早期周围型肺腺癌和肺鳞癌的CT鉴别诊断  

Differential CT diagnosis between early peripheral adenocarcinoma and squamous cell carcinoma of the lung

作　　者：王慧莹 强军[2] 陈殿森[2] WANG Huiying;QIANG Jun;CHEN Diansen(Imaging Center,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang 471000,China;Imaging Center,The First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)影像中心,河南洛阳471000 [2]河南科技大学临床医学院河南科技大学第一附属医院影像中心,河南洛阳471003

出　　处：《医学影像学杂志》2025年第3期48-50,55,共4页Journal of Medical Imaging

基　　金：河南省洛阳市科技发展计划重点项目(医疗卫生)(编号:2302010A)。

摘　　要：目的 对比分析早期周围型肺鳞癌与早期周围型肺腺癌的鉴别诊断要点,提高CT诊断准确率。方法 选取经病理证实的173例早期周围型非小细胞肺癌的CT及病理学资料。比较早期周围型实性非小细胞肺癌(49例鳞癌,42例腺癌)的CT特征,包括肺部背景、病灶大小、形态、长轴方向、分叶征、毛刺征、胸膜凹陷征、血管集束征、血管束增粗、充气支气管征、支气管管壁改变和坏死。采用卡方检验对两组的CT征象进行分析。结果 经统计分析可得肺腺癌女性患者更多。所有早期周围型肺鳞癌均为实性病灶。早期周围型肺腺癌中实性病灶42例,混合磨玻璃病灶50例,磨玻璃病灶32例。与早期实性肺腺癌相比,鳞癌更可能出现肺气肿、与支气管长轴一致、相应支气管管壁增厚、坏死,腺癌更可出现充气支气管征、胸膜凹陷征,差异有统计学意义(P<0.05)。在分叶征、毛刺征和血管集束征方面差异无统计学意义(P>0.05)。亚实性肺腺癌更容易出现血管束增粗,差异有统计学意义(P<0.05)。结论 CT扫描有助于快速区分早期周围型肺腺癌和肺鳞癌,提高CT诊断准确率。Objective The main points of differential diagnosis between early peripheral lung squamous cell carcinoma and early peripheral lung adenocarcinoma were compared to improve the accuracy of CT diagnosis.Methods The CT and pathologi-cal data of 173 patients with early peripheral non-small cell lung cancer confirmed by pathology were retrospectively collected.The CT features of early peripheral solid non-small cell lung cancer(49 cases of squamous cell carcinoma and 42 cases of adeno-carcinoma)were compared,including lung background,lesion size,morphology,axial orientation,lobulation,spiculation,pleural indentation sign,vascular convergence sign,vascular bundle thickening,air bronchogram,as well as bronchial wall change and necrosis.Chi-square test was used to analyze the CT signs of the two groups.Results There were more female pa-tients with lung adenocarcinoma by statistical analysis.All the early peripheral lung squamous cell carcinoma were solid foci.There were 42 solid lesions,50 mixed ground-glass lesions,and 32 ground glass lesions in early peripheral lung adenocarci-noma.Compared with early solid lung adenocarcinoma,squamous carcinoma was more likely to present with emphysema,consis-tent with the bronchial long axis,and corresponding bronchial tube wall thickening and necrosis(P<0.05).Adenocarcinoma was more likely to have air bronchogram and pleural indentation sign(P<0.05).No significant difference was observed in lobula-tion,spiculation and vascular convergence sign(P>0.05).Subsolid lung adenocarcinoma was more prone to vascular bundle thickening sign(P<0.05).Conclusion CT scan may help to quickly distinguish early peripheral lung adenocarcinoma and lung squamous cell carcinoma,and improve the accuracy of imaging diagnosis.

关 键 词：周围型肺鳞癌 周围型肺腺癌 体层摄影术 X线计算机 早期肺癌 病理学 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]