摘要:目的:肺内孤立病灶的良恶性鉴别诊断一直是影像诊断的难点,为了提高小肺癌诊断的准确率,我们对肺内小病灶进行了CT-病理对照研究,探讨肺内小病灶的CT征象及其对小肺癌的诊断价值。方法:选择2cm以下肺内孤立小病灶进行薄层CT扫描,层厚层距均为2mm,CT机为TCT-600XT型,CT扫描后2周内进行手术切除,切除标本固定后;按CT扫描横断方向连续做成病理大切片。将术前CT片与病理大切片在肉眼和显微镜下进行对比研究;结果:72例肺内小病灶中64例为肺癌,CT正确诊断60例,正确诊断率为93.75%,其中45例为早期肺癌。CT值:64例肺癌平均CT值为32.7Hu,良性病灶平均CT值为75.9Hu,两者差异显著,P<0.01。结论:通过CT-病理对照研究,棘突征,空泡征、血管集束征、CT值等征象对小肺癌诊断有很大价值,结合其他CT征象综合判定,能提高小肺癌诊断的准确率。
关键词:肺癌；X线计算机断层；病理学诊断
CT findings and pathological basis of small lesions in the lung (analysis of 72 cases)
Abstract: Objective: The differential diagnosis of benign and malignant lesions in the lung has always been a difficult point in imaging diagnosis. In order to improve the accuracy of diagnosis of small lung cancer, we conducted a CT-pathological study of small lesions in the lung to investigate the CT of small lesions in the lung. Signs and its diagnostic value for small lung cancer. METHODS: Thin-slice CT scans of 2 cm below the isolated small lesions were performed. The thickness of the layers was 2 mm. The CT machine was TCT-600XT. The surgical resection was performed within 2 weeks after CT scan. The specimens were fixed after fixation. CT scan The transverse direction is continuously made into a large section of the pathology. The preoperative CT and pathological sections were compared under naked eyes and microscope. Results: Of the 72 cases of small intrapulmonary lesions, 64 cases were lung cancer, and 60 cases were correctly diagnosed by CT. The correct diagnosis rate was 93.75%, of which 45 cases were early. Lung cancer. CT value: The average CT value of 64 cases of lung cancer was 32.7Hu, and the average CT value of benign lesions was 75.9Hu. The difference was significant (P<0.01). Conclusion: CT-pathological control study, signs of spinous process, vacuole sign, vascular bundle sign, CT value and other signs have great value in the diagnosis of small lung cancer. Combined with other CT signs, the accuracy of diagnosis of small lung cancer can be improved.
Key words: lung cancer; X-ray computed tomography; pathological diagnosis
近年来,肺癌发病率明显增高,但早期诊断,尤其是小肺癌的定性诊断仍有一定难度〔1〕。我们对72例肺内小病灶进行薄层CT扫描,并对切除标本实施连续病理大切片,两者进行对比研究,现报告如下。
1资料与方法
1.1一般资料
选取我院2017年间经CT检查直径肺内小病灶72例,其中男40例,女32例。年龄28～69岁,平均51.4岁。其中60例经术后病理证实,12例由其他方法得到组织学证实。本组64例为肺癌病理类型为腺癌44例、鳞癌8例、小细胞未分化癌6例、细支气管肺泡癌6例;8例为良性病灶(结核4例、炎性假瘤3例、错构瘤1例)。
1.2方法
采用东芝TCT-600XT型CT扫描机,矩阵512×512,曝光时间1.2秒。常规胸部扫描,对病灶区改用薄层CT扫描,层厚层距均为2mm。选择病灶最大层面测量直径和CT值,调整窗位、窗宽,清楚显示病灶边缘、轮廓及内部结构,图像放大2倍摄片。切除标本按CT扫描横断面连续做成病理大切片,将CT图像与病理大切片进行对比观察〔2〕。
2.结果
肺内小病灶的CT征象,见附表。病灶形态:64例肺癌中60例为类圆形,4例为不规则形;8例良性病灶中7例为类圆形,1例为不规则形。良恶性病灶的形态无显著差异。
3.讨论
肺内小病灶薄层CT扫描的意义:本组72例肺内小病灶,CT正确诊断64例,正确诊断率88%;其中64例肺癌,CT正确诊断60例(93.75%),经手术病理证实45例为早癌。因此,我们认为薄层CT扫描对肺内小病灶的定性诊断具有十分重要的临床意义。而小肺癌的CT征象及其病理基础都有什么呢。首先是棘状突起征:病灶边缘呈小圆尖顶状突起。此征为诊断恶性肿瘤重要征象之一。病理证实此征系肿瘤组织和间质结构形成,为癌细胞生长活跃区。血管集束征:病理观察表明近肺门侧的血管集束由增粗的血管或伴行扩张的小支气管构成,此血管为肺小动脉;远肺门侧的血管集束为肺小静脉,说明静脉回流受阻。腾皋军〔3〕研究表明周围型肺癌常有肺动脉供血,中央型则没有;参与供血的肺动脉有三种形态:树枝状、细网状和血窦状。因此,我们认为“血管集束征”的病理基础是参与供血的肺动脉。最后短毛刺征、深分叶征、胸膜凹陷征经统计学处理后,良恶性无显著差异。这些征象目前对肺癌的诊断仍有争议,但本组病例中诊断为肺癌者,出现这些征象的比率并不低。因此,我们认为短毛刺征、深分叶征、胸膜凹陷征在综合判定中有一定价值。肺内小病灶显示边缘光滑锐利、CT值偏低或偏高、钙化、局限性胸膜肥厚粘连(注意与胸膜凹陷征鉴别),卫星灶等指征,均为本组诊断良性病变有价值的依据,相同于有关报道。因此我们认为肺内小结节的检出很重要,而定性诊断尤为重要,如定性为肺癌时,还应注意到早期转移等问题。
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论文作者:姜海彬
论文发表刊物:《医师在线》2019年第02期
论文发表时间:2019/3/4
标签：病灶论文; 肺癌论文; 病理论文; 征象论文; 薄层论文; 血管论文; 胸膜论文; 《医师在线》2019年第02期论文;