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目的:探讨肺周围型小腺癌的高分辨率CT(HRCT)表现及病理特征,为临床影像学诊断寻找重要依据。方法:收集启东市中医院2014年7月至2016年7月共37例病理诊断为肺周围型小腺癌患者的临床资料,所有患者术前均行多层螺旋CT扫描筛查,病灶行HRCT扫描,观察分析病灶的影像学表现及病理特征。结果:37例均表现为单发毛玻璃结节影,均位于周围肺野。其中纯毛玻璃结节21例(56.8%),混合密度16例(43.2%);病灶最大直径0.9~2.8cm,平均(2.2±0.3)cm。其他影像学征象为细支气管扩张征、边缘清晰、胸膜凹陷、分叶及毛刺征。Matsuguma量化分型:Ⅰ~Ⅲ型29例(78.4%),Ⅳ~Ⅴ型8例(21.6%)。病理特征:肿瘤细胞沿肺泡壁呈附壁性生长,肺泡间隔增厚。结论:患者经HRCT检查时发现毛玻璃结节影,如果同时伴有边缘清晰、分叶征、支气管截断征、毛刺征、胸膜凹陷征、空泡征及量化分型较低,应高度警惕肺周围型小腺癌可能。
Objective: To investigate the high resolution CT (HRCT) features and pathological features of peripheral small adenocarcinoma and to find an important basis for clinical imaging diagnosis. Methods: From July 2014 to July 2016, 37 cases of pathological diagnosis of peripheral pulmonary adenocarcinoma were collected from Qidong Hospital of Traditional Chinese Medicine. All patients underwent multi-slice spiral CT scan before operation. The lesions were examined by HRCT Scanning, observation and analysis of lesion imaging features and pathological features. Results: All 37 cases showed solitary frosted glass nodules, all located in the surrounding lung field. Among them, 21 cases (56.8%) had pure glass nodules with a mixed density of 16 cases (43.2%). The maximum diameter of the lesions was 0.9-2.8 cm (average, 2.2 ± 0.3) cm. Other imaging signs of bronchiectasis, clear margins, pleural indentation, lobulation and burr sign. Matsuguma quantitative classification: Ⅰ ~ Ⅲ type in 29 cases (78.4%), Ⅳ ~ Ⅴ in 8 cases (21.6%). Pathological features: tumor cells along the alveolar walls were attached to the growth of alveolar septum thickening. CONCLUSIONS: Frosted nodules were found in patients undergoing HRCT examination. Patients should be highly vigilant about the lungs if they are accompanied by sharp edges, lobulated lobes, bronchial truncation, spiculation, pleural indentation, vacuolar signs and quantified subtypes Small adenocarcinoma may be.