含薄壁囊腔周围型肺癌的CT特征及病理基础分析

Multi-slice CT features and pathological correlation of peripheral lung cancer associated with thin-walled airspace

目的探讨含薄壁囊腔的周围型肺癌的MSCT特征和病理基础。方法回顾性分析2012年至2015年经病理证实的35例伴薄壁囊腔形成的周围型肺癌患者（腺癌25例、鳞癌9例、梭形细胞癌1例）的临床资料、病理类型和MSCT表现。根据病灶内有无实性成分将其分成无实性成分组与有实性成分组，对两组的MSCT征象采用Fisher确切概率法进行比较分析，有随访的病例同时评价病灶的CT动态变化，选取11例手术证实的病例进行病理切片与CT图像对比，分析其形态学表现的病理基础。结果35例患者中，在MSCT上，出现60％以上的征象有圆或类圆形（28例）、分叶征（32例）、多囊（27例）、内壁不光整（33例）、腔内分隔（31例）。无实性成分组（17例）与有实性成分组（18例）的MSCT征象，经统计学分析得出病灶整体形状、毛刺征、支气管截断征、支气管通人腔内、腔内血管穿行及磨玻璃征在两组之间差异有统计学意义（P〈0．05）；有实性成分组中，毛刺征（11例）、支气管截断征（12例）比例高于无实性成分组（均为1例）；无实性成分组中，病灶整体不规则形态（6例）、支气管通入腔内（7例）、磨玻璃征（13例）及腔内血管穿行（12例）的比例高于有实性成分组（分别为1、1、5、3例）。含气囊腔形成的病理基础为肿瘤内部彻底液化坏死，肿瘤沿肺泡壁生长、肺泡壁破坏融合。5例患者随访出现囊腔增大，囊壁增厚。2例患者随访则囊腔缩小，实性成分增多。1例薄壁囊腔的肺癌由纯磨玻璃密度结节演变而来。结论伴薄壁囊腔形成的周围型肺癌MSCT表现具有一定的特征性，囊腔形成的病理基础多样。

dObjective To evaluate muhi-slice CT （MSCT） features and pathological basis of lung cancer containing thin-walled airspace. Methods Thirty-five cases of pathologically confirmed lung cancer containing thin-walled airspace were retrospectively analysed with regard to clinical data, pathological types and MSCT features between 2012 and 2015.There were 35 eases（25 adenocareinoma, 9 squamous carcinoma, 1 spindle cell tumor） in total. MSCT features were compared between the lesions with or without solid component .Fisher exact test was used for the statistical analysis. For dynamic follow-up CT scans, the lesion dynamic change was evaluated .Correlations between the pathological section and CT images of the 11 cases were analysed. Results These features accounted for more than 60% of all MSCT signs in 35 cases, including round shape in 28 cases （80.0%）,lobulation in 32 cases（91.4%）,multiple cysts in 27 eases（77.1%）, irregular inner wall in 33 cases（94.3%）and septum in airspace in 31 cases（88.6%）. Shape, spieulation, bronchus eut-off, blood vessel and bronchus passing through the airspace, and ground-glass opacity were significantly different between the lesions with or without solid component （P〈0.05）.The frequency of spicnlation（11 cases） and bronchus cut-off（12 cases） in mixed solid lesions was higher than that in lesions without solid component（1 case, respectively）.The frequency of irregular shape（6 cases）,blood vessel passing through the airspace（12 cases）,gronnd-glass opacity（13 cases）and bronchus passing through the airspace（7 cases） in lesions without solid were higher than that in solid mixed lesions（l, 1, 5, 3 cases respectively）.The pathological basis of the formation of thin-walled airspace was obvious central necrosis in solid lesions and emphysematous change due to the tumor cells diffused along the inner airspace wall and the alveolar wall destruction.Five lesions were with progressive wall thickening and increased size of the airspace,and two lesions were with decreased size of the airspace and enlarged nodules in followed CT.One case of lung cancer with thin-walled airspace evolved from ground glass nodule. Conclusions The CT manifestation of lung cancer containing thin-walled airspace was characteristic.The pathological basis of the thin-walled airspace was various.