The Clinical Analysis Of Benign And Malignant Lung Occupying Lesions In 28 Patients

Background:Lung cancer is a common cancer, now which has leapt to the top of malignancy. When the clinical manifestations of lung cancer, as well as imaging findings are not typical, and there are many similarities with the pneumonia, tuberculosis, etc, or co-exist, identification is more difficult, and it is easy misdiagnosed. Therefore, to improve the level of differential diagnosis of benign and malignant lung occupying lesions is the issue that urgently need resolve currently.Objective:The aim of this study was to improve the level of diffe-rential diagnosis of benign and malignant pulmonary occupying lesions.Methods:Collected this clinical data of 28 patients diagnosed pneu-monia, lung cancer or tuberculosis. These data came from 2002-2010. Analyzed this clinical data with relevant literature. The criteria included:1. the cases were confirmed by followed up after the anti-inflammatory or obtained pathological basis, and it was difficult to determine its nature when initial diagnosed(14 cases).2. Selected a clinical diagnosis of lung cancer or suspected lung cancer, post-pathologically confirmed lung cancer cases (14 cases) as a reference.Results:1. Final diagnosis 21 cases of lung cancer, including adenocarcinoma 11 cases (mucinous adenocarcinoma 1 case),5 cases of squamous cell carcinoma, adenosquamous carcinoma 1 case, small cell lung cancer (SCLC) 1 case, bronchioloalveolar carcinoma (BAC) 3 cases (Although the BAC is a subtype of adenocarcinoma species, but its has its own characteristics, so it's a separate).4 cases diagnosed by a fiberoptic bronchoscope, the rest, by surgical diagnosis including pleural biopsy. In the 21 cases, there were 7 cases which diagnosed benign lesions or suspected benign lesions, including pneumonia, tuberculosis. A total of 7 cases of benign lesions, including pneumonia 4 cases,2 cases of lesions were diagnosed as pneu-monia by follow-up after anti-inflammatory,2 cases confirmed by posto-perative pathology;tuberculosis in 3 cases, confirmed by postoperative pathology.2. Clinical symptoms Irritating cough in 3 cases, pneumonia in 1 case, lung cancer 2 cases; 9 cases of cough, sputum, lung cancer 7 cases, pneumonia in 2 cases; hemoptysis/bloody sputum in 6 cases,5 cases of lung cancer, pneumonia 1 case; chest pain in 5 cases,4 cases of lung cancer, tuberculosis 1 case; chest tightness, shortness of breath 4 cases,3 cases of lung cancer, tuberculosis 1 case; fever in 4 cases,1 case of lung cancer, pneumonia in 2 cases,1 case of tuberculosis; asymptomatic 7 cases,6 cases of lung cancer, tuberculosis in 1 case.3. Tumor markers Carcinoembryonic antigen (CEA) increased in 12 cases,7 cases of adenocarcinoma,1 case of small cell lung cancer,4 cases of squamous cell carcinoma;Cytokeratin-19 (CYFRA21-1)increased in 3 cases,2 cases of squamous cell carcinoma,1 case of small cell lung cancer; Not seen in 21 cases lung cancer that neuron-specific enolase (NSE) increased.4. CT results(1)Focus distribution A total of 8 cases of right upper lobe, pointed segment in 5 cases (3 cases of lung cancer, pneumonia 2 cases), Back 2 cases of lung cancer, the preceding 1 case of tuberculosis; Right middle lobe in 2 cases,1 case inflammation of the medial segment, lateral segment 1 case of lung cancer; The lower right leaf 5 cases, the former basement section 1 case of lung cancer, back in 2 cases of lung cancer, outer basal segment in 2 cases, (pneumonia 1 case, lung cancer 1 case); Left upper lobe in 5 cases, posterior tip in 2 cases(1 case of lung cancer, I case of tuberculosis), tongue leaves 1 case of lung cancer, and the preceding 2 cases of lung cancer; Left lower lobe in 4 cases, posterior basal segment 1 case of lung cancer, outer basal segment 1 case of tuberculosis, back in 2 cases of lung cancer; Hilum of right lung in 2 cases of lung cancer; Hilum of left lung 2 cases of lung cancer.(2)Focus morphous Patchy shadows in 6 cases,3 cases of lung cancer, pneumonia 3 cases; blocky shadows in 13 cases,12 cases of lung cancer, tuberculosis in 1 case; Density of ground-glass-like nodules 3 cases were lung cancer; Other density nodules in 6 cases, lung cancer in 3 cases, pneumonia in 1 case, tuberculosis in 2 cases.(3)Lesion edge and internal Thin and short spiculation in 11 cases,10 cases of lung cancer, pneumonia in 1 case; Deep lobulation in 1 case, found in lung cancer; Shallow lobulation 2 cases were found in lung cancer; Pleural indentation/retraction in 10 cases,7 cases of lung cancer, pneumonia 1 case, pulmonary tuberculosis in 2 cases; Vacuole sign in 2 cases, were found in lung cancer; Vascular convergence sign in 5 cases, were found in lung cancer.CT misdiagnosed in 4 cases (1 case of tuberculosis was misdiagnosed as lung cancer,3 cases of lung cancer were misdiagnosed as benign lung disease); 10 cases were diagnosed as lung cancer, and were consistent with pathology; 14 cases were ambiguous, finally diagnosed with pneumonia in 4 cases, tuberculosis in 2 cases, lung cancer in 8 cases.5. Sputum cytology results 4 patients underwent sputum cytology. Not found in tumor cells.6. Bronchoscopy results 8 patients underwent bronchoscopy inspe-ction,4 of 6 who were previously diagnosed with lung cancer were confirmly diagnosed (central type lung cancer), one of the 6 patients showed the performance of lung cancer in microscopy with no pathological evidence, while pathological investigation after operation suggested malignancy. The remaining one showed no positive result. One patient undergoing bronchial biopsy was with chronic inflammation, and brush biopsy directed poorly differentiated squamous cell orientation, while inflammation absorbed after anti-inflammatory treatment, which was finally confirmed as pneumonia. In another one case, endoscopic occlusion of the right upper nozzle tip section was seen, with no different color as other part. No mucosal biopsy was performed because of bleeding and no abnormal cell was obtained by brush biopsy. This patient was diagnosed with pneumonia after anti-inflammation therapy. 7. PET/CT results 3 cases of patients underwent this PET/CT examination. The diagnostic criteria included:(1) the SUVmax of pulmonary lesions≥2.5mm; (2) a significant increase of SUVmax (≥20%～30%).2 true-negative results (1 case pneumonia,1 case of tuberculosis) and 1 false-negative result (BAC).Conclusion:To be familiar with the clinical features of lung cancer, pneumonia, and tuberculosis,respectively, focus on detailed history, an experimental anti-inflammatory treatment and dynamic observation of changes in lung imaging, actively apply of sputum cytology and bronchos-copy, properly select PET/CT, CT and other imaging techniques, be attention on a regular basis followed up, grasp the follow-up time, when necessary, make lung biopsy, which help to improve the diagnostic accuracy of lung benign and malignant lesions, and reduce misdiagnosis.