BACKGROUND Lung cancer is the leading cause of cancer-related death.Early diagnosis is critical to improving a patient’s chance of survival.However,lung cancer associated with cystic airspaces is often misdiagnosed o...BACKGROUND Lung cancer is the leading cause of cancer-related death.Early diagnosis is critical to improving a patient’s chance of survival.However,lung cancer associated with cystic airspaces is often misdiagnosed or underdiagnosed due to the absence of clinical symptoms,poor imaging specificity,and high risk of biopsy-related complications.CASE SUMMARY We report an unusual case of cancer in a 55-year-old man,in which the lesion evolved from a small solitary thin-walled cyst to lung squamous cell carcinoma(SCC)with metastases in both lungs.The SCC manifested as rare clustered cystic lesions,detected on chest computed tomography.There were air-fluid levels,compartments,and bronchial arteries in the cystic lesions.Additionally,there was no clear extrathoracic metastasis.After chemotherapy,the patient achieved a partial response,type I respiratory failure was relieved,and the lung lesions became a clustered thin-walled cyst.CONCLUSION Pulmonary cystic lesions require regular imaging follow-up.Lung SCC should be a diagnostic consideration in cases of thin-walled cysts as well as multiple clustered cystic lesions.展开更多
囊腔型肺癌(lung cancer associated with cystic airspaces,LCCA)是一种影像学上表现为肿瘤内或边缘存在囊性空腔的肺癌类型。由于易被误诊或漏诊,LCCA患者的预后不良,因此需要更多临床研究来揭示其特点。目前已有4种影像学分类系统,...囊腔型肺癌(lung cancer associated with cystic airspaces,LCCA)是一种影像学上表现为肿瘤内或边缘存在囊性空腔的肺癌类型。由于易被误诊或漏诊,LCCA患者的预后不良,因此需要更多临床研究来揭示其特点。目前已有4种影像学分类系统,并且近年来对LCCA的关注度逐渐升高,尤其是对其影像学特征进行了一定的研究。既往结果显示,LCCA的病理特征与影像学表现存在相关性,但对于与肺癌相关的驱动基因突变和分子分型的研究仍不充分。由于LCCA难以早期诊断,预后较一般类型肺癌差,本文综述了LCCA的定义、病因与发病机制、影像学特征与诊断依据、组织学和病理学特征及预后等方面的研究进展,以期为临床决策提供参考。展开更多
目的建立一个基于临床特征和术前计算机断层扫描(CT)影像组学的预测模型辅助诊断囊腔型肺癌。方法回顾性分析2020年1月至2021年12月在青岛大学附属医院及济宁医学院附属医院接受手术治疗的患者,纳入病变中含有囊腔的患者296例,并分为囊...目的建立一个基于临床特征和术前计算机断层扫描(CT)影像组学的预测模型辅助诊断囊腔型肺癌。方法回顾性分析2020年1月至2021年12月在青岛大学附属医院及济宁医学院附属医院接受手术治疗的患者,纳入病变中含有囊腔的患者296例,并分为囊腔型肺癌和良性病变两组。从术前CT图像上提取病灶的影像组学特征,并综合分析临床病理特征。将上述特征进行筛选后以随机森林算法构建诊断模型,其中来自青岛大学附属医院的214例患者进行训练和内部验证(D1)。其余82例来自济宁医学院附属医院的患者作为独立的外部验证队列(D2)。通过受试者工作特征曲线(ROC)、校准曲线及决策曲线分析(DCA)对模型的分类能力进行评估。结果囊腔型肺癌组患者年龄高于良性病变组(60.12±9.95 vs 50.86±13.66,P<0.001),其余临床特征差异无统计学意义。影像组学特征经筛选后获得形状平坦度、稳健平均绝对偏差、差异方差等5种影像组学纹理特征。临床与影像组学特征融合后构建随机森林模型在D1(AUC 0.97)和D2(AUC 0.74)上均显示出较好的诊断效能,在D1中的准确性、敏感性与特异性分别为0.92、0.85和0.99。结论构建并外部验证了一个实用的诊断模型,可以比较准确地区分囊腔型肺癌和囊腔样良性病变。这种创新的方法可作为囊腔型肺癌的一种新的无创诊断工具。展开更多
基金Yantai City Science and Technology Development Plan Item,No.2019YD008.
