Skuamöz hücreli akciğer kanseri BT bulguları

Özet

Skvamöz (epidermoid) karsinomda radyolojik olarak hiler dolgunluk, konsolidasyon ve atelektazi oranları yüksektir. Skvamöz karsinomda kavite ve nekroz sıklıkla görülür; ince kesitli toraks BT ise tümörün ana bronş, vasküler yapılar ve lenf nodları ile ilişkisini değerlendirerek evrelemeyi yönlendirir. Skvamöz karsinomda sık görülen kavitasyon, apse veya diğer enfeksiyon benzeri bulgularla karıştırılabilir; ayrıca kistik hava boşluğu içeren akciğer kanserleri sıklıkla geç evrede saptanır.

Faz ve pencere

Kontrastsız tanısal: Akciğer penceresinde santral/periferik kitle, nekrotik alan, kalın düzensiz kavite duvarı ve distal atelektazi/konsolidasyon incelenir.
Kontrastlı tanısal: Canlı tümör periferisi, hiler-mediastinal damar/bronş ilişkisi, nodlar ve plevra/göğüs duvarı yayılımı değerlendirilir.

Önerilen pencereler G genişlik, M merkez; değerler Hounsfield birimi (HU)

AkciğerG 1500 / M −600
MediastenG 350 / M +50

BT bulguları

Santral hiler kitle veya bronş duvarından kaynaklanan endobronşiyal yumuşak doku görülebilir.
Skvamöz karsinomda tümör dokusunda nekroz ve kalın, düzensiz kavite gelişimi sık görülen bulgulardır.
Skvamöz (epidermoid) karsinomda radyolojik olarak hiler dolgunluk, konsolidasyon ve atelektazi sık izlenen bulgulardır.
İnce kesitli akciğer penceresi BT ile skvamöz karsinomda tümörün solid komponenti, hiler dolgunluk, distal konsolidasyon ve atelektazi değerlendirilir.
İpsilateral hiler/mediastinal lenf nodları, diğer akciğerde ayrı odaklar ve plevral bulgular aranır.

Ölçütler ve sınıflamalar

TNM 9. baskı akciğer kanseri: TNM sistemi; T tümörün yerel yayılımını, N bölgesel lenf nodu tutulumunu ve M uzak metastazı tanımlar.

Normalde

Santral hava yolu lezyonları BT'de bronş duvarı kalınlaşması veya endoluminal nodül olarak görülebilir. Bronş duvarı kalınlaşması ve endoluminal nodüller, santral hava yolu lezyonlarının BT bulguları arasında yer alır.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s1278; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Akciğer apsesi: nekrotik kavite ve sıvı seviyesi yapabilir; çevresel konsolidasyonla örtüşür.
Kaviteli metastaz: bilinen primer tümör öyküsü ve çeşitli boyutlarda çoklu pulmoner nodüller ile uyumludur.
Granülomatoz polianjiit: çoklu nodül/kavite yapabilir.
Tüberküloz ve fungal enfeksiyonlar kaviteli akciğer lezyonlarının ayırıcı tanısında yer alabilir.

Tuzaklar

Düzensiz sınırlı kaviter lezyonlar maligniteyi çağrıştırabilir ancak apse ve granülomatöz hastalıklar tarafından taklit edilebilir.
Ana bronş tutulumu veya obstrüktif pnömoni/atelektazi, tümörün T kategorisi değerlendirmesinde dikkate alınır.
TNM-9'da ana bronş tutulumu ve atelektazi/obstrüktif pnömonit T2 kapsamındadır; karina, büyük damar veya kalp invazyonu T4 kapsamındadır.
TNM-9 boyut eşikleri: T1 ≤3 cm, T2 >3–5 cm (T2a >3–4, T2b >4–5 cm), T3 >5–7 cm, T4 >7 cm.

Kendini dene

TNM-9'da ana bronş tutulumu veya atelektazi/obstrüktif pnömonit hangi T kategorisi kapsamındadır?
Cevabı göster
T2; alt kategori tümör boyutuna göre belirlenebilir. Ana bronş tutulumu ve atelektazi/obstrüktif pnömonit T2 kapsamındadır; T2a ve T2b alt kategorileri tümör boyutuna göre de belirlenebilir.
Onkolojik FDG-PET/BT'nin BT bileşeninde görülen kaviter pulmoner lezyonlarda yanlış pozitif ve yanlış negatif yorumları azaltmaya hangi yaklaşım yardımcı olabilir?
Cevabı göster
Lezyonları sistematik BT değerlendirmesiyle inceleyip görüntüleme bulgularını klinik verilerle bütünleştirmek. Kaviter morfoloji tek başına erken benign etiketlemeye yol açmamalıdır. BT bileşeninin sistematik değerlendirilmesi ve bulguların klinik verilerle bütünleştirilmesi yanlış pozitif ve yanlış negatif yorumları azaltmaya yardımcı olabilir.

İlgili konular

Kaynaklar

Bu sayfadaki 32 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 20 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.