干旱区生态环境知识资源中心(Arid): 肺外恶性肿瘤患者肺内孤立性结节的CT-病理对照研究

Arid

	肺外恶性肿瘤患者肺内孤立性结节的CT-病理对照研究
其他题名	Differential diagnoses of solitary pulmonary nodule in patients with extrapulmonary malignant tumor:CT and pathologic correlation
	李成洲 1; 肖湘生 1; 刘会敏 1; 刘士远 1; 李惠民 1; 董伟华 1; 丁飚 2; 张庆华 1
来源期刊	中华放射学杂志
ISSN	1005-1201
出版年	2004
卷号	38 期号:8 页码:824-830
中文摘要	目的用多因素回顾性研究的方法,探讨肺外恶性肿瘤患者肺内直径＜3 cm的孤立性结节(ETM-SPN)定性诊断的可能性,并评价CT的鉴别诊断价值.方法搜集经证实的直径＜3 cm的ETM-SPN病例83例,通过对性别、年龄、吸烟史、肺内外病灶的平均时间间隔、肺内结节的CT形态学特征,以及肺外肿瘤病理类型与肺结节性质的关系等行多因素分析,探讨ETM-SPN定性诊断的相关因素.结果83例肺部结节中孤立性转移瘤、原发性支气管肺癌、良性病灶分别为43、33和7例.平均年龄为(57.4315.33)岁,男女之比为1.59:1.原发性支气管肺癌和孤立性转移瘤组的平均年龄和男女之比分别为(62.4811.96)岁、1.20:1和(54.1016.49)岁(t=3.34,P＜0.05)、2.31:1(x2=0.0209,P＞0.05).各组吸烟率间,原发性支气管肺癌组(39.3%,11/17)与孤立性转移瘤组(35.9%,14/39)和非原发性肺癌组(33.3%,15/45)间差异均无显著意义(chi2=0.640,P＞0.05;chi2=0.931,P＞0.05).原发性肺癌组和孤立性转移瘤组的肺内外肿瘤确诊的平均时间间隔分别为(65.6213.45)个月和(22.834.19)个月,两组间差异有显著性意义(Wilcoxon秩和检验,U=2.796,P＜0.01).肺外肿瘤为鳞癌(10例)和腺癌(58例)者,其肺内病灶原发性肺癌、孤立性转移瘤比例分别为7:3和24:34,差异无显著性意义(chi2=1.781,P＞0.05).CT形态学特征分析结果,原发性肺癌和孤立性转移瘤两组间"毛刺"和"光整"的显示率差异有显著性意义(chi2=8.562,P＜0.01;chi2=15.220,P＜0.001);而"分叶"显示率差异无显著性意义(chi2=2.054,P＞0.05).原发性肺癌组和孤立性转移瘤组肺结节平均最大径分别为(2.861.18)cm和(2.621.31)cm,两组间差异无显著性意义(t=1.29,P＞0.05).CT和手术病理对照分析37例经肺门和纵隔淋巴结清扫术的病例,结果原发性肺癌和孤立性转移瘤组淋巴结癌细胞浸润率间差异无显著性意义(chi2=2.801,P＞0.05).结论直径＜3 cm的ETM-SPN的定性诊断,主要应结合患者的年龄、两瘤时间间隔和肺内病灶的CT形态学特征,而与性别、吸烟史、是否有肺门纵隔淋巴结转移,以及肺外肿瘤的病理类型无显著相关性.
