15?mm以下周围型小肺癌的影像学检出和诊断

目的 评价胸部平片、常规CT（CCT）、螺旋CT（SCT）和高分辨率CT（HRCT）等各种影像学手段对15mm以下周围型小肺癌的检出和诊断能力。方法 回顾性分析59例经手术病理证实的15mm以下周围型小肺癌的临床表现及胸部平片、CCT、SCT和HRCT等的检查结果。因咳唔、咯血等症状就医发现5例，由健康体检发现37例，因其他疾病检查发现17例。病理Ⅰ期53例，Ⅱ期以上6例。结果 胸部平片的假阴性诊断率为47．5％，CCT的假阴性诊断率为17．6％，只有SCT可以检出全部病例而未发生漏诊。HRCT在显示肿瘤密度和各种征象细节的能力和准确性方面均优于胸部平片和CCT。15mm以下周围型小肺癌在HRCT征象方面与较大肺癌比较有明显差别。结论 SCT、HRCT是检出和诊断15mm以下周围型小肺癌的最佳影像学手段。应当提倡CT引导下的经皮肺穿刺活检技术。

Detection and diagnosis of small peripheral lung cancers less than 15 mm in diameter

Objective To assess the value of chest film, conventional CT (CCT), Spiral CT (SCT) and high resolution CT (HRCT) for detection and diagnosis of small peripheral lung cancers less than 15 mm in diameter. Methods Chest film, CCT, SCT and HRCT were taken in 59 cases of peripheral lung cancers less than 15*!mm in diameter confirmed by operation and pathology. Their value in the diagnosis was analysed retrospectively. Results In 47% of chest films and 17% of CCT, the small lung cancer was not detected. However no tumor escaped detection by SCT. HRCT was superior for showing density and detailed image signs compared to chest film and CCT. The CT features of small peripheral lung cancers was different from those of larger peripheral lung cancers. Conclusion The SCT is the best method for detection, and HRCT for diagnosis of small peripheral lung cancers less than 15 mm in diameter.