Contrast-Enhanced Ultrasound In The Diagnosis Of Central Lung Cancer With Atelectasis And Its Clinical Application In Biopsy

PART ? The Characteristics of Contrast-enhanced Ultrasonography and Contrast-enhanced Mode of Central Lung Cancer with atelectasisObjective:To investigate the characteristics of contrast-enhanced ultrasonography and contrast-enhanced ultrasound enhancement model in central lung cancer with atelectasis,To explore the clinical value of contrast-enhanced ultrasound in central lung cancer with atelectasis.Method:Forty-six patients with central lung cancer with atelectasis underwent CEUS and CECT examinations.The CEUS examination recorded the time to enhancement(TE),time to peak(TTP)of central lung cancer and atelectasis.The study analysed the characteristic of the CEUS enhancement model in central lung cancer,and the differences between these two tissues.Meanwhile,it compared the differences pulmonary artery and bronchial artery phase images obtained by CECT scan between central lung cancer and atelectasis by naked eye.In addition,40 patients with peripheral lung cancer were selected for comparison with central lung cancer,and the above parameters were recorded.Result:Of all 46 patients with central lung cancer companying with atelectasis,40 patients had central lung cancer with a "slow in and fast out" pattern compared with atelectasis;4 patients with central lung cancer showed a "fast in and fast out" pattern,and the other two patients with central lung cancer showed a "same in and same out" pattern.95.6%(44/46)patients in this group were able to been distinguished between tumor and atelectic lung tissue by CEUS.Of the 46 patients,76.1%(35/46)were able to been distinguished between tumor and atelectic lung tissue through CECT.There were no significant differences between two groups(?2=7.068,p=0.019).TE were 12.9711.31s,5.5±0.69s,respectively in central lung cancer and atelectasis while TTP in both groups were 25.46±2.89s,9.6±1.8s,respectively.Within groups,differences were significant(t=65.262,p=0.000;t=81.550,p=0.000).TE were 12.97±1.31s,12.96±1.42s,respectively in central and peripheral lung cancer while TTP in both groups were 25.46± 2.89s,25.96±2.50s,respectively.Within groups,differences were not significant(t=0.057,p=0.95;t=-0.839,p=0.404).Conclusion:Central lung cancer with atelectasis has typical features of contrast-enhanced ultrasound,and most of them show the pattern of "slow in and fast out",and some of them show the pattern of "fast in and fast out" and "same-in and same-out".Contrast-enhanced ultrasound can distinguish the tumors from atelectasis.It can reveal tumors hidden in atelectasis,which is beneficial to the discovery of lung cancer with pulmonary atelectasis.For patients unable to tolerate bronchoscopy or iodine allergy,CEUS could find the tumor hidden in the atelectic lung.Part ? Contrast-enhanced ultrasound for needle biopsy of centrallung cancer with atelectasisObjectTo explore the value of contrast-enhanced ultrasound(CEUS)in the needle biopsy of central lung cancer with atelectasis.Method:Twenty-six patients with central lung cancer companying with atelectasis were randomly divided into CEUS-guided needle biopsy group(n=13)and conventional ultrasound-guided needle biopsy group(n=13).The patients in the CEUS group underwent CEUS and then had a biopsy for the mass of central lung cancer.The patients in the control group received no CEUS,and had the biopsy under conventional ultrasound guidance.In this study,the number of biopsy needles,the success rate of the biopsy,pathological diagnosis,and post-puncture complications were recorded.Thirty patients with peripheral lung cancer were included during the same period and underwent CEUS-guided needle biopsy.This study analysed the success rate of percutaneous biopsy and the incidence of complications between central lung cancer companying with atelectasis and peripheral lung cancer.Result:In the CEUS group,the average number of punctures in the 13 patients was 2.3 and 13 cases were successfully punctured.The success rate was 100%.There were 2 cases with mild complications,who had a small amount of hemoptysis and sputum blood.Of Conventional ultrasound group of 13 cases,3 cases gave up puncture due to failed to distinguish between central lung cancer and atelectasis tissue through conventional ultrasound),10 cases averagely received 2.5 percutaneous punctures.8 cases had successful biopsy(61.5%),and mild complications in 3 cases occurred,of which 1 cases had hemoptysis or sputum blood,and 2 case had a small amount of mild pneumothorax.They were monitored without any treatment.Between the CEUS group and the conventional ultrasound group,the success rate of biopsy was significantly different(p<0.05).The complication incidence in central lung cancer with atelectasis was similar to that of the peripheral lung cancer group(p>0.05).Conclusion:CEUS examination could clearly distinguish the tumor from atelectasis.CEUS-guided biopsy could avoid necrosis area,large blood vessels in the puncture path,and increase the success rate of puncture and reduce complication rate.For patients of central lung cancer companying with atelectasis with aging,poor general condition,or unable to tolerate bronchoscopic biopsy,CEUS may be used in biopsy.