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目的 用多因素回顾性研究的方法,探讨肺外恶性肿瘤患者肺内直径<3 cm的孤立性结节(ETM-SPN)定性诊断的可能性,并评价CT的鉴别诊断价值。方法 搜集经证实的直径<3 cm的ETM-SPN病例83例,通过对性别、年龄、吸烟史、肺内外病灶的平均时间间隔、肺内结节的CT形态学特征,以及肺外肿瘤病理类型与肺结节性质的关系等行多因素分析,探讨ETM-SPN定性诊断的相关因素。结果 83例肺部结节中孤立性转移瘤、原发性支气管肺癌、良性病灶分别为43、33和7例。平均年龄为(57.43±15.33)岁,男女之比为1.59:1。原发性支气管肺癌和孤立性转移瘤组的平均年龄和男女之比分别为(62.48±11.96)岁、1.20:1和(54.10±16.49)岁(t=3.34,P<0.05)、2.31:1(X2=0.0209,P>0.05)。各组吸烟率间,原发性支气管肺癌组(39.3％,11/17)与孤立性转移瘤组(35.9％,14/39)和非原发性肺癌组(33.3％,15/45)间差异均无显著意义(X2=0.640,P>0.05;X2=0.931,P>0.05)。原发性肺癌组和孤立性转移瘤组的肺内外肿瘤确诊的平均时间间隔分别为(65.62±13.45)个月和(22.83±4.19)个月,两组间差异有显著性意义(Wilcoxon秩和检验,U=2.796,P<0.01)。肺外肿瘤为鳞癌(10例)和腺癌(58例)者,其肺内病灶原发性肺癌、孤立性转移瘤比例分别为7:3和24:34,差异无显著性意义(X2=1.
Objective To investigate the possibility of qualitative diagnosis of solitary pulmonary nodules (ETM-SPN) with diameter less than 3 cm in patients with extrapulmonary malignant tumors by multi-factor retrospective study and to evaluate the differential diagnostic value of CT. Methods Totally 83 ETM-SPN cases with diameter less than 3 cm were collected. According to the gender, age, smoking history, the average time interval between internal and external lesions, CT morphological features of pulmonary nodules, and extra-pulmonary tumor pathological types And pulmonary nodules and other multi-factor analysis of the relationship between factors to explore the qualitative diagnosis of ETM-SPN related factors. Results 83 cases of pulmonary nodules solitary metastasis, primary bronchial lung cancer, benign lesions were 43, 43 and 7 cases. The average age was (57.43 ± 15.33) years old, the ratio of male to female was 1.59: 1. The mean age and the ratio of male to female in primary bronchogenic carcinoma and solitary metastatic tumor were (62.48 ± 11.96), 1.20: 1 and (54.10 ± 16.49) years (t = 3.34, P <0.05) (X2 = 0.0209, P> 0.05). Between smoking groups, the rates of smoking in primary bronchial lung cancer group (39.3%, 11/17) and solitary metastasis group (35.9%, 14/39) and non-primary lung cancer group (33.3%, 15/45) There was no significant difference (χ2 = 0.640, P> 0.05; X2 = 0.931, P> 0.05). The average time interval of tumor diagnosis between primary lung cancer group and solitary metastasis group was (65.62 ± 13.45) months and (22.83 ± 4.19) months, respectively, with significant difference between the two groups (Wilcoxon rank sum Test, U = 2.796, P <0.01). Extrapulmonary tumors were squamous cell carcinoma (10 cases) and adenocarcinoma (58 cases). The rates of primary lung cancer and solitary metastasis in lung were 7: 3 and 24: 34, respectively, with no significant difference (X2 = 1.