肺浸润性黏液腺癌CT表现及临床特征分析

CT manifestations and clinical characteristics of pulmonary invasive mucinous adenocarcinoma

目的 探讨术后病理证实为原发性浸润性肺黏液腺癌(PIMA)患者的CT影像学表现及临床病理特征。方法 回顾性分析安徽省胸科医院胸外科2019年11月至2021年11月经手术后病理确诊的PIMA共78例患者的临床资料。结果 78例中,男33例(42.3%),女45例(57.7%),年龄(60.3±7.8)岁。血清癌胚抗原(CEA)升高(>5 ng/mL)9例(11.5%)。根据临床表现可分为无症状者60例(76.9%),有症状者18例(23.1%),包括咳嗽、咳黏液痰8例,胸闷、胸背部痛4例,其他症状6例。影像学:两肺下叶51例(65.4%)和外周型71例(91.0%),其中完全实性结节46例(59.0%),常见征象包括浅分叶、血管集束征。术后病理分期Ⅰ期、Ⅱ期、Ⅲa期及以上的患者分别为61例(78.2%)、9例(11.5%)和8例(10.3%)。13例患者行基因检测,8例检测到Kirsten大鼠肉瘤病毒癌基因(KRAS)突变,1例检测到表皮生长因子受体(EGFR)基因突变。22例患者行程序性死亡配体1(PD-L1)表达检测,其中肿瘤比例评分(TPS)<1%为18例(81.8%)。结论 除咳痰为黏液痰外,PIMA临床症状无特殊;CT显示病灶发生于肺下叶和外周、完全实性多见,浅分叶、血管集束征为常见征象;实验室检测PD-L1表达水平较低;KRAS突变相对较多;这些特征在PIMA的诊断和鉴别诊断中有一定价值。

Objective To investigate the CT imaging manifestations and clinicopathologic features of patients with primary pulmonary invasive mucinous adenocarcinoma(PIMA)diagnosed pathologically after surgery.Methods The clinical data of 78 patients with PIMA diagnosed pathologically after surgery in the Department of Thoracic Surgery of Anhui Chest Hospital from November 2019 to November 2021 were retrospectively analyzed.Results Among the 78 cases,33(42.3%)were male and 45(57.7%)were female,aged(60.3±7.8)years in total,and serum carcinoembryonic antigen(CEA)was increased(>5 ng/mL)in 9 cases(11.5%).According to the clinical characteristics,patients could be divided into the asymptomatic group(60 cases,76.9%)and the symptomatic group(18 cases,23.1%).The symptomatic group included 8 cases with coughing and coughing up mucus sputum,4 cases with chest tightness and chest and back pain,and 6 cases with other symptoms.Imaging manifestations showed that 51(65.4%)lesions were located in the inferior lobes of both lungs and 71(91.0%)in the peripulmonary,of which 46 patients(59.0%)had completely solid nodules,and common signs included shallow lobulation and vascular cluster sign.Postoperative pathologic stagesⅠ,Ⅱ,Ⅲa were found in 61(78.2%),9(11.5%)and 8(10.3%)patients,respectively.Moreover,genetic testing was performed in 13 patients,of which 8 cases were detected with mutations of Kirsten rat sarcoma viral oncogene(KRAS),and 1 case was detected with mutations of epidermal growth factor receptor(EGFR)gene.Twenty-two patients were tested for the expression of programmed death-ligand 1(PD-L1),and 18(81.8%)of these patients had a tumor proportional score(TPS)of<1%.Conclusion Except for expectoration of mucous sputum,PIMA has no specific clinical symptoms.CT manifestations show that the lesions usually occur in the inferior lobes and peripulmonary of the lungs,and most pulmonary nodules are completely solid,which with signs of shallow lobulation and vascular cluster.Laboratory tests show that the expression level of PD-L1 is low,and the KRAS mutations are relatively more frequent.These features have some value in the diagnosis and differential diagnosis of PIMA.