Ohtsuka Takashi, Nomori Hiroaki, Horio Hirotoshi, Naruke Tsuguo, Suemasu Keiichi
Department of Thoracic Surgery, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan.
Lung Cancer. 2003 Dec;42(3):291-6. doi: 10.1016/s0169-5002(03)00360-x.
To clarify the differences in radiological findings between primary lung cancers and benign nodules measuring less than 10mm, we examined chest computed tomography (CT) findings. Of 82 patients with solitary pulmonary nodules less than 10mm in diameter who had undergone surgical biopsy, 21 patients with primary lung cancer and 45 patients with benign lesions (9 patients with tuberculosis, 12 with non-specific inflammation, 10 with benign lung tumor, 10 with intrapulmonary lymph nodes and 4 with others) were examined. Seven patients with atypical adenomatous hyperplasia and nine patients with metastatic lung cancer were excluded. Primary lung cancers had an ill-defined tumor margin and spiculation significantly more frequently than benign nodules (P<0.01). Involvement of bronchi or vessels was observed significantly more frequently in primary lung cancers than in benign nodules (P<0.05), while pleural indentation did not show significant differences in frequency. Retrospective chest X-ray or CT films were reviewed for seven patients with primary lung cancers and 12 with benign nodules, with a mean interval of 24+/-17 months. Primary lung cancers enlarged or appeared as new nodules more frequently than benign lung nodules (P<0.05). Among 17 lung cancer patients who underwent mediastinal lymph node dissection, the cancer was at a more advanced stage than T1N0M0 in four (24%). We conclude that ill-defined margins, spiculation, involvement of bronchi or vessels, and tumor enlargement visualized by CT are still important signs of malignancy even for nodules less than 10mm in size. Tumor size, even for lung cancers measuring less than 10mm, is not an indication for limited resection.
为了阐明原发性肺癌与直径小于10mm的良性结节在影像学表现上的差异，我们对胸部计算机断层扫描（CT）结果进行了研究。在82例接受手术活检的直径小于10mm的孤立性肺结节患者中，对21例原发性肺癌患者和45例良性病变患者（9例肺结核、12例非特异性炎症、10例良性肺肿瘤、10例肺内淋巴结和4例其他病变）进行了检查。排除了7例非典型腺瘤样增生患者和9例转移性肺癌患者。原发性肺癌的肿瘤边界不清和毛刺征出现频率显著高于良性结节（P<0.01）。原发性肺癌中支气管或血管受累的观察频率显著高于良性结节（P<0.05），而胸膜凹陷在频率上无显著差异。对7例原发性肺癌患者和12例良性结节患者的回顾性胸部X线或CT片进行了复查，平均间隔时间为24±17个月。原发性肺癌比良性肺结节更频繁地增大或出现新结节（P<0.05）。在17例行纵隔淋巴结清扫的肺癌患者中，4例（24%）癌症分期超过T1N0M0。我们得出结论，即使对于直径小于10mm的结节，CT显示的边界不清、毛刺征、支气管或血管受累以及肿瘤增大仍然是恶性肿瘤的重要征象。肿瘤大小，即使对于直径小于10mm的肺癌，也不是进行有限切除的指征。
