| Objective:To compare the clinical and chest CT findings of lung squamous cell carcinoma and lung adenocarcinoma,aiming at improving the accuracy of preoperative differential diagnosis of lung squamous cell carcinoma and lung adenocarcinoma and providing a basis for clinical treatment.Materials and methodsThe clinical and imaging data were collected,53 cases of primary lung squamous cell carcinoma and 53 cases of primary lung adenocarcinoma were confirned by puncture,thoracoscopy and surgical pathology.The clinical and imaging data of two groups of lung cancer patients were compared and analyzed.Both groups of lung cancer patients underwent serum tumor markers CEA(Carcino-embryonic antigen),NSE(Neuron-specific enolase),CYFRA21-1(Cell keratinocyte fragment 21-1),SCC(Squamous cell carcinoma antigen)examination and chest CT scan.CT equipment is Siemens Somatomsensation 64-slice spiral CT,layer thickness/layer spacing 5mm/2.5mm,tube voltage 120kV,tube current 140mA,matrix 512×512,lung algorithm and standard algorithm reconstruction(reconstruction layer thickness 2.5mm,layer spacing 1mm),some lesions were scanned in a thin layer of small field of view.Dual-phase enhanced scanning:non-ionic contrast agent iodophor 70.90ml,injection rate 3～5ml/s,delay time for the arterial phase 20～25s,venous phase 60s.Compare gender,age,clinical symptoms,serum tumor markers CEA,NSE,CYFRA21-1,SCC in two different pathological types of lung cancer patients.Comparison of chest CT images of primary lesions(size,lobulation,burr,necrosis,cavities,vacuoles,relationship with bronchi,pulmonary arteriovenous and pleural,peripheral lung field changes,enhanced performance).According to the method of literature,the relationship between tumor and bronchus and pulmonary blood vessels was classified and compared.CT images of central and peripheral lung squanous cell carcinoma and that of peripheral lung squamous cell carcinoma and peripheral lung adenocarcinoma were compared.Statistical analysis was performed using the SPSS 18.0 software package for statistical analysis.The mean value of the measurement data was expressed as x±s,and the difference between the two groups was compared by the t-test of the independent sample.The difference between the two groups of eounting data was measured by chi-square test.For small sample count data(case number ≤40),the difference between the two groups was tested by exact probability method.P<0.05 suggested that the difference was statistically significant.Results:(1)The gender percentage of lung squamous cell carcinoma was 90.57%(48 cases)for males and 9.43%(5 cases)for females.The sex ratio of lung adenocarcinoma group was 47.17%(25 cases)for males and 52.83%(28 cases)for females.The gender composition difference was statistically significant(P<0.001).The average age of onset of lung squamous cell carcinoma was(63±10.23)years old,and the average age of onset of lung adenocarcinoma group was(62±9.77)years old.There was no significant difference in the mean age of onset between the two groups.The positive expression rates of CEA,NSE,CYFRA21-1 and SCC in lung squamous cell carcinoma were 16.67%,56.25%,62.5%and 43.75%.The positive expression rates of CEA,NSE,CYFRA21-1 and SCC in lung adenocarcinoma group were 43.14%,31.91%,40.43%and 21.28%.The positive expression rate of CEA in lung adenocarcinoma group was higher than that in lung squamous cell carcinoma group(P<0.01).The positive expression rates of NSE,CYFRA21-1 and SCC in lung squamous cell carcinoma group were higher than those in lung adenocarcinoma group(P<0.05).The contents of CEA,NSE,CYFRA21-1 and SCC in lung squamous cell carcinoma were(3.58±3.04)ng/ml,(16.59±5.96)ng/ml,(5.63±5.97)ng/ml,(5.96±5.13)ng/ml.The contents of CEA,NSE,CYFRA21-1 and SCC in lung adenocarcinoma group