| Background and ObjectiveLung cancer is one of the highest morbidity and mortality rates of malignant tumors in the word. Bronchioloalveolar carcinoma (BAC) is a special type of lung cancer. In 1960, Liebow named a special kind of adenocarcinoma with BAC which occurred in the peripheral lung with clear boundary, and does not destroy the alveolar septum for the first time. The foreign study found that the incidence of BAC growth rapidly nearly half a century, accounting for the proportion of lung cancer increased from 5.0% in 1955 to 24.0% in 1990, almost equal to squamous cell carcinoma of lung, and is about 30% to 50% of lung cancer in female. In China, BAC accounted for about 20% of lung cancer. Most of them are between 40 and 60 years old. Because the BAC patients'clinical characteristics with large number of white foam sputum are rare, if so, are more common in the late. And between different individuals, the clinical manifestations, pathology and imaging are complex. It is difficult to diagnose in clinical timely and easily lead to Misdiagnosed, delaying treatment opportunity. We will review the Clinical features, chest CT and thin slice CT features, and pathologic signs of the cases. The purpose is to improve the diagnostic accuracy and reduce misdiagnosis.Materials and Methods23 cases which have complete clinical data and confirmed by pathology are collected in our study. These cases are all from The First Affiliated Hospital of Shantou University Medical College between 2005-2010. We analyze their CT and thin slice CT features to find the relative characteristic imaging. Discuss the imaging features of various types of BAC and their corresponding pathological features.ResultsAll the 23 finally diagnosed as BAC cases have plain scanning and 2mm thin slice reconstruction. male:female=10:13, average age 55 years, median age 60 years, maximum age 70 years, minimum age 24 years. There are 5 smokers. Eight of them have typical white foam sputum. The CT diagnostic accuracy rate is 69.6% (16/23), more than half (57.1%, 4/7) of the misdiagnosed cases are diagnosed as tuberculosis. According to the CT signs; BAC could be classified into three types: solitary nodule (n=10) 43.5% (10/23), in which there are 3 enhanced scanning cases, inflammatory consolidation (n=8) 34.8% (8/23), and multiple nodules (n=5) 21.7% (5/23). 80.0% (8/10) of the solitary BAC cases are peripheral distribution, aerated bronchus sign or bubble-like attenuation are found in 9 cases, the peritumoral or intratumoral ground-glass opacity (GGO) are found in 7, lobulated sign in 6, marginal spiculated sign in 9, and hollowed pleura in 5. Vessel embedding sign are found in 2 of the 3 enhanced cases, vessel convergence sign in 3. Air bronchus can be found in all the 8 consolidated BAC cases. GGO sign are found in 6, honeycomb-like sign in 5. gland alveolar nodules in 4. In most of the cases(6/8), the signs are found in lower lungs. In multiple BAC cases, aerated bronchus sign or bubble-like attenuation are found in 3 cases, GGO sign are found in 3, and spiculated sign are found in 4.ConclusionThe imaging features of BAC are complicated, more exact diagnoses can be made through deep and careful analysis on the imaging features of the manifestation of each type. |
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