肺低分化鳞癌:CT表现特点及术前CT分期的价值

摘要目的探讨CT影像表现特征及术前CT检查在肺低分化鳞癌T及N分期中的价值。方法2000年5月～2006年5月共有179例肺低分化鳞癌患者在我院进行了CT扫描检查（其中132例患者接受了肺叶切除术）。其中行CT增强扫描者142例，行CT平扫37例。所有患者均经病理诊断证实。由2位科放射科医师共同对所有患者的CT扫描结果进行影像学分析、分期（包括原发肿瘤及淋巴结病变），并与病理诊断结果进行对照研究。结果在所有179例肺低分化鳞癌患者，中央型病变53．6％（96例），周围型病变46．4％（83例）。96例中央型病变患者中，CT影像学表现为肺门肿块者94例，腔内型病变者2例，出现空洞者5例，伴随阻塞性改变者69例。83例周围型病变患者中，最大径范围1．5—12cm，82例为实性病变，1例为部分实性病变；其中48例（58．0％）患者的病灶直径〉4cm，伴空洞病变表现的患者12例（14．0％）。直径≤3cm的病灶占周围型病变的21例（25．3％），中心可出现坏死（12例）及空洞（2例），可见广泛淋巴结肿大（3例）。术前CT对原发肿瘤及淋巴结分期（cTN）与术后病理对原发肿瘤及淋巴结分期（pTN）一致者46．2％（61例），cTN与pTN不一致者53．8％（71例）。CT对原发肿瘤（T分期）评估准确者78．8％（104例），不准确者21．2％（28例），其中低估12．1％（16例），高估9．1％（12例）。CT对淋巴结病变（N分期）评估准确者56．8％（75例），不准确者43．2％（57例），其中低估18．2％（24例），高估25．0％（33例）。结论肺低分化鳞癌多为典型鳞癌的CT表现。病灶直径≤3cm的周围型低分化肺鳞癌可发生坏死及纵隔广泛淋巴结转移。直径〈1cm的纵隔淋巴结可转移，而良性淋巴结肿大亦较常见。尽管CT在低分化鳞癌分期上价值有限，但仍具有重要作用。

Poorly differentiated pulmonary squamous carcinoma: CT characterization and the value in preoperative staging by CT

Objective To analyze the CT manifestations in mous carcinoma and to evaluate the use of chest CT patients with poorly differentiated pulmonary squascanning in staging poorly differentiated pulmonary squamous carcinoma. Methods Between May 2000 and May 2006, 179 patients with poorly differentiated pulmonary squamous carcinomas underwent chest CT examinations in our hospital, 142 underwent enhanced CT scan, 37 underwent non-enhanced CT scan only, and 132 received radical surgical treatment. CT findings were reviewed and compared with surgery -pathological findings by two radiologists together. The poorly differentiated pulmonary squamous carcinomas were confirmed in all patients. Results Of all 179 patients with poorly differentiated pulmonary squamous carcinomas, central lesions were found in 96 cases （53.6%） and peripheral lesions were seen in 83 cases （46. 4% ）. In patients with central lesions, hilar masses were found in 94 cases and main stem bronchus involvement in 2, with obstructive diseases in 69 and cavitation in 5 cases. Eighty-two of 83 patients with peripheral lesions were found with solid lesions, the rest one was found with part -solid lesion, in whom the diameters of the lesions were 〉14 cm in 48 （58.0%） cases, and cavitations were noted in 12 （14.0%）. Peripheral lesions 〈3 em in diameter were seen in 21 cases （25.3%）, in which necrosis, cavitations, and extensive mediastinal and hilar lymph node enlargement were noted in 12, 2 and 3 cases. Complete TN agreement was 46. 2% （61/ 132）. The clinical T category with CT scan was correct in 78.8% （104/132） patients. In the remaining 28 patients with the incorrect clinical T category with CT scan, the clinical T category was underestimated in 16 （12. 1% ） and overestimated in 12 （9. 1% ）. The clinical N category with CT scan was correct in 56. 8% （75/132）, was underestimated in 24 （18.2%）, and was overestimated in 33cases （25.0%）. Conclusion The typical CT manifestations exist in most patients with poorly differentiated pulmonary squamous carcinoma. Tumor necrosis and extensive mediastinal and hilar lymphadenopathy are often noted in small peripheral lesions （≤3cm）. The lymphadenopathy is often noted in patients with even smaller nodes （ 〈 1 cm in diameter）. However, benign lymph node enlargement can also be noted. Chest CT scanning in staging poorly differentiated pulmonary squamous carcinoma has limited values but is still useful.