细支气管肺泡癌的CT征象分析

Analysis of CT findings in bronchioloalveolar carcinoma

目的:回顾性分析细支气管肺泡癌(BAC)的临床及CT表现,提高BAC的诊断水平。材料与方法:2002年6月～2007年6月经手术病理诊断为BAC病例,按照WHO对BAC的定义重新评价病变性质,从中划分BAC及含有BAC成分的混合性腺癌,并分析BAC在薄层CT上的表现。评价指标包括:病灶部位、数目、大小、形态、边缘、密度、有无空泡征(或囊状影)、充气支气管征、血管集束征、有无淋巴结肿大等。结果:曾诊断为BAC且保留薄层CT图像的病例共145例,符合BAC定义标准的32例(22.1%),其中男性占62.5%。肿瘤标记物CEA和CA125的阳性率分别为10%和5%。病变平均直径<3cm,CT均表现为单纯的磨玻璃(GGO)结节,82.9%密度不均,97.1%边界清晰,分叶征、充气支气管征及空泡征的发生率分别为62.9%、60%、57.1%,均无肺门纵隔淋巴结转移。结论:BAC的早期诊断中,薄层CT图像上病变形态学特征更有诊断意义。

Objective： To develop the diagnostic level of bronchioloalveolar carcinoma （BAC） by analyzing the clinical features and CT presentations of BAC. Materials and Methods： All the cases of BAC comfirmed by operation and pathology were retrospectively analyzed from June 2002 to June 2007. These cases were review using the 2004 revised WHO classification of BAC and separated them into two groups, pure BAC and mixed subtype adenoearcinoma with BAC components. The CT presentations of pure BAC were analyzed. Evaluated findings included the number （solitary or multiple）, size, morphous, contours, density and gas-containing space of lesions. Other CT findings such as air bronchogram, vascular converging and lymphadenopathy were also assessed. Results： 145 surgically resected cases with thin-section CT images were histologically diagnosed as BAC from 2002 to 2007. Of these, 32 （22.1%） proved to be pure BAC using the 2004 revised WHO elassification. There were 20 men（62.5%） and 12 women（37.5%）. The positive rate of tumor markers CEA and CA125 was 10% and 5%, respectively. The mean diameter of BAC was less than 3cm and all of the cases presented pure ground glass opacity. 82.9% of them showed inhomogeneous density, 97.1% well-defined margin. The rate of lobulated shape, air bronchogram and gascontaining space were 62.9%, 60%, 57.1%, respectively and lymphadenopathy in none of these BAC. Conclusion： In the diagnosis of early stage of BAC, some morphologic features of lesions on thin slice CT may be more important.