Polverosi R, Zanellato E, Zanlungo P
Servizio di Radiologia, USSL 8, Ospedale, Montebelluna, Treviso.
Radiol Med. 1995 Oct;90(4):418-23.
Small cell lung cancer (SCLC) is a highly malignant tumor which is nearly always metastatic at diagnosis and generally staged as a localized or diffuse disease. The authors compared the capabilities and the advantages of CT with those of chest films in the diagnosis, staging and follow-up of this type of cancer in 54 patients (52 men and 2 women, mean age: 62 years, range: 45 to 79 years). All the patients were submitted to the same examinations 3 months (18 patients), 6 months (6 patients), 9 months (6 patients) and 12 months (2 patients) after radiochemotherapy. Median survival time was 13 months (range: 6-20 months). On staging, radiography showed mediastinal masses (63%), bronchial narrowing (57%), hilar masses (45%), atelectasis (37%), pleural effusion (29%), pericardial thickening and/or effusion (22%), multiple (20%) or single (16%) peripheral masses and tracheal narrowing (2%). CT was more sensitive, chiefly in depicting mediastinal masses (34 cases demonstrated by CT vs 12 by chest films), bronchial narrowing (38 vs 0) and pericardial involvement (12 vs 0); after CT, 12 patients with localized disease on chest films were diagnosed as having diffuse disease. Complete response after therapy, i.e., the total disappearance of all signs and symptoms of disease for 30 days at least, was depicted by CT in 16 patients and by chest films in 9 patients. Partial response-i.e., disease decrease by 50% or more, with no new lesions, for 30 days at least--was depicted by CT in 16 patients and by chest films in 4 patients. Finally, no response or disease progression was depicted by CT in 10 patients and by chest films in 9 patients. To conclude, the presence of mediastinal and hilar masses, with bronchial narrowing, atelectasis, pleural/pericardial involvement, sometimes with a peripheral mass, are strongly suggestive of small cell lung cancer. CT was more sensitive than chest films in the staging of localized and diffuse disease, but it failed nevertheless to improve significantly the diagnosis, prognosis and follow-up of SCLC relative to chest films (p = 0.34).
小细胞肺癌（SCLC）是一种高度恶性肿瘤，几乎在诊断时就已发生转移，通常分为局限性或弥漫性疾病。作者比较了CT与胸部X线片在54例此类癌症患者（52例男性和2例女性，平均年龄：62岁，范围：45至79岁）诊断、分期及随访中的能力和优势。所有患者在放化疗后3个月（18例患者）、6个月（6例患者）、9个月（6例患者）和12个月（2例患者）接受相同检查。中位生存时间为13个月（范围：6至20个月）。在分期方面，X线片显示纵隔肿块（63%）、支气管狭窄（57%）、肺门肿块（45%）、肺不张（37%）、胸腔积液（29%）、心包增厚和/或积液（22%）、多发（20%）或单发（16%）外周肿块以及气管狭窄（2%）。CT更敏感，主要体现在显示纵隔肿块（CT显示34例，胸部X线片显示12例）、支气管狭窄（38例对0例）以及心包受累（12例对0例）；经CT检查后，胸部X线片显示为局限性疾病的12例患者被诊断为弥漫性疾病。治疗后完全缓解，即疾病的所有体征和症状至少消失30天，CT显示16例患者，胸部X线片显示9例患者。部分缓解，即疾病减少50%或更多且无新病灶至少30天，CT显示16例患者，胸部X线片显示4例患者。最后，CT显示10例患者无反应或疾病进展，胸部X线片显示9例患者。总之，纵隔和肺门肿块的存在，伴有支气管狭窄、肺不张、胸膜/心包受累，有时伴有外周肿块，强烈提示小细胞肺癌。在局限性和弥漫性疾病分期方面，CT比胸部X线片更敏感，但相对于胸部X线片，它在小细胞肺癌的诊断、预后及随访方面仍未显著改善（p = 0.34）。
