23例细支气管肺泡癌的CT影像学分析
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摘要
背景与目的
肺癌是世界上发病率和死亡率最高的恶性肿瘤之一,细支气管肺泡癌(bronchioloalveolar carcinoma, BAC)属肺腺癌的一种特殊类型。1960年Liebow首次用BAC命名一种发生在肺的外周、边界清楚、不破坏肺泡间隔的腺癌。国外学者研究发现,近半个世纪以来,细支气管肺泡癌的发病率迅速增长,占肺癌的比例从1955年5.0%上升到1990年24.0%,几乎与肺鳞癌相等,并占女性肺癌的30%~50%。在国内,BAC约占肺癌的20%,男性较多见,发病年龄在40~60岁。由于BAC患者临床上特征性大量白色泡沫痰并不多见,如果有亦多见于晚期,且BAC在不同个体之间的临床、病理及影像学表现复杂,故临床上不易及时诊断,容易造成误诊,延误治疗时机。本文回顾性分析细支气管肺泡细胞癌(BAC)的临床特点、胸部CT的影像学征象及病理学基础,其目的在于提高BAC影像诊断的准确率,减少误诊。
材料与方法
搜集2005-2010年经汕头大学医学院第一附属医院检查并最终得到病理诊断的23例细支气管肺泡癌的CT表现进行回顾性分析,寻找其相对特征性的表现,探讨各型病变的影像特征及其对应的病理关系。
结果
23例确诊BAC病例均行CT平扫及2mm薄层重建,男:女=10:13,平均发病年龄55岁,中位发病年龄60岁,最大发病年龄70岁,最小发病年龄24岁。其中5例吸烟。8例患者有咳白色泡沫样痰。CT诊断正确率69.6%(16/23),误诊者超过一半57.1%(4/7)被误诊为结核。根据CT征象将BAC分为3型:孤立结节型10例,占43.5%(10/23),其中增强扫描3例;炎症实变型8例,占34.8%(8/23);及多发结节型5例,占21.7%(5/23)。其中孤立结节型中80.0%(8/10)分布于肺野外带,支气管充气征/空泡征90%(9/10),瘤周或瘤内磨玻璃密度征70%(7/10),分叶征60.0%(6/10),毛刺征90%(8/10),胸膜凹陷征50.0%(5/10),3例增强病例均见血管集束征,血管包埋征66.7%(2/3)。8例炎症实变型见枯树枝征100%(8/8),磨玻璃密度征75%(6/8),蜂窝征62.5%(5/8),腺泡样结节50%(4/8),病变发生在下肺为主,占75.0%(6/8)。多发结节型中3例见支气管充气征/空泡征,3例见磨玻璃密度征,4例见毛刺征。
结论
细支气管肺泡癌的影像表现复杂多样,掌握各型BAC的典型影像学表现,有助于本病的的正确诊断。
Background and Objective
Lung 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 Methods
23 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.
Results
All 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.
Conclusion
The 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.
