CT在单发结节或肿块型肺结核和肺癌鉴别中的作用研究

Research on the function of CT in the differentiation of single nodule or mass type pulmonary tuberculosis and lung cancer

目的探讨CT在单发结节或肿块型肺结核和肺癌鉴别诊断中的应用价值,为结节或肿块型肺结核和肺癌的鉴别诊断提供参考依据。方法选择广州市胸科医院2018年1月到2019年12月收治的60例肺结节或肿块疑似肺癌患者为研究对象,对所有患者行CT检查,术后均行病理学检查,比较两种检查方法的疾病检出率和诊断价值。结果 60例疑似肺癌患者中,38例为结节或肿块型肺结核,22例为肺癌;结节或肿块型肺结核患者中,病灶位于肺上叶尖后段18例(47.37%),直径<3cm 26例(68.42%),病灶内空洞钙化27例(71.05%),病灶内多点坏死30例(78.94%),病灶内支气管迂曲扩张26例(68.42%),高于肺癌患者的4例(18.18%)、7例(31.82%)、6例(27.27%)、10例(45.45%)、7例(31.82%),差异有统计学意义(P<0.05);肺癌患者中,边缘模糊9例(40.91%),有分叶和切迹11例(45.45%),毛刺状7例(31.82%),高于结节或肿块型肺结核患者的2例(5.26%)、3例(7.89%)、1例(2.68%),差异有统计学意义(P<0.05);CT检查对单发结节或肿块型肺结核的检出率为92.11%,肺癌检出率为90.91%,与术后病理学检查对比差异无统计学意义(P>0.05);CT疾病诊断敏感性为92.11%,特异性为90.91%,准确性为91.67%,漏诊率为7.89%,误诊率为9.09%,与术后病理学检查对比差异无统计学意义(P>0.05)。结论 结节或肿块型肺结核和肺癌影像学表现差异明显;CT鉴别单发结节或肿块型肺结核和肺癌的准确性高、特异性强,一定程度上代替穿刺活检等有创检查,为疾病治疗的开展提供参考依据。

Objective To evaluate the value of CT in the differentiation of single nodule or mass type pulmonary tuberculosis and lung cancer,and to provide reference for the differential diagnosis of nodular or mass pulmonary tuberculosis and lung cancer.Methods A total of 60 patients with suspected lung cancer admitted to Guangzhou Chest Hospital from January 2018 to December 2019 were selected as study subjects.CT examination was performed on all patients,postoperative pathological examination was performed,and the disease detection rate and diagnostic value of the two examination methods were compared.Results Among the 60 patients with suspected lung cancer,38 cases were nodular or mass pulmonary tuberculosis and 22 cases were lung cancer;In patients with nodular or mass pulmonary tuberculosis,18 cases (47.37%) had lesions located in the posterior segment of the upper lobe tip,26 cases (68.42%) had diameter less than 3cm,27 cases (71.05%) had cavity calcification,30 cases (78.94%) had multipoint necrosis,26 cases (68.42%) had tortuous bronchiectasis,which was higher than that in 4 cases (18.18%),7 cases (31.82%),6 cases (27.27%) and 10 cases (45.45%) of lung cancer 7 cases (31.82%),the difference was statistically significant (P<0.05);Among the patients with lung cancer,9 cases (40.91%) had blurred edges,11 cases (45.45%) had lobulation and notch,7 cases (31.82%) had burr,which was higher than 2 cases (5.26%),3 cases (7.89%) and 1 case (2.68%) of nodular or mass pulmonary tuberculosis (P<0.05).The detection rate of single nodule or mass type pulmonary tuberculosis granulation by CT examination was 92.11%,and that of lung cancer was 90.91%.Compared with postoperative pathology,the data showed no no significant difference (P>0.05).The sensitivity,specificity and accuracy of CT disease diagnosis were 92.11,90.91%,91.67%,missed diagnosis rate 7.89%,and misdiagnosis rate 9.09%.Compared with postoperative pathology examination,there was no significant difference (P>0.05).Conclusion The imaging findings of nodular or mass pulmonary tuberculosis and lung cancer were significantly different.CT has high accuracy and high specificity in differentiating nodular or mass pulmonary tuberculosis and lung cancer.It can replace invasive examination such as needle biopsy to some extent,and provide reference for disease treatment.