100例细支气管肺泡癌CT诊断、临床表现及误诊分析

Analysis on CT Diagnosis, Clinical Symptoms, Misdiagnosis of 100 Cases of Bronchioalveolar Carcinoma

回顾分析了100例经手术和/或病理证实的各类型细支气管肺泡癌(BAC)的CT征象、临床表现及误诊情况.结果表明:BAC的临床表现无突出特点,咳大量白色泡沫痰特征性症状的发病率只有14.0%.痰内脱落癌细胞检出率亦仅15.3%,癌胚抗原(CEA)测定对肺实变型和弥漫型BAC有诊断意义,而孤立结节型BAC则主要靠手术证实.X线平片只能查出异常阴影,CT则可显示特征性征象,可分为孤立结节型(37.0%)、肺实变型(19.0%)和弥漫型(44.0%)3种主要类型.BAC首诊误诊率为38.0%,其中有一半病例被误诊为肺结核,主要原因是我国近年来肺结核发病率回升,大家对它的警惕性较高,而对BAC的重视和认识不够所致.

The CT symptom, clinical manifestation, and misdiagnosing reason of 100 cases of bronchioalveolar carcinoma (BAC) confirmed by operation and/or histopathology were analyzed. The results showed that there were not any obvious distinguishing feature in clinical manifestation for BAC, and only 14.0 percent of cases showed the characteristic symptom with large amount of white foamy sputum, meanwhile, the detectable rate for the cancer cell exfoliated in sputum was only 15.3 percent, however, carcinoma embryo antigen (CEA) test was still valuable for clinically diagnosing BAC belonging to consolidation type or diffuse type, while the BAC of solitary nodular type mainly depended on further confirmation by operation. Moreover, for BAC, Xray film only can show abnormal shadow, yet CT can reflect some characteristic symptoms, and it can be divided into 3 main types: solitary nodular type (37.0%), consolidation type (19.0%), and diffuse type (44.0%). The misdiagnosis rate for BAC was 38.0% at the first diagnosis. Among those cases, nearly half of them were diagnosed as pulmonary tuberculosis. The main reason for misdiagnosis was that an attention was mainly paid to the rebound of the disease incidence of pulmonary tuberculosis in recent years in China, and thus resulted in a deficient emphasis and a shallow understanding in BAC.