术前恶性不除外手术病理确诊肺部良性病变297例患者临床-放射-病理特征分析:一项中国单中心回顾性队列研究  

Clinical-radiological-pathological Characteristics of 297 Cases of Surgical Pathology Confirmed Benign Pulmonary Lesions in Which Malignancy Could Not Be Excluded in Preoperative Assessment:A Retrospective Cohort Analysis in a Single Chinese Hospital

作　　者：留永健[1] 陈闽江[1] 郭超[2] 钟巍[1] 叶秋月[1] 赵静[1] 周晴[1] 高晓星[1] 刘潇衍[1] 梁红格 石岳泉 蒋德利娜 刘洪生[2] 徐燕[1] 李单青 王孟昭[1] Yongjian LIU;Minjiang CHEN;Chao GUO;Wei ZHONG;Qiuyue YE;Jing ZHAO;Qing ZHOU;Xiaoxing GAO;Xiaoyan LIU;Hongge LLANG;Yuequan SHI;Delina JIANG;Hongsheng LIU;Yan XU;Shanqing LI;Mengzhao WANG(Department of Respiratory and Critical Care Medicine,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Thoracic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院呼吸与危重症医学科,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院胸外科,北京100730

出　　处：《中国肺癌杂志》2020年第9期792-799,共8页Chinese Journal of Lung Cancer

基　　金：国家“十三五”重大新药创制专项子课题“创新药物临床评价示范性平台建设”(No.2019ZX09734001-002);中国医学科学院医学与健康科技创新工程项目(No.2018-I2M-1-003);北京市自然科学基金(No.7194311)资助。

摘　　要：背景与目的随着癌症早筛意识的提高,低剂量计算机断层扫描(low-dose computed tomography,LDCT)用于肺癌筛查在中国广泛开展。尽管有部分胸部LDCT筛查所见的肺部病灶是肿瘤病灶,但大多数的肺部结节是良性病变。如何有效的对肺部病灶进行术前鉴别,如何降低部分可避免手术的良性疾病的手术切除比例,是需要关注的问题。方法本研究纳入2017年1月1日-2018年12月31日期间北京协和医院诊治的,术前考虑肺部恶性病变不能除外,经手术病理确认为良性病变的患者,回顾性分析患者临床信息。结果 297例患者纳入本研究,占我院肺部病灶行肺部手术治疗患者的9.8%。197例(66.3%)患者因体检行LDCT筛查发现肺部病灶。肺部病变胸部CT影像学评估情况,可评估的323个病灶,平均长径为(17.9±12.1)mm,直径≥8 mm的占91.0%,实性最多见(212/323, 65.6%),此类肺部病灶可有毛刺征(71/323, 22.0%)、分叶征(94/323, 29.1%)、胸膜牵拉征(81/323, 25.1%)、血管集束征(130/323, 40.2%)、空泡征(23/323, 7.1%)等,提示恶性病变的影像学特征。292例(98.3%)行电视辅助胸腔镜手术(video-assisted thoracoscopic surgery, VATS),232例(78.1%)患者行肺楔形切除术,13例(4.4%)行肺段切除术,51例(17.2%)患者行肺叶切除术。4例(1.3%)患者出现手术并发症。术后病理类型前3位的是感染性疾病98例(33.0%)、炎性结节96例(32.3%)和错构瘤64例(21.5%)。结论因术前不能排除恶性而行手术切除的肺部良性病灶,影像学表现以实性病灶多见,但多具有提示恶性的影像学特征。VATS可作为一种明确病原病理的重要活检方式。此类病灶病理结果以感染性疾病和炎性结节最为常见,错构瘤第三。Background and objective Low dose computed tomography(LDCT)for lung cancer screening is widely employed in China as a result of increasing cancer screening awareness.Although some pulmonary lesions detected by LDCT are cancerous,most of the pulmonary nodules are benign.It is important to make effective preoperative differentiation of pulmonary lesions and to obviate the need for surgery in some patients with benign disease.Methods From January 1,2017 to December 31,2018,patients in our institution with surgical pathology confirmed benign pulmonary lesions in which malignancy could not be excluded in preoperative assessment were enrolled in this study.Retrospective analysis of clinical data was conducted.Results 297 cases were collected in this study.Prevalence of benign disease in patients underwent resection for focal pulmonary lesions is 9.8%in our institution.In 197 patients(66.3%),pulmonary lesions were detected by LDCT screening.A total of 323 assessable pulmonary lesions were detected by chest CT.The average diameter of pulmonary lesions was(17.9±12.1)mm,and 91.0%of which were greater than or equal to 8 mm.Solid nodules accounted for 65.6%of these lesions.Imaging characteristics suggesting malignancy were common,including spicule sign(71/323,22.0%),lobulation(94/323,29.1%),pleural indentation(81/323,25.1%),vascular convergence sign(130/323,40.2%)and vacuole sign(23/323,7.1%).292 patients(98.3%)underwent video-assisted thoracoscopic surgery(VATS).Pulmonary wedge resection was performed in 232 cases(78.1%),segmental resection in 13 cases(4.4%)and lobotomy in 51 cases(17.2%).Surgical complications occurred in 4 patients(1.3%).The most frequent findings on surgical pathology analysis were:infectious lesions in 98 cases(33.0%),inflammatory nodules in 96 cases(32.3%),and hamartoma in 64 cases(21.5%).Conclusion Solid nodules accounted for most of these benign pulmonary lesions in which malignancy could not be excluded preoperatively,and imaging characteristics suggesting malignancy were common.VATS is an importan

关 键 词：肺部良性病变 肺结节 肺肿瘤 肺癌筛查 

分 类 号：R734.2[医药卫生—肿瘤]