文摘BACKGROUND Lung cancer is the leading cause of cancer-related death.Early diagnosis is critical to improving a patient’s chance of survival.However,lung cancer associated with cystic airspaces is often misdiagnosed or underdiagnosed due to the absence of clinical symptoms,poor imaging specificity,and high risk of biopsy-related complications.CASE SUMMARY We report an unusual case of cancer in a 55-year-old man,in which the lesion evolved from a small solitary thin-walled cyst to lung squamous cell carcinoma(SCC)with metastases in both lungs.The SCC manifested as rare clustered cystic lesions,detected on chest computed tomography.There were air-fluid levels,compartments,and bronchial arteries in the cystic lesions.Additionally,there was no clear extrathoracic metastasis.After chemotherapy,the patient achieved a partial response,type I respiratory failure was relieved,and the lung lesions became a clustered thin-walled cyst.CONCLUSION Pulmonary cystic lesions require regular imaging follow-up.Lung SCC should be a diagnostic consideration in cases of thin-walled cysts as well as multiple clustered cystic lesions.
基金国家自然科学基金项目(No.82360562、No.82272980、No.82060426、No.81702274)云南省基础研究计划项目(No.202201 AY 070001-133)云南省科技厅基础研究专项(No.202201AT070011)资助。
文摘囊腔型肺癌(lung cancer associated with cystic airspaces,LCCA)是一种影像学上表现为肿瘤内或边缘存在囊性空腔的肺癌类型。由于易被误诊或漏诊,LCCA患者的预后不良,因此需要更多临床研究来揭示其特点。目前已有4种影像学分类系统,并且近年来对LCCA的关注度逐渐升高,尤其是对其影像学特征进行了一定的研究。既往结果显示,LCCA的病理特征与影像学表现存在相关性,但对于与肺癌相关的驱动基因突变和分子分型的研究仍不充分。由于LCCA难以早期诊断,预后较一般类型肺癌差,本文综述了LCCA的定义、病因与发病机制、影像学特征与诊断依据、组织学和病理学特征及预后等方面的研究进展,以期为临床决策提供参考。
文摘目的建立一个基于临床特征和术前计算机断层扫描(CT)影像组学的预测模型辅助诊断囊腔型肺癌。方法回顾性分析2020年1月至2021年12月在青岛大学附属医院及济宁医学院附属医院接受手术治疗的患者,纳入病变中含有囊腔的患者296例,并分为囊腔型肺癌和良性病变两组。从术前CT图像上提取病灶的影像组学特征,并综合分析临床病理特征。将上述特征进行筛选后以随机森林算法构建诊断模型,其中来自青岛大学附属医院的214例患者进行训练和内部验证(D1)。其余82例来自济宁医学院附属医院的患者作为独立的外部验证队列(D2)。通过受试者工作特征曲线(ROC)、校准曲线及决策曲线分析(DCA)对模型的分类能力进行评估。结果囊腔型肺癌组患者年龄高于良性病变组(60.12±9.95 vs 50.86±13.66,P<0.001),其余临床特征差异无统计学意义。影像组学特征经筛选后获得形状平坦度、稳健平均绝对偏差、差异方差等5种影像组学纹理特征。临床与影像组学特征融合后构建随机森林模型在D1(AUC 0.97)和D2(AUC 0.74)上均显示出较好的诊断效能,在D1中的准确性、敏感性与特异性分别为0.92、0.85和0.99。结论构建并外部验证了一个实用的诊断模型,可以比较准确地区分囊腔型肺癌和囊腔样良性病变。这种创新的方法可作为囊腔型肺癌的一种新的无创诊断工具。
