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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (02) : 218 -222. doi: 10.3877/cma.j.issn.1674-6902.2024.02.009

论著

依据影像学特征的原发性肺类癌的分型及鉴别意义
谭明超1, 龚明福1, 陈佳1,†(), 张曦1, 孙雅娟1   
  1. 1. 400037　重庆，陆军（第三）军医大学第二附属医院放射科
  • 收稿日期:2024-01-05 出版日期:2024-04-25
  • 通信作者: 陈佳
  • 基金资助:
    陆军军医大学苗圃人才项目(2019R059)

Classification and differential diagnosis of primary lung carcinoid based on imaging features

Mingchao Tan1, Mingfu Gong1, Jia Chen1,†(), Xi Zhang1, Yajuan Sun1   

  1. 1. Department of Radiology, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
  • Received:2024-01-05 Published:2024-04-25
  • Corresponding author: Jia Chen
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谭明超, 龚明福, 陈佳, 张曦, 孙雅娟. 依据影像学特征的原发性肺类癌的分型及鉴别意义[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 218-222.

Mingchao Tan, Mingfu Gong, Jia Chen, Xi Zhang, Yajuan Sun. Classification and differential diagnosis of primary lung carcinoid based on imaging features[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(02): 218-222.

目的

分析原发性肺类癌(primary lung carcinoid, PLC)的分型及临床鉴别诊断，比较典型类癌与不典型类癌影像征象差异，提高肺类癌影像诊断水平。

方法

回顾性分析54例经组织病理学证实的原发性肺类癌患者的临床及CT资料，其中典型类癌21例，不典型类癌33例，比较二者包括位置、大小、形态、走行、边缘、钙化、转移、平扫及增强CT值等指标。

结果

21例典型类癌与33例不典型类癌病灶位置分为中央型/周围型，二者分别为15/6例、4/29例(P<0.001)，典型类癌以中央型为主，不典型类癌以周围型为主。21例典型类癌平均直径为(1.85±1.10)cm，18例呈结节，3例呈团块；33例不典型类癌平均直径为(4.36±2.54)cm，13例呈结节，20例呈团块，(P<0.05)，典型类癌以结节型为主，不典型类癌比典型类癌更大，以团块型为主。典型类癌与不典型类癌边缘可分为分叶、光滑，典型类癌为13/8例，不典型类癌为5/28例(P<0.001)。典型类癌未发现转移灶，不典型类癌中15例可见转移(P<0.001)。典型类癌及不典型类癌的走形、钙化情况差异不大，不具有统计学意义(P>0.05)。CT平扫两者CT值分别为(37.32±19.26)Hu、(33.74±13.30)Hu；增强扫描二者平均强化值分别为(61.38±34.72)Hu、(51.87±27.86)Hu。

结论

典型类癌与不典型类癌的位置、大小、形态、边缘、钙化、强化和转移等CT影像特征部分存在差异，具有统计学意义，影像学征象鉴别二者具有临床意义。

关键词: 原发性肺类癌, 典型肺类癌, 不典型肺类癌, 螺旋CT影像学
Objective

To analyze the classification and clinical differential diagnosis of primary lung carcinoid (PLC), to compare the differences between typical and atypical carcinoid imaging signs, and to improve the level of imaging diagnosis of lung carcinoid.

Methods

The clinical and CT data of 54 patients with primary pulmonary carcinoid confirmed by histopathology were retrospectively analyzed, including 21 cases of typical carcinoid and 33 cases of atypical carcinoid. The two patients were compared, including location, size, shape, progression, margin, calcification, metastasis, plain scan and enhanced CT values.

Results

The 21 cases of typical carcinoid and 33 cases of atypical carcinoid were divided into central type and peripheral type, 15/6 cases and 4/29 cases respectively (P<0.001). The central type was dominant in typical carcinoid and the peripheral type was dominant in atypical carcinoid. The mean diameter of 21 cases typical carcinoid patients was (1.85±1.10) cm, with nodules in 18 cases and mass in 3 cases. The average diameter of 33 cases atypical carcinoids was (4.36±2.54) cm, 13 cases were nodules, and 20 cases were clumps (P<0.05). Typical carcinoids were mainly nodules, while atypical carcinoids were larger than typical carcinoids and mainly clumped. The margins of typical carcinoid and atypical carcinoid were segmented and smooth, with 13/8 cases of typical carcinoid and 5/28 cases of atypical carcinoid (P<0.001). No metastases were found in typical carcinoids, and 15 cases of atypical carcinoids showed metastases (P<0.001). There was no significant difference in shape and calcification between typical carcinoid and atypical carcinoid (P>0.05). The CT values of plain scan were (37.32±19.26)Hu and (33.74±13.30)Hu, respectively. The average intensification values were (61.38±34.72)Hu and (51.87±27.86)Hu, respectively.

Conclusions

There were some differences in the location, size, shape, margin, calcification, enhancement and metastasis of typical carcinoid and atypical carcinoid, which were statistically significant (P<0.05). Understanding the differences in the above signs would help to distinguish the two carcinoids.

Key words: Primary lung carcinoid, Typical carcinoid, Atypical carcinoid, Spiral CT imaging diagnosis
表1 肺内典型类癌和不典型类癌的CT征象(例)
CT特征 典型类癌(n＝21) 不典型类癌(n＝33) χ2 P值
中央型/周围型 15/6 4/29 19.793 0.000
结节/团块 18/3 13/20 11.261 0.001
类圆形或圆形/沿支气管走行 16/5 24/9 0.080 0.777
光滑/分叶 13/8 5/28 12.623 0.000
有钙化/无钙化 1/20 3/30 0.351 0.554
有转移/无转移 0/21 15/18 13.217 0.000
图1 PLC患者影像资料。注：A、B：左下支气管典型类癌，男，18岁。A：CT增强轴位纵隔窗示肿块形成"冰山征"；B：CT增强冠状位纵隔窗示病灶呈不均匀明显强化；C：右肺上叶后段不典型类癌，男，48岁，CT平扫轴位肺窗示病灶临近胸膜，可见"胸膜凹陷征"；D：左肺上叶下舌段不典型类癌，男，63岁，CT平扫轴位肺窗示病灶沿支气管走行，呈"三角形"；E、F：右肺下叶后基底段典型类癌，男，69岁；E：CT平扫轴位纵隔窗病灶内可见小点状钙化；F：CT平扫冠状位肺窗示病灶沿支气管走行呈"串珠样"
图2 右下支气管腔内典型肺类癌。注：A-D：右下支气管腔内典型类癌，男，69岁。A、B：纤维支气管镜可见右下支气管腔内暗红色实质性肿块，肿块内可见出血，包膜完整。C、D：细胞核呈圆形或卵圆形、染色质细而分布均匀，分裂象少见，CgA(＋)，Syn(＋)
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