囊腔类肺癌的临床、影像学及病理学特征分析

Clinical,imaging and pathological features of cystic lung cancer

目的:分析囊腔类肺癌的临床资料、CT影像学表现及病理学特征,加深对此类病变的认识。方法:回顾并分析河北医科大学附属第四医院经手术后病理学检查证实的98例囊腔类肺癌,2名放射科医师分析其影像学表现,记录临床病理学资料。结果:患者年龄为37~76岁,平均为(59.2±9.1)岁,男性59例(60.2%),有吸烟史者53例(54.1%),肿瘤最大径范围1.1~17.5 cm,平均值(3.0±2.0)cm,囊腔最大径范围0.5~6.1 cm,平均值(1.6±1.0)cm。实性病变58例(59.2%),亚实性24例(24.5%),磨玻璃16例(16.3%)。影像学表现>50%的有外周型85例(86.7%),形态不规则70例(71.4%),瘤肺交界不清晰69例(70.4%),分叶征67例(68.4%),胸膜牵扯征79例(80.6%),血管集束征84例(85.7%)。囊腔形态规则59例(60.2%),囊腔壁不均匀增厚64例(65.3%),内壁光滑60例(61.2%),内部分隔58例(59.2%)。全部病变中有81例(82.7%)腺癌,行表皮生长因子受体(epidermal growth factor receptor,EGFR)基因检查的共65例,37例(56.9%)有突变;患者均行淋巴结清扫,10例(10.2%)有淋巴结转移。共12例有CT随访记录,囊腔及软组织均无变化2例,余10例病变变化明显。结论:囊腔类肺癌男性多见,中老年好发,病理学类型以腺癌多见,EGFR基因突变较多,淋巴结转移概率小。除具有一般肺癌恶性征象外,CT还表现为囊壁不均匀增厚,存在壁结节,短期随访病变有变化,熟悉这些表现,便于指导临床及时采取干预治疗。

Objective:To analyze the clinical data,CT imaging and pathological features of cystic lung cancer could deepen the understanding of such lesions.Methods:A retrospective analysis was performed on 98 cases of cystic lung cancer confirmed by surgery or pathology in Hebei Medical University Fourth Hospital.Two radiologists analyzed their imaging findings and recorded clinical pathology data.Results:The age range of patients was 37-76 years old,with an average of(59.2±9.1)years old.And 59 males(60.2%),53 cases(54.1%)had a history of smoking.The largest diameter range of tumors were 1.1-17.5 cm,mean(3.0±2.0)cm,the maximum diameter of the cyst 0.5-6.1 cm,mean(1.6±1.0)cm.58 cases(59.2%)were solid tumor lung interface,24 cases(24.5%)were subsolid lesions,and 16(16.3%)cases were ground glass lesions.The proportion of CT imaging signs was greater than 50%.85(86.7%)cases with peripheral types,70(71.4%)cases with irregular shapes,69(70.4%)cases with unclear edges,67(68.4%)cases with lobulated sign,79(80.6%)cases with pleural involvement sign,84(85.7%)cases with vascular cluster sign,59(60.2%)cases with regular lumen shape,64(65.3%)cases with uneven lumen wall thickening,60(61.2%)cases with smooth inner wall,and 58(59.2%)cases with internal space.Among the total lesions,81 cases(82.7%)were adenocarcinoma,65 cases were examined for epidermal growth factor receptor(EGFR)gene,and 37 cases were mutated(56.9%).All patients underwent lymph node dissection,and 10(10.2%)cases had lymph node metastasis.A total of 12 cases were followed up with CT.There were no changes in the cystic cavity and soft tissue in 2 cases,changes were obvious in 10 cases.Conclusion:Cystic lung cancer is more common in men(60.2%)and more common in middle-aged and elderly people(59.2±9.1).The pathological type is adenocarcinoma(82.7%),with more EGFR mutation (56.9%) and less lymph node metastasis (10.2%). In addition to the general manifestations of lung cancer,MSCT is also characterized by uneven cystic wall and presence of wall nodules. Short-term follow-up showed changes in the lesions.Familiarize with these manifestations can guide timely clinical intervention and treatment.