胸片普查延迟诊断的周围型小肺癌X线表现的回顾性分析

Retrospective analysis of X-ray features of delay-diagnosed small peripheral lung cancer in chest radiographic screening

目的胸片普查延迟诊断的周围型小肺癌早期X线表现及动态变化特点。方法回顾性分析15例胸部X线摄片延迟诊断的周围型小肺癌的影像学特征。将本组病例按检出前和检出时病灶形态、大小、密度和边缘进行了对比。结果回顾性分析延迟诊断的15例患者初次胸片均有异常改变,包括：1）微结节伴有纹理聚集3例。2）灶状浸润7例。3）不规则结节状5例。检出时全部病灶均发展成（20.7±9.1）mm结节。从初次显现至病灶检出相距时间为8～47个月,平均16.3个月,倍增时间为35～233 d。结论周围型小肺癌胸片较容易漏诊,认识其早期表现、动态比较观察以往胸片和及早行建议胸部CT扫描有助于降低小肺癌的延迟诊断率。

[Objective]To investigate the dynamic X-ray features of small peripheral lung cancer delay-diagnosed in chest radiographic screening. [Methods]A retrospective review of serial chest radiographs was performed in 15 patients who underwent chest radiographic examination yearly from Jun. 2003 to Sept. 2012 and in whom a small peripheral lung cancer had been delay- diagnosed. Fourteen patients with small lung cancers were proved by pathology,1 patient has typical imaging findings and clinical presences. [Results]By retrospective review, abnormalities were detected in all the 15 patients, including： micronodule gathering lesions in 3 cases, focal infiltration in 7 cases, irregular nodule lesions in 5 case. All the lesions has grown to nodule lesions, average diameter of（20.7±9.1）mm at the time of radiographic detection. The interval from initial show to detection of small peripheral tumors ranged from 8 months to 47 months, average 16.3 month.The doubling time of these lesions ranged 35 days to 233 days. [Conclusion]It is very easy to ignore small peripheral lung cancer at chest radiography. Recognition of the early X-ray appearances of small lung cancer, dynamic reviewing the past films and recommendation of chest CT scan in time will be helpful to decrease the delayed diagnostic rate.