Study On The Value Of Contrast-enhanced Ultrasound In The Differential Diagnosis Of Lung Adenocarcinoma And Lung Squamous Cell Carcinoma

Part Ⅰ: Study on the value of contrast-enhanced ultrasound in evaluating blood perfusion in primary lung cancer lesions Objective:To explore the application value of contrast-enhanced ultrasound(CEUS)in evaluating blood perfusion in primary lung cancer,and to compare and analyze the characteristics of CEUS of the time to enhancement(TE),Distribution of vessels(DV),the homogeneity of enhancement(HE)and the extent of enhancement(EE)in primary lung cancer lesions with different blood supply sources,and to explore the potential clinical application value of CEUS in selecting treatment plans for primary lung cancer patients.Methods:A total of 136 lesions were selected from 136 patients with pathologically confirmed primary lung cancer in our hospital,of which 69 were adenocarcinoma,48 were squamous cell carcinoma,9 were small cell carcinoma,6 were large cell neuroendocrine carcinoma,3were sarcomatoid carcinomas,and 1 was adenosquamous carcinoma.All lesions were examined by ultrasound and CEUS,and the lesions were studied according to their TE,this is classified as either an early PA pattern of enhancement or a delayed BA pattern of enhancement.And to analyze DV(indefinite pattern,chaotic pattern,treelike pattern),HE(homogeneous and inhomogeneous),EE(non-enhancement,hypo-enhancement,isoenhancement and hyperenhancement)in both groups.Results:Among the 136 primary lung cancer lesions,a total of 75(55.1%)lesions showed early PA pattern of enhancement,and 61(44.9%)delayed BA pattern of enhancement lesions,and the pathological types of primary lung cancer lesions from different blood supply sources were statistically significant(P<0.05),and the maximum radial mean values of lesions were similar,and the difference was not statistically significant(P>0.05).The DV,HE and EE of primary lung cancer lesions with different blood supply sources showed some differences.Delayed BA pattern of enhancement lesions were more common with indefinite pattern(55.7%,34/61),and early PA pattern of enhancement was more often seen in lesions with contrast in the form of striated vascular-like enhancement,of which chaotic pattern accounted for about 40.0%(30/75),treelike pattern accounted for29.3%(22/75),and this pattern was only seen in early PA pattern of enhancement,the difference was statistically significant(P<0.001).Homogeneous enhancement was more common in early PA pattern of enhancement(57.3%,43/75),and inhomogeneous enhancement was mostly seen in lesions with delayed BA pattern of enhancement lesions(60.7%,37/61),and the difference was statistically significant(P=0.037).136 lesions did not show non-enhancement,and mostly iso-enhancement and hyperenhancement seen in lesions with early PA pattern enhancement(77.3%,58/75),and hypo-enhancement seen in lesions with delayed BA pattern enhancement(55.7%,34/61),and the differences were statistically significant(P<0.001).Conclusion:(1)CEUS can well evaluate the source of blood supply to primary lung cancer lesions,and both bronchial arteries and pulmonary arteries can be used as the source of blood supply to primary lung cancer.The pathological types of primary lung cancer lesions vary depending on the blood supply source.(2)There were differences in the DV,HE,and EE of the lesions with different blood supply source lesions.Early PA pattern enhancement lesions tend to show chaotic pattern or treelike pattern,homogeneous,iso-enhancement or hyperenhancement.Delayed BA pattern enhancement lesions are more common with indefinite pattern,inhomogeneous and hypoenhancement.(3)CEUS can be helpful in the selection of treatment regimens(such as transarterial chemoembolization and anti-angiogenic drug therapy)and the evaluation of treatment effects in patients with lung cancer.Part Ⅱ: Study on the value of conventional ultrasound and CEUS in the differential diagnosis of lung adenocarcinoma and lung squamous cell carcinomaObjective: A comparative analysis of the differences in conventional ultrasound characteristics and CEUS characteristics between lung adenocarcinoma(ADC)and lung squamous cell carcinoma(SCC).And to investigate the clinical value of ultrasound and CEUS in the differential diagnosis of ADC and SCC.Methods: Sixty-nine patients with pathologically confirmed primary adenocarcinoma with a total of 69 lesions and 48 patients with primary squamous cell carcinoma with a total of 48 lesions were selected from our hospital.All lesions were examined by conventional ultrasound and CEUS,and the conventional ultrasound characteristics(localization,size,morphology,internal blood flow,air bronchogram)and CEUS characteristics(TE,DV,HE,EE)were compared and analyzed.Results:(1)Conventional ultrasound: conventional ultrasound characteristics of ADC and SCC differed only in the maximum diameter of the lesions,with the mean maximum diameter of ADC lesions measuring(5.24±2.68)cm and the mean maximum diameter of SCC lesions measuring(6.80±2.61)cm,and the lesions of SCC were larger than those of ADC(P=0.002).the differences between the remaining conventional ultrasound characteristics were not statistically significant(P>0.05).(2)CEUS: There were some differences between ADC and SCC in terms of TE,DV,HE.Early PA pattern enhancement(66.7%,46/69)and homogeneous enhancement(68.1%,47/69)were mostly seen in ADC lesions,while delayed BA pattern enhancement(52.1%,25/48)and inhomogeneous enhancement(70.8%,34/48)were mostly seen in SCC lesions,and the differences were statistically significant(P<0.05).Comparison of lesion DV of ADC and SCC,the chaotic pattern was mostly seen in SCC(54.2% vs 34.8%),and treelike pattern enhancement was mostly seen in ADC(21.7% vs 6.3%).The differences in indefinite pattern enhancement and the EE were not statistically significant between ADC and SCC lesions(P > 0.05).Conclusion:(1)There are differences between ADC and SCC in the conventional ultrasound characteristics,the mean maximum diameter of SCC lesions is larger than that of ADC lesions.(2)There are differences in the CEUS characteristics between ADC and SCC lesions,with early PA pattern enhancement and homogeneous enhancement more common seen in ADC lesions and delayed BA pattern enhancement and inhomogeneous enhancement were more common in SCC lesions.Comparison of lesion DV of ADC and SCC,Chaotic pattern enhancement was more common in SCC lesions,treelike pattern enhancement had a greater chance of appearing in ADC.And there was no significant difference in indefinite pattern and EE in ADC and SCC lesions.(3)There are certain differences in the conventional ultrasound characteristics and CEUS characteristics of ADC and SCC lesions,which need to be further studied in larger cases.