原发抑或转移:恶性肿瘤患者孤立性肺病灶的鉴别诊断

Primary or Metastastic:Differential Diagnosis of Solitary Pulmonary Lesion in Patients with Extrapulmonary Malignancy

目的:通过分析肺外恶性肿瘤患者孤立性肺病灶(EPM-SPL)鉴别诊断的相关因素,探讨对EPM-SPL进行定性诊断的可能性。方法:搜集经临床证实肺外恶性肿瘤并经CT检查发现肺内孤立性病灶的患者114例,对年龄、性别、吸烟史、发现肺内外病灶的平均时间间隔、肺内结节或肿块的CT形态学特征等进行多因素分析。结果:114例中原发性支气管肺癌(A组)、孤立性肺转移瘤(B组)和良性病灶(C组)分别为49例(含黏液表皮样癌1例)、54例和11例。A、B组患者的平均年龄分别为(63.4±11.9)岁和(53.4±16.5)岁(t=3.25,P=0.02);A组的吸烟率为47.7%(21/44,5例吸烟史不详),B+C组的吸烟率为35.6%(21/59,6例吸烟史不详),组间差异无显著性意义(χ2=0.768,P>0.05);A组发现肺内外肿瘤的平均时间间隔为(68.7±71.2)个月,显著长于B组的(28.2±33.0)个月(t=3.96,P<0.001);A组肺部肿瘤的平均最大径为(3.9±2.6)cm,B组为(3.2±2.3)cm,两组间差异有显著性意义(t=2.33,P<0.05);A组肺内肿块在CT影像上毛刺征的显示率显著高于B组(χ2=6.69,P<0.05),而B组肿块边缘光整的显示率高于A组(χ2=8.54,P<0.001);两组间肿块分叶征和边界清楚征的显示率之间差异无显著性意义(P>0.05)。结论:EPM-SPL的定性诊断与患者的年龄、发现肺内外肿瘤的时间间隔、肺内病灶的大小和CT形态学上有无毛刺和分叶征有相关性,而与性别、吸烟史无显著相关性。

Objective：To study the correlative diagnostic factors of solitary pulmonary lesions in patients with primary extrapulmonary malignant tumor （EPM-SPL）, and to evaluate the role of CT in the differential diagnosis of EPM-SPL. Methods： 114 patients with pathologically confirmed EPM-SPL were enrolled in this study. In order to explore the influencing factors related to the diagnosis of tumor nature, the histological characteristics of pulmonary lesions were correlatively analyzed in accordance with the following factors, namely,age and sex of the patients, their smoking history, the mean time interval between the intra and extrapulmonary lesions found and the CT morphological features of the intrapulmonary nodules or masses. Results： All the 114 patients were divided into three groups, designated as group A （n=49, patients with primary lung cancer） ,group B （n= 54, patients with solitary metastatic lesions） and group C （n= 11, patients with benign lung lesions）. The mean age of patients in group A （m= 63.4 ± 11.9y） was significantly older than that in Group B （ m= 53.4 ± 16.5y,t=3.25 and P 0.02）. There were no significant differences in smoking rates of the patients among the 3 groups （group A,47.7% ,group B and C,35.6% ,χ^2 =0. 768,P〉0.05）. In the follow-ups of 112 patients,it was shown that mean intervals between the intra and extrapulmonary lesions found were significantly longer in group A （68. 7± 71. 2 month） than those in group B （28.2±33.0 month,t=3.96,P〈0. 001）, The maximal tumor diameters in group A were measured as （3.9±2.6）cm,and those in group B were measured as （3.2±2.3）cm. The difference between the two groups revealed remarkable significance （t=2.33, P〈0.05）. On CT images, the demonstration rate of spiculation sign in the lesions of group A was significantly higher than that in group B （χ^2=6.69,P〈0.05） ,while the demonstration rate of smooth tumor margin sign in group B was higher than that in group A （χ^2 =8.54 ,P〈0. 001）. The differences of demonstration rates of tumor lobulation and sharp margin signs between group A and B showed no remarkable significance. Conclusion： The specific diagnosis of EPM-SPL is correlated to the ages of the patients, the time interval between the intra and extrapulmonary tumors found, the size of the intrapulmonary tumor and whether there are CT signs of spiculation and lobulation in the tumors,while there are no remarkable evidences demonstrating the correlation of the specific diagnosis with sex and smoking history of the patients.