肺癌是世界上发病率和死亡率最高的恶性肿瘤之一,细支气管肺泡癌(bronchioloalveolar carcinoma, BAC)属肺腺癌的一种特殊类型。1960年Liebow首次用BAC命名一种发生在肺的外周、边界清楚、不破坏肺泡间隔的腺癌。国外学者研究发现,近半个世纪以来,细支气管肺泡癌的发病率迅速增长,占肺癌的比例从1955年5.0%上升到1990年24.0%,几乎与肺鳞癌相等,并占女性肺癌的30%~50%。在国内,BAC约占肺癌的20%,男性较多见,发病年龄在40~60岁。由于BAC患者临床上特征性大量白色泡沫痰并不多见,如果有亦多见于晚期,且BAC在不同个体之间的临床、病理及影像学表现复杂,故临床上不易及时诊断,容易造成误诊,延误治疗时机。本文回顾性分析细支气管肺泡细胞癌(BAC)的临床特点、胸部CT的影像学征象及病理学基础,其目的在于提高BAC影像诊断的准确率,减少误诊。
材料与方法
搜集2005-2010年经汕头大学医学院第一附属医院检查并最终得到病理诊断的23例细支气管肺泡癌的CT表现进行回顾性分析,寻找其相对特征性的表现,探讨各型病变的影像特征及其对应的病理关系。
结果
23例确诊BAC病例均行CT平扫及2mm薄层重建,男:女=10:13,平均发病年龄55岁,中位发病年龄60岁,最大发病年龄70岁,最小发病年龄24岁。其中5例吸烟。8例患者有咳白色泡沫样痰。CT诊断正确率69.6%(16/23),误诊者超过一半57.1%(4/7)被误诊为结核。根据CT征象将BAC分为3型:孤立结节型10例,占43.5%(10/23),其中增强扫描3例;炎症实变型8例,占34.8%(8/23);及多发结节型5例,占21.7%(5/23)。其中孤立结节型中80.0%(8/10)分布于肺野外带,支气管充气征/空泡征90%(9/10),瘤周或瘤内磨玻璃密度征70%(7/10),分叶征60.0%(6/10),毛刺征90%(8/10),胸膜凹陷征50.0%(5/10),3例增强病例均见血管集束征,血管包埋征66.7%(2/3)。8例炎症实变型见枯树枝征100%(8/8),磨玻璃密度征75%(6/8),蜂窝征62.5%(5/8),腺泡样结节50%(4/8),病变发生在下肺为主,占75.0%(6/8)。多发结节型中3例见支气管充气征/空泡征,3例见磨玻璃密度征,4例见毛刺征。
结论
细支气管肺泡癌的影像表现复杂多样,掌握各型BAC的典型影像学表现,有助于本病的的正确诊断。
Background and Objective
Lung 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 Methods
23 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.
Results
All 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.
Conclusion
The 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.
引文
1.Liebow AA. Bronchioloalveolar carcinoma. Adv Intern Med, 1960, 10: 329-358.
2.Barsky SH, Cameron R, Osann KE, et al. Rising Incidence of Bronchioloalveolar Lung Carcinoma and it’s Unique Clinicopathologic Features [J]. Cancer, 1994, 73(4):1163-1170.
3.Barkley JE, Green MR. Bronchioloalveolar Carcinoma [J]. J ClinOncol, 1996, 14(8): 2377- 2386.
4.陈境弟,柳学国等.肺癌临床CT诊断[M].广州:中山大学出版社, 2008:41.
5.陈琼荣.细支气管肺泡癌临床病理研究进展.中国肺癌杂志, 2007, 10(4): 345-346.
6.邓宇,曾庆思,伍筱梅等.细支气管肺泡癌影像学特征的深入性探讨.放射学实践, 2005, 33(22): 128-131.
7.康本武,冉隆中.细支气管肺泡癌48例CT特征与病理分析.中国误诊学杂志,2009,
9(10): 2445.
8.Colby TV, Noguchi M, Henschke C, et al. Adenocarcinoma. In: Travis WD, Brambilla E, Muller-Hermelink HK, et al eds. World Health Organization classification of tumour. Pat hology & genetics of tumours of the lung, pleura, thymus and heart. Lyon: LARC Press, 2004:39-40.
9.忠利,孙雷娜. WHO2004版肺癌组织学分类与临床意义.中国肿瘤影像学, 2009, 2: 145-147.
10. Behnaz, Goudarzi, Heather A, Jacene, and Richard L. Wahl. Diagnosis and Differentiation of Bronchioloalveolar Carcinoma from Adenocarcinoma with Bronchioloalveolar Components with Metabolic and Anatomic Characteristics Using PET/CT [J]. Nucl Med, 2008; 49: 1585-1592.
