中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

173 例术前 CT 疑诊为恶性肿瘤的肺良性病变特征分析

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目的 分析术前 CT 表现疑似肺癌的肺良性病变的 CT 特征及患者的临床表现,以提高临床诊断的准确性。 方法 2006 年 6 月至 2016 年 12 月,2 239 例患者在首都医科大学附属北京朝阳医院接受肺部手术并术后病理证实为肺良性病变。其中,术前增强 CT 存在误诊考虑恶性可能性大的患者为 173 例(男 101 例、女 72 例,平均年龄 56.0 岁),归属于 20 种不同疾病,这 20 种疾病共包括 907 例肺良性病变(误诊和非误诊)。对 173 例患者的 CT 及临床特征进行分析。 结果 907 例肺良性病变术前增强 CT 容易误诊为恶性病变的病种依次为:肺平滑肌瘤(100.0%)、肺放线菌病(75.0%)、肺隐球菌病(71.4%)、硬化性血管瘤(50.0%)和机化性肺炎(44.2%)。173 例术前胸部 CT 误诊为恶性患者,主要临床表现为发热(17.3%)、咳嗽(56.6%)、黄痰(8.7%)、咯血(28.9%)、胸痛(16.2%)、白细胞计数升高(18.5%)及癌胚抗原升高(4.6%)。173 例胸部 CT 考虑恶性可能性大的肺部良性病变中,较常见的疾病依次为:肺结核(29.5%)、机化性肺炎(28.9%)、肺错构瘤(6.4%)和肺脓肿(6.4%)。173 例患者 CT 多表现为结节或肿块影,70.5% 的病灶≤3 cm,病灶有类似肺癌表现,如边缘毛刺(49.1%)、分叶(33.5%)、胸膜凹陷(27.2%)及明显强化(39.3%),同时部分患者具有肿瘤不常见征象,如钙化(12.7%)、中心液化(18.5%)、卫星灶(9.8%)、肺多发结节(42.2%)。24.3% 患者存在纵隔或肺门淋巴结肿大。 结论 CT 征象是诊断肺疾病的重要依据,但部分肺良性病变其 CT 表现有类似肺癌的特征,有时需要动态观察并结合患者临床特征,在影像变化中识别疾病本质。

Objective To improve accuracy of clinical diagnosis through analyzing the CT characteristics and clinical manifestations of patients with benign lung diseases whose CT manifestations initially led to a suspicion of lung cancer. Methods This study collected 2 239 patients of benign lung disease verified by postoperative pathology in the Department of Thoracic Surgery, Beijing Chao-yang Hospital from June 2006 to December 2016. Lesions of 173 patients (101 males and 72 females with a mean age of 56.0 years) were considered very likely to be malignant on preoperative contrast CT scan, which were sorted to 20 types of lung diseases, and the 20 types of diseases contained 907 patients diagnosed or misdiagnosed. Statistical analyses were performed using the CT and clinical characteristics of the 173 patients. Results Among the 907 patients with benign lung disease, the benign pathologies that were most commonly misdiagnosed by preoperative enhanced CT were pulmonary leiomyoma (100.0%), pulmonary actinomycosis (75.0%), pulmonary cryptococcosis (71.4%), sclerosing hemangioma (50.0%) and organizing pneumonia (44.2%). Among the 173 patients with benign diseases, the most common diseases were tuberculosis (29.5%), organizing pneumonia (28.9%), pulmonary hamartoma (6.4%) and pulmonary abscess (6.4%). In the 173 patients, 17.3% had fever, 56.6% coughing, 8.7% yellow sputum, 28.9% hemoptysis, 16.2% chest pain, 18.5% elevated leukocyte counts and 4.6% elevated carcinoembryonic antigen levels. Most of the CT manifestations consisted of nodular or mass shadows, 70.5% of which had foci≤3 cm and manifestations were similar to those of lung cancer, such as a spiculated margin (49.1%), lobulation (33.5%), pleural indentation (27.2%) and significant enhancement (39.3%). Furthermore, some patients had uncommon tumor signs, such as calcification (12.7%), central liquefactive necrosis (18.5%), satellite foci (9.8%) and multiple pulmonary nodules (42.2%). Moreover, 24.3% of the patients had enlarged lymph nodes of the mediastinum or hilum. Conclusion As the CT manifestations of some benign lung conditions are similar to those of lung cancer, careful differential diagnosis is necessary to identify the basic characteristics of the disease when the imaging results are ambiguous, and the diagnosis of a lung disease need incorporate the patients' clinical characteristics and a comprehensive analysis.

关键词: 肺癌; 肺良性病; CT 特点; 临床特征; 鉴别诊断; 误诊

Key words: Lung cancer; benign lung disease; CT characteristics; clinical characteristics; differential diagnosis; misdiagnosis

引用本文: 陈其瑞, 刘艳, 司丽芳, 胡滨, 李彤, 李辉. 173 例术前 CT 疑诊为恶性肿瘤的肺良性病变特征分析. 中国胸心血管外科临床杂志, 2018, 25(11): 935-941. doi: 10.7507/1007-4848.201712080 复制

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