HRCT征象在鉴别周围型肺鳞癌和腺癌中的价值

HRCT Signs of Peripheral Lung Cancer: Its Value in Differentiating Squamous Carcinoma with Adenocarcinoma

目的 探讨胸部HRCT征象在鉴别周围型肺鳞癌和腺癌中的价值。资料与方法 搜集具有完整胸部HRCT资料并经病理学证实的 12 1例周围型肺癌 (鳞癌 5 4例 ,腺癌 6 7例 ) ,对其影像表现进行全面回顾分析 ,以进一步认识周围型肺鳞癌和腺癌的CT表现。结果 (1)周围型肺鳞癌的平均直径大于周围型肺腺癌 ,其差别具有显著性 (P =0 .0 0 0 ) ;(2 )深分叶征、灶状坏死及病灶广基与胸膜相连征在周围型肺鳞癌的出现率明显高于周围型肺腺癌 (分别为P =0 .0 0 0 ,P =0 .0 0 0 ,P =0 .0 0 5 ) ;(3)胸膜凹陷征在周围型肺腺癌的出现率明显高于周围型肺鳞癌 (P =0 .0 0 6 ) ;(4 )空泡征或空气支气管征、支气管血管集束征、毛刺征、棘突征在周围型肺鳞癌和腺癌中的出现率不具有显著性差别 (P值均 >0 .0 5 )。结论 HRCT观察肺癌征象更为细致可靠。深分叶征、灶状坏死及病灶广基与胸膜相连征三者两两组合或三者同时组合时对诊断周围型肺鳞癌的特异性高达 90 %～ 10 0 % ,在周围型肺鳞癌和腺癌的鉴别诊断中具有一定的价值。

Objective To evaluate HRCT signs in differentiating peripheral pulmonary squamous carcinoma with adenocarcinoma.Materials and Methods HRCT features of 54 cases with peripheral pulmonary squamous carcinoma and 67 cases with adenocarcinoma were retrospectively analyzed.Results (1) The mean diameter of peripheral pulmonary squamous carcinoma was significantly larger than that of adenocarcinoma (P=0.000). (2) The occurrence of deep lobulation sign, focal necrosis and widened-base attached to thoracic wall was markedly higher in peripheral pulmonary squamous carcinoma than in adenocarcinoma (P=0.000, P=0.000 and P=0.005, respectively). (3) The occurrence of pleural indentation was obviously higher in peripheral pulmonary squamous carcinoma than in adenocarcinoma (P=0.006). (4) No significant difference in the occurrence of vacuole sign, air bronchogram, broncho-vessel convergence sign, spicule sign and spinous sign was found between squamous carcinoma and adenocarcinoma (P>0.05).Conclusion HRCT can display lung cancer's signs in detail. When three or two of the following sings, i.e. the deep lobulation sign, focal necrosis and widened base attached to thoracic wall, are coexisted, the diagnostic specificity for peripheral pulmonary squamous carcinoma will be up to 90%～100%.