摘要
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
作者
陈其瑞
刘艳
司丽芳
胡滨
李彤
李辉
CHEN Qirui;LIU Yan;SI Lifang;HU Bin;LI Tong;LI Hui(Department of Thoracic Surgery,Belting Chao-yang Hospital,Capital Medical University,Beifing,100020,P.R.China;Department of Respiratory and Critical Care Medicine,Beijing Chao-yang Hospital,Capital Medical University,Beijing,100020 P.R.China;Department of Ridiology,Beijing Chao-yang Hospital,Capital Medical University,Beijing,100020,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2018年第11期935-941,共7页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
肺癌
肺良性病
CT特点
临床特征
鉴别诊断
误诊
Lung cancer
benign lung disease
CT characteristics
clinical characteristics
differential diagnosis
misdiagnosis