英文摘要	Objective To determine the definitive diagnostic possibility of solitary pulmonary nodule in patients with a primary extrapulmonary neoplasm ( ETM-SPN) , and to further evaluate the differential diagnosis value of CT in ETM-SPN with a multivariate retrospective study. Methods Eighty-three patients with pathologically and clinically proved extrapulmonary malignant neoplasm and a solitary pulmonary nodule smaller than 3 cm in diameter were included in this study. The histologic characteristics of the nodules were correlated with those of the extrapulmonary neoplasm, and patient age, gender, smoking history, disease free interval between extrapulmonary malignancy and diagnosis of lung lesion. In all 83 cases, CT scans were reviewed to confirm the solitary nature, size, and nodular morphology of the lung lesion. Results Of all 83 cases, the mean age was (57. 43 15. 33 ) years. There were 51 males and 32 females, with the ratio of 1. 59:1. The lesions included solitary metastasis in 43 oases, pulmonary malignant lesion in 33, and benign lesion in 7. Between primary lung cancer group and solitary metastasis group, there was no significant difference for gender ratio (1. 20: 1vs2. 31:1, x2 = 0. 0209, P>0.05) , but there was significant difference between the mean age [(62.4811.96) yrs vs (54.1016.49)yrs, t=3.34, P<0. 05 ]. In primary lung cancer and metastasis patient group, the percentage of patients who had smoking history was 39. 3% (11/17) and 35. 9% (14/39) , respectively. Patients with a primary lung cancer had no significant higher frequency of smoking history than those with a metastatic lesion ( x =0. 640, P > 0.05). Of 81 cases who had followed up. The mean time of diseases free interval between extrapulmoanry malignancy and pulmonary lesion was (39.73 6.29) months (range; 0 ~ 300 months, median, 20.00 months) , those of primary lung cancer and metastatic group were (65. 62 13. 45) months and (22. 83 4. 19) months, respectively, which had significant differrecnce between the two groups( Wilcoxon rank sum test, U = 2.796, P < 0. 01 ) . Of all 83 cases, there were 10 squamous cell carcinomas and 58 adenocarcinomas of extrapulmonary malignancy. The odds ratio of primary lung cancer and metastasis were 7:3 and 24: 34, respectively (x2 =1.781, P>0. 05) , and it didn’t show statistical significant releveance between pathologic patterns of extrapulmonary malignancy and characteristics of lung nodule. Of all 83 cases, the mean diameter was (2. 77 1. 25) cm, and that of 33 cases of primary lung cancer and 43 cases of solitary metastasis lesion were (2. 86 1. 18) cm and (2. 62 1.31) cm, respectively, which had no significant difference between the two groups (t = 1.29, P > 0. 05 ) . There was a statistically significant association between primary lung cancer and metastasis group for spiculate and smooth edge of lung lesion (X2 = 8. 562 , P < 0. 01; x2 = 15. 220, P < 0. 001). The study showed that lung nodule with a spiculated margin may correlate to a primary lung carcinoma, whereas smooth edge may more frequently manifeste in a metastatic pulmonary lesion. CT-pathologic correlative analyses of hilar and mediastinal adenopathy were reviewed in 37 patients who underwent lobeoctomy and thoraceotomy. There was no statistical significant difference between primary lung cancer group and metastasis group ( x2 =2. 801, P > 0. 05). Conclusion The likelihood of a primary lung cancer versus a metastasis of ETM-SPN smaller than 3 cm mainly depends on the patient’s age, free interval bewteen two tumors, CT morphological characteristics of lung lesion. This study shows there has no significant relevancy to the factors as gender, smoking history, the histologic patterns of the extrapulmonary neoplasm or whether there has hilar or mediastinal adenopathy.
中文关键词	硬币病变 ; 肺 ; 肿瘤转移 ; 诊断 ; 鉴别 ; 体层摄影术 ; X线计算机 ; 病理学
英文关键词	Coin lesion pulmonary Neoplasm metastasis Diagnosis differential Tomography X-ray computed Pathology
语种	中文
国家	中国
收录类别	CSCD
WOS类目	MEDICINE GENERAL INTERNAL
WOS研究方向	General & Internal Medicine
CSCD记录号	CSCD:1666984
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/205818
作者单位	1.第二军医大学长征医院影像科, 上海 200003, 中国; 2.第二军医大学长征医院影像科, 上海 200002, 中国
推荐引用方式 GB/T 7714	李成洲,肖湘生,刘会敏,等. 肺外恶性肿瘤患者肺内孤立性结节的CT-病理对照研究[J],2004,38(8):824-830.
APA	李成洲.,肖湘生.,刘会敏.,刘士远.,李惠民.,...&张庆华.(2004).肺外恶性肿瘤患者肺内孤立性结节的CT-病理对照研究.中华放射学杂志,38(8),824-830.
MLA	李成洲,et al."肺外恶性肿瘤患者肺内孤立性结节的CT-病理对照研究".中华放射学杂志 38.8(2004):824-830.