Clinical Analysis Of Pulmonary Diseases With Cavernous Lesions As Imaging Features

Objective: We retrospectively analyzed the clinical features of pulmonary diseases characterized by cavitation as an imaging feature,and combined with CT imaging,bronchoscopic performances,pathological diagnosis,and serological examination etc.to improve the clinical understanding of this type of disease and improve the ability of its differential diagnosis.Materials and methods: Totally 123 inpatients with pulmonary cavity lesions whose definitive diagnoses were confirmed by postoperative pathological biopsy,CT guided percutaneous lung puncture,fiberoptic bronchoscopy,sputum examination.Clinical data include gender,age,smoking history,past medical history including history of personal cancer,hypertension and diabetes mellitus,weight changes,clinical symptoms,pathological dignosis and serum tumor-marker test;CT images:(1)the location and size of the lesion containing cavity;(2)the position of the cavity in the lesion;(3)the maximum diameter of the cavity;(4)the shape of the cavity;(5)thick cavity,the uniformity and maximum thickness of the cavity wall;(6)calcification,vacuole sign,air bronchogram;(7)the features of the inner and outer margin of the cavity;(8)surrounding tissues around the lesion and other accompanying images;Bronchoscopic information: bronchoscopic manifestations,exfoliative cytology,histopathology and associated etiological examinations of the sampled specimens obtained from brushing,bronchoalveolar lavage fluid(BALF),endobronchial biopsy(EBB),transbronchial lung biopsy(TBLB),bronchoscopic needle biopsy(TBNA),ultrasound-guided TBNA(EBUS-TBNA)were retrospectively analyzed.Results: Of 123 patients with lung cavity lesions,101 cases were single cavity,accounting for 82.1%,and there were 22 cases with multiple cavities.Carcinomatous cavities were 67 cases,taking up 54.47%,and 56 cases of benign cavities.Male patients took a higher proportion of both.The average age of both was 63.0±10.9 years old and52.2±16.1 years old respectively.There was no significant difference in gender,but theaverage age was statistically significant between the two groups(p<0.05).In all patients,there were 53 cases of previous or current smoking,among which there were 37 cases of malignant cavities,taking up 70%.The tumor markers of 52 patients were tested and the cytokeratin 19 fragment(CYFRA211)was elevated in 37 patients including 32 patients with malignant cavities,accounting for 86.5%.The carcinoembryonic antigen(CEA)was higher in 19 patients and all of them with malignant cavities.Among the 101 cases with single cavity,the benign and malignant cavities were 40 and 61 respectively.There were 9cases and 35 cases of lesions located at the lower lobe of both lungs in the two groups respectively.There were 23 cases with malignant cavities in the right lung lower lobe(37.7%,23/61);There are 63 cases with clear boundary of lesions,of which there are 52 cases with malignant cavities(82.5%,52/63)and the statistical difference between the two groups is significant(p<0.05);the maximum thickness of the cavity wall of malignant cavities is bigger than that of benign cavities and the difference between the two groups is statistically significant(p<0.05);the cases with these signs in malignant hollows such as burr,lobulation,vascular convergence,bronchial truncation,eccentric cavity,irregular shape of the cavity,obviously uneven internal margin,wall nodule,and lymphadenopathy more than benign voids,the statistical differences between the two groups were significant(p<0.05),but the following signs,for example,cavity wall calcification,satellite lesions,patch or flaky fuzzy infiltration in benign cavities were more than malignant and there was a statistically significant difference between the two groups(p<0.05).Contrast-enhanced CT was performed in 52 cases of all and showed homogeneous enhancement in 27 patients and malignant cavitations were 85.2%(23/27).Under the bronchoscope,such as neoplasms in the airway,stenosis or occlusion of the lumen,or granular uplift of mucous membranes are more common in malignant cavities,but swelling and congestion of mucosa are more common in benign cavities.That the bronchoscopic manifestations above were statistical differences between benign and malignant cavities(p<0.05).The cytology and histopathology of the sampled specimens and related etiological examinations had important diagnostic value for the diagnosis and differential diagnosis of benign and malignant lung cavities.Conclusions: The clinical symptoms of patients with lung benign and malignant cavities are not specific,but clinical data e,for example,age,smoking history,and tumor-markers(CYFRA211,CEA)have a reference value in the differential diagnosis ofboth;CT imaging features such as location of the lesion in the right lower lung lobe,eccentric cavity,irregular shape of the cavity,clear boundary of the lesion,burr sign,lobulation sign,vascular bundle sign,bronchial truncation sign,obviously uneven inner edge of the cavity,wall nodules,and enlarged lymph nodes are associated with malignant cavities;the bronchoscopic findings,for instance,granular bulge of mucous membrane,neoplasms in the airway and stenosis or occlusion of lumen contribute to the diagnosis of malignant cavities,exfoliative or malignant cells of the sampled specimens can further support the diagnosis.That comprehensive analysis of clinical-imaging-bronchoscopic features of the patients with pulmonary cavity lesions can improve the accuracy of the diagnosis.