Hwang Jung Hwa, Song Koun-Sik, Park Seung-Il, Lim Tae-Hwan, Kwon Kui Hyang, Goo Dong Erk
Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea.
Korean J Radiol. 2005 Apr-Jun;6(2):94-101. doi: 10.3348/kjr.2005.6.2.94.
We wanted to describe the retrospective CT features of subtle pleural metastasis without large effusion that would suggest inoperable lung cancer.
We enrolled 14 patients who had open thoracotomy attempted for lung cancer, but they were proven to be inoperable due to pleural metastasis. Our study also included 20 control patients who were proven as having no pleural metastasis. We retrospectively evaluated the nodularity and thickening of the pleura and the associated pleural effusion on the preoperative chest CT scans. We reviewed the histologic cancer types, the size, shape and location of the lung cancer and the associated mediastinal lymphadenopathy.
Subtle pleural nodularity or focal thickening was noted in seven patients (50%) having pleural metastasis and also in three patients (15%) of control group who were without pleural metastasis. More than one of the pleural changes such as subtle pleural nodularity, focal thickening or effusion was identified in eight (57%) patients having pleural metastasis and also in three patients (15%) of the control group, and these findings were significantly less frequent in the control group patients than for the patients with pleural metastasis (p = 0.02). The histologic types of primary lung cancer in patients with pleural metastasis revealed as adenocarcinoma in 10 patients (71%) and squamous cell carcinoma in four patients (29%). The location, size and shape of the primary lung cancer and the associated mediastinal lymphadenopathy showed no significant correlation with pleural metastasis.
If any subtle pleural nodularity or thickening is found on preoperative chest CT scans of patients with lung cancer, the possibility of pleural metastasis should be considered.
我们旨在描述无大量胸腔积液的细微胸膜转移的回顾性CT特征，此类特征提示肺癌无法手术切除。
我们纳入了14例因肺癌尝试进行开胸手术但因胸膜转移而被证明无法手术的患者。我们的研究还包括20例被证明无胸膜转移的对照患者。我们回顾性评估了术前胸部CT扫描中胸膜的结节状和增厚情况以及相关的胸腔积液。我们复查了组织学癌症类型、肺癌的大小、形状和位置以及相关的纵隔淋巴结肿大情况。
7例（50%）有胸膜转移的患者以及3例（15%）无胸膜转移的对照组患者出现了细微胸膜结节或局灶性增厚。8例（57%）有胸膜转移的患者以及3例（15%）对照组患者出现了不止一种胸膜改变，如细微胸膜结节、局灶性增厚或胸腔积液，并且这些发现在对照组患者中的出现频率显著低于胸膜转移患者（p = 0.02）。胸膜转移患者中原发性肺癌的组织学类型显示，10例（71%）为腺癌，4例（29%）为鳞状细胞癌。原发性肺癌的位置、大小和形状以及相关的纵隔淋巴结肿大与胸膜转移无显著相关性。
如果在肺癌患者的术前胸部CT扫描中发现任何细微胸膜结节或增厚，应考虑胸膜转移的可能性。
