Gandara David R, Aberle Denise, Lau Derick, Jett James, Akhurst Tim, Heelan Robert, Mulshine James, Berg Christine, Patz Edward F
University of California Davis Cancer Center, Sacramento, CA, USA.
J Thorac Oncol. 2006 Nov;1(9 Suppl):S20-6.
Bronchioloalveolar carcinoma (BAC) is a previously uncommon subset of adenocarcinoma with unique epidemiology, pathology, radiographic presentation, clinical features, and natural history compared with other non-small cell lung cancer (NSCLC) subtypes. Classically, BAC demonstrates a relatively slow growth pattern and indolent clinical course. However, in a subset of patients, rapid growth and death from bilateral diffuse consolidative disease occurs within months of diagnosis or recurrence. Recent data suggest that the incidence of BAC is increasing, notably in younger nonsmoking women. The initial radiographic presentation of BAC varies considerably, from single ground glass opacities (GGOs) or nodules of mixed ground glass and solid attenuation to diffuse consolidative or bilateral multinodular disease. The rising incidence of BAC is also reflected in recent lung cancer screening studies employing helical computed tomography (CT), where the differential diagnosis of GGOs includes not only BAC and overt adenocarcinoma, but inflammatory disease, focal fibrosis, and atypical adenomatous hyperplasia. Because advanced-stage BAC presents as measurable mass lesions in fewer than 50% of cases, determination of radiographic response to therapy by standard criteria is often difficult. Here, we review current data regarding the radiographic imaging of BAC: its radiographic presentations in asymptomatic early-stage and in advanced-stage disease, the functional imaging characteristics of BAC, and challenges of response assessment, including evolving opportunities for computer-assisted image analysis.
细支气管肺泡癌（BAC）是腺癌中一种以前不太常见的亚型，与其他非小细胞肺癌（NSCLC）亚型相比，具有独特的流行病学、病理学、影像学表现、临床特征和自然史。传统上，BAC表现出相对缓慢的生长模式和惰性的临床病程。然而，在一部分患者中，在诊断或复发后的数月内会出现双侧弥漫性实变疾病导致的快速生长和死亡。最近的数据表明，BAC的发病率正在上升，特别是在年轻的非吸烟女性中。BAC的初始影像学表现差异很大，从单个磨玻璃影（GGO）或混合磨玻璃和实性密度的结节到弥漫性实变或双侧多发结节性疾病。BAC发病率的上升也反映在最近采用螺旋计算机断层扫描（CT）的肺癌筛查研究中，其中GGO的鉴别诊断不仅包括BAC和显性腺癌，还包括炎症性疾病、局灶性纤维化和非典型腺瘤样增生。由于晚期BAC在不到50%的病例中表现为可测量的肿块病变，因此按照标准标准确定对治疗的影像学反应通常很困难。在此，我们回顾了有关BAC影像学的当前数据：其在无症状早期和晚期疾病中的影像学表现、BAC的功能成像特征以及反应评估的挑战，包括计算机辅助图像分析不断发展的机会。
