周围型肺鳞癌和肺腺癌HRCT表现的比较

The comparison of CT findings between peripheral pulmonary squamous cell carcinoma and pulmonary adenocarcinoma

目的对比分析周围型肺鳞癌和肺腺癌的主要HRCT表现并探讨其病理机制,进一步提高对周围型肺癌CT征象的认识。方法对照分析经手术病理证实的35例周围型肺鳞癌和40例周围型肺腺癌主要HRCT征象,并探讨CT征象与病理学的联系。结果与周围型肺腺癌比较,周围型肺鳞癌瘤体较大、以肿块为主要表现、瘤体边界多数清楚、边缘易出现多浅分叶、瘤体内多有坏死;腺癌瘤体较小、以结节为主要表现、瘤体边缘多见深分叶、毛刺、棘状突起、胸膜凹陷征和血管集束征、瘤体内易见小透亮影,以上征象的显示率有显著性差异(P<0.05)。周围型肺鳞癌可见支气管铸形征和多边形结节;周围型肺腺癌可见磨玻璃结节。结论不同的组织学特点和生物学行为决定了周围型肺鳞癌与肺腺癌HRCT表现的差异,结合临床资料术前鉴别两者是可能的。

Objective To compare the principal HRCT features of peripheral pulmonary squamous cell carcinoma and pulmonary adenocarcinoma and to explore their pathological mechanism, in order to improve the recognition of the CT signs of peripheral pulmonary carcinoma. Methods The principal HRCT signs of thirty-five cases with pathologically proved peripheral pulmonary squamous cell carcinoma and forty cases with pathologically proved peripheral pulmonary adenocarcinoma were analyzed retrospectively to explore he relationship between CT features and pathological findings.Results The main features of peripheral pulmonary squamous cell carcinoma included larger masses, clear boundary, superficial sublobes and intra-tumor necrosis. While peripheral pulmonary adenocarcinoma mostly demonstrated as smaller nodules, deep sublobes, spiculations, spiculate protuberance, pleural indentation, vessel converging signs, and vacuole signs. The different of these above findings of peripheral pulmonary squamous cell carcinoma and adenocarcinoma were significant （P〈0.05）. Peripheral pulmonary squamous cell carcinoma may depict bronchial casts and polygonal nodules; and peripheral pulmonary adenocarcinoma may demonstrate ground glass-like nodules. Conclusion The difference of the CT findings between peripheral pulmonary squamous cell carcinoma and peripheral adenocarcinoma is based on their different histological features and biological behaviors. It is possible to differentiate them before operation in combination with clinical information.