早期中央型肺癌CT诊断与支气管镜及病理组织学对照

Diagnosis of early central lung cancer with CT: correlation with bronchoscopic and histopathologic findings

目的 研究中央型肺癌早期CT表现及其病理学基础 ,并评价CT在鉴别诊断中的作用。方法 对 17例病理证实的早期中央型肺癌及 10例类似中央型肺癌的良性病变进行分析 ,CT采用SR 70 0 0及 (或 )LightspeedPlus扫描机 ,3 0或 1 5mm层厚薄层扫描 ,将CT表现与支气管镜及手术病理组织学表现对照。结果 17例病变CT均显示 ,3例显示为局部支气管管壁增厚、管腔内壁不规则 ,支气管镜显示黏膜表面粗糙、红肿。14例显示管腔狭窄、闭塞 ,其中 4例合并亚段支气管黏液栓 ,10例合并阻塞性肺炎或肺不张 ,支气管镜表现为腔内息肉样病灶。病理组织学显示 1例累及黏膜 ,5例累及黏膜下 ,11例侵犯支气管软骨层。 10例良性病变中 ,CT检查怀疑 6例恶性病变 ,4例不排除恶性 ,支气管镜检查 5例显示内壁不均匀增厚、粗糙 ,2例管腔内凝血块 ,1例管腔内结节 ,2例未见异常。结论 薄层CT扫描能可靠地显示支气管细微病变 ,是诊断早期中央型肺癌非常有用的方法。

Objective To study the CT findings of early central lung cancer and correlative pathologic basis, and to evaluate the role of CT in the differential diagnosis of central lung cancer Methods Seventeen patients with early central lung cancer and 10 patients with benign lesions resembling the central lung cancer were analyzed Thin section CT was performed with a section thickness of 3 mm or 1 5 mm at Philips SR 7000 or GE Lightspeed Plus scanner The visibility of the lesions was correlated with bronchoscopic and histopathologic findings Results All 17 lesions were visualized at CT Three lesions showed focal bronchial wall thickening and internal bronchial wall irregularity, bronchial mucous coarsening, redness and swollening at bronchoscopy Fourteen lesions showed focal narrowing or obliteration of the bronchial lumen, 4 complicated with subsegmental bronchial mucoid impaction, 10 with obstructive pneumonia or atelectasis Corresponding bronchoscopic view disclosed intraluminal polypoid protrusions The epithelia were involved in 1 case, subepithelia in 5, and cartilaginous involvement in 11 according to the depth of invasion of the bronchial wall at histopathology Among 10 patients with benign lesions, 6 cases were suspected as bronchogenic carcinoma and the possibility of bronchogenic carcinoma was not excluded at CT in 4 cases There were 5 patients with uneven thickening of internal bronchial wall, 2 with lumen blood clots, 1 with lumen nodule, and no abnormalities in 2 patients at bronchoscopy Conclusion Thin section CT has been proved to be a reliable method for demonstrating the mild changes of the bronchi and to be a valuable tool for the diagnosis of early central lung cancer