were(10.83±18.89)ng/ml,(18.17±8.77)ng/ml,(3.61±3.56)ng/ml,(2.80±4.21)ng/ml.The serum CEA level in patients with lung adenocarcinoma was higher than that in lung squamous cell carcinoma,the content of CYFRA21-1 and SCC level was lower than that in lung squamous cell carcinoma,and the difference was statistically significant(P<0.05).The average diameter of the lung squamous cell carcinoma group was(4.40±1.60)cm,and the average diameter of the lung adenocarcinoma group was(3.10±1.33)cm.The average diameter of lung squamous cell carcinoma was larger than that of adenocarcinoma(P<0.001).(2)Among the 53 cases of lung squamous cell carcinoma,the most common CT signs were obstructive pneumonia(34/53,64.15%),lobulation(32/53,60.38%),necrosis(31/53,58.49%),and burr(18/53,33.96%),pleural basal connection(17/53,32.07%),pleural indentation(12/53,22.64%).Among the 53 cases of lung adenocarcinoma,the most common CT signs were lobulation(40/53,75.47%),burr(36/53,67.92%),Pleural indentation(32/53,60.38%),obstructive pneumonia(13/53,24.53%),necrosis(10/53,18.87%),vacuoles(9/53,16.98%).The incidence of necrosis,deep lobulation,pleural basal and obstructive pneumonia in lung squamous cell carcinoma was higher than that in lung adenocarcinoma(P<0.01).The incidence of superficial lobes,burrs,and pleural indentations in lung adenocarcinoma was higher than that in lung squamous cell carcinoma(P<0.001).In lung squamous cell carcinoma,the incidence of obstructive pneumonia in central lung squamous cell carcinoma was higher than that in peripheral lung squamous cell carcinoma(P<0.05).The incidence of necrosis,vacuole and burr in peripheral lung squamous cell carcinoma was higher than that in central lung squamous cell carcinoma.In peripheral lung cancer,the incidence of necrosis,deep lobulation,and pleural plaque in peripheral lung squamous cell carcinoma was higher than that in peripheral lung adenocarcinoma(P<0.001).The incidence of shallow lobulation and plexural indentation in peripheral lung adenocarcinoma was higher than that in peripheral lung squanous cell carcinoma(P<0.05).(3)In the relationship between squamous cell carcinoma and the bronchi,there were 40 cases(75.47%)of type Ⅰ,7 cases(13.21%)of type Ⅱ,and 6 cases(11.32%)of type Ⅳ,with type Ⅰ predominant.Type Ⅰ was the main type of the relationship between adenocarcinoma focus and the bronchi,but it can be classified as type Ⅲ.The classification of lung squamous cell carcinoma and adenocarcinoma and bronchial relationship showed a difference in type Ⅲ(P value<0.05).In the relationship between squamous eell carcinoma and pulmonary artery and vein,there were 3 cases(5.66%)of type Ⅰ,6 cases(11.32%)of type Ⅱ,13 cases(24.53%)of type Ⅲ,and 31 cases(58.49%)of type Ⅳ,with type Ⅳ predominant.The relationship between adenocarcinoma focus and pulmonary artery and vein was mainly classified as type Ⅱ and type Ⅲ,i.e.vascular cluster sign and angiographic sign.The classification of lung squamous cell carcinoma,adenocarcinoma and peripheral vascular lung dynamics showed a difference between type Ⅱ and type Ⅳ(P value<0.01).(4)There were significant differences in CT values and enhancement methods between squamous cell carcinoma and adenocarcinoma after plain and enhanced(P<0.01).The squamous cell carcinoma was mainly uneven enhancement,and the CT value of plain scan was significantly higher than that of adenocarcinoma,the CT value after enhancement was significantly lower than that of adenocarcinoma.Conclusions:Primary lung squamous cell carcinoma and lung adenocarcinoma have many different clinical and imaging features.Familiarity with these differences can help improve the accuracy of preoperative differential diagnosis and provide a basis for clinical treatment. |
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