤、良性病灶分别为 4 8、4 8和 7例 ,平均年龄为 (5 7.6 9± 15 .77)岁 ,男女之比为 1.78∶ 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比分别为 (6 3.5 0± 11.91)岁、1.88∶ 1和 (5 3.4 8± 16 .88)岁、1.89∶ 1;原发性肺癌组的平均发病年龄显著大于孤立性转移瘤组 (t=3.34,P=0 .0 2 )。各组吸烟率无显著性差异。原发性支气管肺癌和孤立性转移瘤组的两瘤平均时间间隔分别为(6 6 .78± 75 .2 )个月和 (2 8.4 0± 37.0 )个月 ,后者显著短于前者 (P<0 .0 5 ) ;时间间隔≥ 2 4个月 ,原发性肺癌例数明显增多(P<0 .0 5 )。原发性肺癌和孤立性转移瘤两组间“毛刺”和“光整”的显示率有显著性差异 (P<0 .0 1,P<0 .0 0 1) ;而“分叶”和“清楚边界”显示率无显著性差异。原发性肺癌组和孤立性转移瘤组肺部病灶的最大径有显著性差异 (P<0 .0 5 )。在病灶最?

Objective:To study the definitive diagnosis possibility of solitary pulmonary nodules in patients with primary extrapulmonary malignant tumor (EPM-SPN),and to study the role of CT in differential diagnosis of EPM-SPN.Methods: Totally 103 patients with EPM-SPN were pathologically confirmed. The histologic characteristics of the lung nodule were analyzed in accordance with age, gender, smoking history, disease free interval between extrapulmonary malignancy and diagnosis of lung lesions, histologic pattern of the extrapulmonary neoplasms, and CT morphological characteristics. Results: Of all 103 patients,there were 48 cases solitary metastatic lesions, 48 primary lung cancers and 7 benign lesions. The mean age was (57.69±15.77) years and the male to female ratio was 1.78∶1. There was no significant difference in gender ratio(1.88∶1 vs 1.89∶1, χ 2=0.020 9,P>0.05) between primary lung cancer and solitary metastasis groups, but there was significant differrence between mean age (63.50±11.91 yr vs 53.48±16.88 yr, t=3.34,P=0.02).Smoking history had no significant difference among all groups. Of 101 patients during follow-up,the disease free interval between extrapulmoanry malignancy and pulmonary lesion in primary lung cancer and metastatic group were (66.78±75.2) and (28.40±37.0) months,respectively(t=3.96, P< 0.001). When free interval was longer than 24 months, there were more primary lung cancer cases than solitary pulmonary metastasis (χ 2=4.350,P<0.05).The mean maximum diameter of primary lung cancer and solitary metastasis lesion group were (4.76 ±2.60) cm and (3.50±2.83) cm,respectively (t=2.29,P<0.05).When the mean maximum diameter larger than 4 cm,there were more primary lung cancer cases than metastasis ones(χ 2=4.277,P<0.05). Lung nodule or mass with a spiculated margin may correlate to primary lung carcinoma(χ 2=8.562,P<0.01), whereas smooth edge may be more frequently seen in lung metastasis lesion(χ 2=15.220,P<0.01). Conclusion: Differential diagnosis of EPM-SPN may mainly depend on the patients' ages, intervals between 2 tumors, CT morphological characteristics, but not relevant to gender ratio or smoking history.