11.李润明,王丽华,李映南.细支气管肺泡癌的影像学分型及动态变化[J].实用放射学杂志, 2003, 19 (5) : 422-425.
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16.Kitamura H, Kameda Y, Ito T, et al. Atypical adenomatous hyperplasia of the lung: Implications for the pathogenesis of peripheral lung adenocarcinoma. Am J Clin Pathol, 1999, 111(5): 610-622.
17.TAKAYUKI FUKUI and TETSUYA MITSUDOMI. Small Peripheral Lung Adenocarcinoma: Clinicopathological Features and Surgical Treatment[J]. Surg Today, 2010,
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19.罗赛(ROSAIJ),回允中.阿克曼外科病理学上卷[M].第8版.沈阳:辽宁教育出版社, 1999: 375-381.
20.Ohori NP, Maria S. Cytopathologic diagnosis of bronchioloalveolar carcinoma: does it correlate with the 1999 World Health Organization definition[J]. Am J Clin Pathol, 2004,
122(1): 44-50.
21.赵倩,蔡祖龙,赵绍宏等.细支气管肺泡癌的CT征象分析[J].中国临床医学影像杂志, 2009, 20 (3): 164-166.
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25.董军.孤立型细支气管肺泡癌30例CT征象分析.中外医疗, 2009, 12: 168.
26.彭光明,蔡祖龙等.空泡征的CT-病理再研究.中华放射学杂志, 1996, 30(6): 392-395.
27.Oda S, Awai K, Liu D, et al. Ground-glass opacities on thin-section helical CT: differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia. 2008; 190: 1363-1368.
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1.Liebow AA. Bronchioloalveolar carcinoma. Adv Intern Med, 1960, 10: 329-358.
2.Barsky SH, Cameron R, Osann KE, et al. Rising Incidence of Bronchioloalveolar Lung Carcinoma and it’s Unique Clinicopathologic Features [J]. Cancer, 1994, 73(4): 1163-1170.
3.Barkley JE, Green MR. Bronchioloalveolar Carcinoma [J] . ClinOncol ,1996 ,14(8) :2377-2386.
4.陈境弟,柳学国等.肺癌临床CT诊断[M].广州:中山大学出版社, 2008:41.
5.Kitamura H, Kameda Y, Ito T, et al. Atypical adenomatous hyperplasia of the lung: Implications for the pathogenesis of peripheral lung adenocarcinoma. Am J Clin Pathol, 1999,111(5): 610-622.
6.陈琼荣.细支气管肺泡癌临床病理研究进展.中国肺癌杂志, 2007, 10(4):345-346
7.邓宇,曾庆思,伍筱梅等.细支气管肺泡癌影像学特征的深入性探讨.放射学实践, 2005,
33(22): 128-131.
8.张国帧.细支气管肺泡癌的CT影像及其鉴别诊断.中华结核和呼吸杂志, 2009, 32(11):
805-807
9.康本武,冉隆中.细支气管肺泡癌48例CT特征与病理分析.中国误诊学杂志, 2009,
9(10):2445.
10.TAKAYUKI FUKUI and TETSUYA MITSUDOMI. Small Peripheral Lung Adenocarcinoma: Clinicopathological Features and Surgical Treatment[J]. Surg Today, 2010, 40:191-198.
11.罗赛(ROSAIJ),回允中.阿克曼外科病理学上卷[M].第8版.沈阳:辽宁教育出社,1999:
375-381.
12.Colby TV, Noguchi M, Henschke C, et al. Adenocarcinoma. In Travis WD, Brambilla E, Muller-Hermelink HK, et al eds. World Health Organization classification of tumours. Pathology & genetics of tumours of the lung, pleura, thymus and heart. Lyon: LARC Press, 2004:39-40.
13.忠利,孙雷娜. WHO2004版肺癌组织学分类与临床意义.中国肿瘤影像学, 2009, 2:
145-147.
