Kurimoto N, Murayama M, Yoshioka S, Nishisaka T, Inai K, Dohi K
Department of Surgery, Iwakuni Minami Hospital, Yamaguchi, Japan.
Chest. 1999 Jun;115(6):1500-6. doi: 10.1378/chest.115.6.1500.
We assessed the usefulness of endobronchial ultrasonography in the determination of the depth of tumor invasion of the tracheobronchial wall.
We performed a needle-puncture experiment on normal tissue of 45 specimens to determine the laminar structure of the tracheobronchial wall. In addition, we compared the ultrasonographic determinations of tumor invasion from 24 lung cancer cases with the histopathologic findings.
The cartilaginous portions of the extrapulmonary bronchi and the intrapulmonary bronchi exhibited a five-layer structure. Starting on the luminal side, the first layer (hyperechoic) was a marginal echo, the second layer (hypoechoic) was the submucosal tissue, the third layer (hyperechoic) was the marginal echo on the inner side of the bronchial cartilage, the fourth layer (hypoechoic) was bronchial cartilage, and the fifth layer (hyperechoic) was the marginal echo on the outer side of the cartilage. In the membranous portions, the first layer (hyperechoic) was a marginal echo, the second layer (hypoechoic) was smooth muscle, and the third layer (hyperechoic) corresponded to the adventitia. Comparisons between the ultrasonograms and the histopathologic findings in 24 lung cancer cases revealed that depth diagnosis was the same in 23 lesions (95.8%) and was different in 1 lesion (4.2%). In the single case in which the findings were different, lymphocytic infiltration that protruded between the cartilage rings was mistakenly interpreted as tumor infiltration.
This method allows visualization of the laminar structure of the tracheobronchial wall, which is impossible with other diagnostic imaging methods.
我们评估了支气管内超声检查在确定气管支气管壁肿瘤浸润深度方面的实用性。
我们对45个标本的正常组织进行了针刺实验，以确定气管支气管壁的分层结构。此外，我们将24例肺癌病例的肿瘤浸润超声检查结果与组织病理学结果进行了比较。
肺外支气管和肺内支气管的软骨部分呈现出五层结构。从管腔侧开始，第一层（高回声）是边缘回声，第二层（低回声）是黏膜下组织，第三层（高回声）是支气管软骨内侧的边缘回声，第四层（低回声）是支气管软骨，第五层（高回声）是软骨外侧的边缘回声。在膜性部分，第一层（高回声）是边缘回声，第二层（低回声）是平滑肌，第三层（高回声）对应于外膜。对24例肺癌病例的超声图像与组织病理学结果进行比较发现，23个病变（95.8%）的深度诊断相同，1个病变（4.2%）的深度诊断不同。在结果不同的单个病例中，软骨环之间突出的淋巴细胞浸润被错误地解释为肿瘤浸润。
这种方法可以显示气管支气管壁的分层结构，这是其他诊断成像方法无法做到的。
