细支气管肺泡细胞癌与其他类型肺腺癌的对比分析

Comparative analysis of clinical features of bronchioloalveolar carcinoma and other types of adenocarcinoma of the lung

目的 探讨细支气管肺泡细胞癌(BAC)与其他类型腺癌(简称肺腺癌)临床表现的差异。方法 回顾性地对比分析32例BAC患者和92例肺腺癌患者的临床表现,包括症状、体征、胸部X线和纤维支气管镜检查等。结果 BAC患者的胸部X线影像学改变具有特征性,32例BAC中4例(12 % )表现为双肺多发斑片影,有时伴磨玻璃征,或大片实变影内密度不均,内有蜂房样透亮区,呈蜂窝征,部分病变可见支气管气影;肺腺癌患者无此特点(P =0 0 2 )。2例(6 % )BAC患者表现为肺内多发性的结节影,边界清楚,直径1～5cm ,密度均匀或不均;92例肺腺癌组中2 1例(2 3% )患者有此表现,两组比较有显著性差异(P =0 0 4 )。BAC累及肺门淋巴结和胸膜少于肺腺癌,两组分别为8例(2 5 % )和5 0例(5 4 % ) (P =0 0 0 4和0 0 4 )。2 3例BAC患者行纤维支气管镜检查,未能明确诊断;肺腺癌组6 4例中2 7例(42 % )镜下可见新生物,2 3例(36 % )活检明确诊断(P <0 0 5 )。结论 与肺腺癌比较,BAC在X线影像学上的弥漫型病变有特征性。

Objective To identify the clinical feature of bronchioloalveolar carcinoma (BAC) distinguishing from other types of adenocarcinoma of the lung.Methods Clinical,radiographic and bronchoscopic data of 32 patients with BAC and 92 patients with other types of adenocarcinoma were collected and analyzed. Results Diffuse pulmonary lesions as patchy consolidation with or without air bronchogram or ground-glass opacity were found in 4 patients(4/32,12%) with BAC but not in patients with adenocarcinoma (P=0.02).Multiple well-defined nodules sizing from 1 cm to 5 cm in diameter was found in more cases of adenocarcinoma(21/92,23%) than in patients with BAC (2/32,6%,P=0.04).Hilar or mediastinal lymph node enlargement was more frequent in the patients with adenocarcinoma (50/92,54%) than in patients with BAC (8/32,25%,P=0.004).Bronchoscopy was conducted in patients with BAC without diagnostic yield.However,diagnostic yield was achieved in 23 patients (23/64,36%)with adenocarcinoma who received bronchoscopic examnination.Conclusions Patients with BAC have characteristic radiographic presentations.Bronchoscopy is less valuable in diagnosis of BAC.