超声造影引导下肺活检对周围型肺癌的诊断价值

Diagnostic value of contrast-enhanced ultrasound guided lung biopsy for peripheral pulmonary tumors

目的探讨超声造影(CEUS)引导下肺活检对周围型肺癌的诊断价值,以及不同肺肿瘤增强模式与微血管密度(MVD)的关系。方法以胸部CT检查且二维超声能清楚显示的42例(42个)肺周围型占位病变患者为研究对象,CEUS观察病变峰值强度、增强指数。随后在CEUS引导下经皮穿刺活检病灶增强明显的部分,避开无增强坏死区域,全部标本进行病理学检查并做微血管密度计数。结果 42例患者均接受经皮穿刺活检,病理诊断为腺癌22例(其中2例为黏液腺癌),中高分化鳞癌8例,低分化鳞癌6例,小细胞癌6例。肺腺癌MVD、CEUS峰值强度及增强指数均高于鳞癌,差异有统计学意义(P<0.05)。肺腺癌、鳞癌CEUS峰值强度及强度指数均与其MVD呈正相关(P<0.01)。腺癌中12例(54.55%)出现瘤体内坏死区,鳞癌中9例出现瘤体内坏死区(64.29%),小细胞癌4例(66.67%)出现瘤体坏死区。结论 CEUS能够反映不同类型肺肿瘤的增强模式差异,有助于周围型肺肿瘤的诊断和鉴别诊断,能够准确指导穿刺活检取材,分析肿瘤MVD,作为抗血管治疗的依据。

Objective To investigate the diagnostic value of contrast-enhanced ultrasound （CEUS） guided lung biopsy for peripheral lung cancer,and the relationship between enhancement patterns and microvessel density（MVD） in lung tumors with different types. Methods A total of 42 patients with peripheral lung occupying lesions（42 lesions） were included in the study, and all of the lesions were clearly observed in chest CT and ultrasound. CEUS was used to measure the peak intensity and enhancement index. Then CEUS-guided percutaneous biopsy was performed in the obviously enhanced area of the lesions, and the necrotic area without enhancement should be avoided. Pathological examination and MVD counting were conducted in all specimens. Results Of 42 patients receiving percutaneous biopsy, 22 cases were pathologically diagnosed as adenocarcinoma （2 cases with mucinous adenocarcinoma were involved in）, 8 cases as moderately- or well-differentiated phosphorus cancer, 6 cases as poorly-differentiated squamous cell carcinoma, and 6 cases as small cell carcinoma. The MVD, peak intensity and enhancement index of the lung adenocarcinoma were higher than those of the squamous cell carcinoma （ P 〈0.05）. The peak intensity and enhancement index measured by CEUS were positively correlated with MVD in either lung adenocarcinoma or squamous cell carcinoma（ P 〈0.01）. Necrosis within the tumor was found in 12 cases （54.5%） of adenocarcinoma , 9 cases （64.2%） of squamous cell carcinoma and 6 cases （66.6%） of small cell carcinoma . Conclusion CEUS can reflect the difference in enhancement patterns among lung tumors with different types. It is beneficial to the diagnosis and differential diagnosis of peripheral lung cancers, accurate guidance for the puncture and biopsy and analysis on tumor MVD, and can be the basis for anti-vascular therapy .