14.Ohori NP, Maria S. Cytopathologic diagnosis of bronchioloalveolar carcinoma: does itcorrelate with the 1999 World Health Organization definition[J]. Am J Clin Pathol, 2004, 122(1): 44-50.
15.赵倩,蔡祖龙,赵绍宏等.细支气管肺泡癌的CT征象分析[J].中国临床医学影像杂志, 2009, 20 (3) : 164-166.
16.Behnaz, Goudarzi, Heather A, Jacene, and Richard L. Wahl. Diagnosis and Differentiation of Bronchioloalveolar Carcinoma from Adenocarcinoma with Bronchioloalveolar Components with Metabolic and Anatomic Characteristics Using PET/CT [J]. Nucl Med, 2008; 49: 1585-1592.
17.李润明,王丽华,李映南.细支气管肺泡癌的影像学分型及动态变化[J].实用放射学杂志, 2003, 19 (5) : 422-425.
18.殷泽富.胸部CT诊断学[M].济南:山东科学技术出版社, 1996:142.
19.刘志强,王琳等.细支气管肺泡癌CT特征及病理基础分析.社区医学杂志, 2009, 7(7):
16-17.
20.董军.孤立型细支气管肺泡癌30例CT征象分析.中外医疗, 2009, 12:168.
21.彭光明,蔡祖龙等.空泡征的CT-病理再研究.中华放射学杂志, 1996, 30(6): 392-395.
22.Oda S, Awai K, Liu D, et al. Ground-glass opacities on thin-section helical CT: differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia. 2008; 190: 1363- 1368.
23.岳新建.细支气管肺泡癌26例高分辨CT特征分析.中国医疗前沿, 2009, 4(20): 72.
24.Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR 2002; 178: 1053-1057.
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32.叶彩儿,叶民.细支气肺泡癌的CT诊断.温州医学院学报, 2003, 33: 126-127.
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1.Liebow AA. Bronchioloalveolar carcinoma. Adv Intern Med, 1960, 10: 329-358.
2.Barsky SH, Cameron R, Osann KE, et al. Rising Incidence of Bronchioloalveolar Lung Carcinoma and it’s Unique Clinicopathologic Features [J]. Cancer, 1994, 73(4): 1163-1170.
3.Barkley JE, Green MR. Bronchioloalveolar Carcinoma [J] . ClinOncol ,1996 ,14(8) :2377-2386.
4.陈境弟,柳学国等.肺癌临床CT诊断[M].广州:中山大学出版社, 2008:41.
5.Kitamura H, Kameda Y, Ito T, et al. Atypical adenomatous hyperplasia of the lung: Implications for the pathogenesis of peripheral lung adenocarcinoma. Am J Clin Pathol, 1999,111(5): 610-622.
6.陈琼荣.细支气管肺泡癌临床病理研究进展.中国肺癌杂志, 2007, 10(4):345-346
7.邓宇,曾庆思,伍筱梅等.细支气管肺泡癌影像学特征的深入性探讨.放射学实践, 2005,
33(22): 128-131.
8.张国帧.细支气管肺泡癌的CT影像及其鉴别诊断.中华结核和呼吸杂志, 2009, 32(11):
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9.康本武,冉隆中.细支气管肺泡癌48例CT特征与病理分析.中国误诊学杂志, 2009,
9(10):2445.
10.TAKAYUKI FUKUI and TETSUYA MITSUDOMI. Small Peripheral Lung Adenocarcinoma: Clinicopathological Features and Surgical Treatment[J]. Surg Today, 2010, 40:191-198.
11.罗赛(ROSAIJ),回允中.阿克曼外科病理学上卷[M].第8版.沈阳:辽宁教育出社,1999:
375-381.
12.Colby TV, Noguchi M, Henschke C, et al. Adenocarcinoma. In Travis WD, Brambilla E, Muller-Hermelink HK, et al eds. World Health Organization classification of tumours. Pathology & genetics of tumours of the lung, pleura, thymus and heart. Lyon: LARC Press, 2004:39-40.
