肺内10mm以内孤立结节的临床分析

Clinical Analysis of Solitary Pulmonary Nodule Measuring Less Than 10 mm

背景与目的:肺癌是目前发病率和死亡率较高的恶性肿瘤,其预后很大程度上取决于早期诊断和治疗,而放射影像学如X线平片和CT是发现和诊断肺癌最重要的手段之一,但是对于30mm以内肺周围孤立结节(solitarypulmonarynodules,SPN)的诊断较难,尤其对10mm以内SPN的影像诊断更难。本研究拟对CT影像学10mm以内SPN进行分析总结。方法:对CT影像学上直径<10mm且最终通过各种方法获得病理学证据的102例SPN进行分析,比较良恶性病变的差异,总结小结节肺癌的影像学特征。结果:肺内<10mm的SPN中,以良性病变为主,占64.7%,分别是炎性假瘤、良性肿瘤、结核等;原发性肺癌占24.5%,其中分期较晚肺癌(ⅡA期及以上)占5.9%,影像学上可藉边缘不齐、有毛刺征、气管和血管受累、强化值差异等特点与良性病变鉴别;肺转移癌占10.8%,其影像学表现与原发性肺癌相似。结论:肺内<10mm的SPN中,以良性肿瘤为主,其次为肺癌。

BACKGROUND ＆ OBJECTIVE. Lung cancer is a malignant disease with high incidence and mortality, and its prognosis is to large degree determined by early diagnosis and treatment. X-ray chest film and computed tomography （CT） are important means to discover and diagnose lung cancer. But it is difficult to diagnose single pulmonary nodules （SPN） measuring less than 30 mm, especially for those less than 10 mm. This study was to analyze the CT imaging features of SPN measuring less than 10 mm. METHODS： The clinical and radiologic features of 102 cases of pathologically diagnosed SPN measuring less than 10 mm with CT reports were analyzed. The differences between benign and malignant lesions were compared. Imaging features of SPN of lung cancer were summarized. RESULTS, Of the 102 cases of SPN measuring less than 10 mm, 66 （64.7%） were benign lesions, 25 （24.5%） were primary lung cancer, and 11 （10.8%） were metastatic lung cancer. The benign lesions included inflammatory pseudotumor, benign tumor, lung tuberculosis, and so on. Primary lung cancers, including 6 advanced cases （stage ⅡA and higher stage）, had several radiological features different from benign nodules, such as ill-defined margins, spiculation, bronchus or vessel involvement. Also, the enhanced CT value was higher in malignant nodules than in benign nodules except inflammation pseudotumor. The SPNs of metastatic lung cancer had similar radiologic features to those of primary lung cancer. CONCLUSION. SPNs measuring less than 10 mm are mainly composed of benign lung tumor and primary lung cancer.