13.忠利,孙雷娜. WHO2004版肺癌组织学分类与临床意义.中国肿瘤影像学, 2009, 2:
145-147.
14.Ohori NP, Maria S. Cytopathologic diagnosis of bronchioloalveolar carcinoma: does itcorrelate with the 1999 World Health Organization definition[J]. Am J Clin Pathol, 2004, 122(1): 44-50.
15.赵倩,蔡祖龙,赵绍宏等.细支气管肺泡癌的CT征象分析[J].中国临床医学影像杂志, 2009, 20 (3) : 164-166.
16.Behnaz, Goudarzi, Heather A, Jacene, and Richard L. Wahl. Diagnosis and Differentiation of Bronchioloalveolar Carcinoma from Adenocarcinoma with Bronchioloalveolar Components with Metabolic and Anatomic Characteristics Using PET/CT [J]. Nucl Med, 2008; 49: 1585-1592.
17.李润明,王丽华,李映南.细支气管肺泡癌的影像学分型及动态变化[J].实用放射学杂志, 2003, 19 (5) : 422-425.
18.殷泽富.胸部CT诊断学[M].济南:山东科学技术出版社, 1996:142.
19.刘志强,王琳等.细支气管肺泡癌CT特征及病理基础分析.社区医学杂志, 2009, 7(7):
16-17.
20.董军.孤立型细支气管肺泡癌30例CT征象分析.中外医疗, 2009, 12:168.
21.彭光明,蔡祖龙等.空泡征的CT-病理再研究.中华放射学杂志, 1996, 30(6): 392-395.
22.Oda S, Awai K, Liu D, et al. Ground-glass opacities on thin-section helical CT: differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia. 2008; 190: 1363- 1368.
23.岳新建.细支气管肺泡癌26例高分辨CT特征分析.中国医疗前沿, 2009, 4(20): 72.
24.Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR 2002; 178: 1053-1057.
25.徐美,杨霞,张志尧.肺不典型腺瘤样增生与细支气管肺泡癌[J].中国肿瘤临床, 2001, 28 (7): 526-529.
26.Tsushima Y, Suzuki K, Watanabe S. Multiple lung adnocarcinomas showing ground-glass opacity. Eur J Cardiothorac Surgopacities on thoracic compited tomography. Ann Thorac Surg, 2006, 82: 1508-1510.
27.梁晓平.细支气管肺泡癌的临床及CT诊断分析.当代医学, 2009, 15(4): 96-97.
28.赫占林,姜洪等.细支气管肺泡癌的高分辨CT表现.黑龙江医学,2009,2(33):116-118.
29. Aquino SL, Chiles C, Harlford P. Distinction of Consolidative BronchioloalveolarCarcinoma from Pneumnonia: do CT Criteria work [J]. AJR , 1998 ,171 (2) :359-363.
30.兰国红.弥漫型肺泡癌的影像学诊断.实用医学杂志, 2008, 15(12): 1533-1534.
31.李薇,王华,郝青林.实变型细支气管肺泡癌的影像学表现及病理变化.昆明医学院学报,2009(5): 89-92.
32.叶彩儿,叶民.细支气肺泡癌的CT诊断.温州医学院学报, 2003, 33: 126-127.
33.贾俐聪.细支气管肺泡癌的影像学表现及鉴别诊断.河北医药, 2007, 29(12): 1389-1391.
34.邢占刚, CT诊断细支气管肺泡癌18例分析.航空航天医药, 2010, 21(11): 2103.
35.吴昊,滑炎卿,张国桢.细支气管肺泡癌的CT特征与分型[J], 2002, 11(2): 113-114.
36.周小辉,苑小历. 32例酷似粟粒性肺结核的肺泡癌的临床诊断.东南国药. 2009, 11(6): 510-511