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Objective To explore the dose of template-assisted 192Ir source hypofractionated stereotactic brachytherapy (SABT) for peripheral lung cancer. Methods We retrospectively analyzed the dose parameters of GTV and OARs of 28 peripheral lung cancer patients treated with template-assisted 192Ir-source hypofractionated SABT, and compared the dose parameters between SABT with virtual SBRT. Results The Dmean and V150 for the GTV in the SABT plan were significantly higher than those in the SBRT plan (all P < 0.01). For OARs, all dosimetric parameters in the SABT plan were significantly lower than those in the SBRT plan (all P < 0.01), except for the D1000cm3 and D1500cm3 for the lung (P > 0.05). Conclusion Template-assisted 192Ir source hypofractionated SABT ensures high dose in the gross tumor volume and reduces the dose in organs at risk in the treatment of peripheral lung cancer.
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Objective To analyze the effect of the new conformal index(nCI)and the conventional conformal index(CI)on the treament planning quality of lung stereotopic radiotherapy(SBRT).Methods A total of 19 peripheral lung cancer patients,treated with SBRT in Fujian Medical University Union Hospital from 2014 to 2017,were analyzed retrospectively.Each patient was planned twice yielding identical CI and nCI.The prescription to 95％of planning target volume(PTV)was 48 Gy in four fractions,and renormalization was performed when needed for nineteen nCI plans.The Wilcoxon signed-rank test was used to examine the dosimetric index.Results The dose conformity plots indicate that nCI does not only reflect the dose to the organ at risk outside tumor,but also represents the dose distribution in the PTV.In addition,nCI was stricter with treatment planning qualities when the dose around PTV was closer to the prescribed dose.The value of target coverage(TC),the ratio of out-of-target volumes receiving 105％prescribed dose to the target volume(R105％),the ratio of volume covered by 50％isodose line to the target volume(R50％),and the ipsilateral lung V20were 98.70％,0.56,5.53,15.59％in the CI plans,vs.90％,0,4.99,14.42％in the corresponding nCI plans,respectively.All index were significantly lower in the nCI group(Z ＝-3.823,-3.180,-3.823,-3.783,respectively,P＜0.05).The ratio of the maximum dose to the 2 cm external margin from the PTV(D2 cm)to the maximum dose to the PTV were 63.70％and 64.07％respectively in the two groups,and the differences were not statistially significant(P＞0.05).The conformity values denoted a clinically favorable value as 1 between D95％and D99％of nCI plans,yet were not applicable to CI plans.Conclusions It is more clinically relavant to evaluate lung SBRT plans using nCI,TC and other indicators collectively than using CI alone.
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Objective To analyze the factors related to the metastasis of lung squamous cell carcinoma in patients with central and peripheral types of lung squamous carcinoma, and provide evidence-based basis for preoperative preparation, intraoperative lymph node treatment choice and postoperative treatment. Methods Clinical data of 142 patients with lung squamous carcinoma who performed operation in Tianjin Medical University Cancer Institute and Hospital from January 2014 to December 2015 were retrospectively analyzed. There were 83 cases of central lung squamous cell carcinoma and 59 cases of peripheral lung squamous carcinoma in these 142 patients. Single factor and multiple factor Logistic regression analysis were used to analyze the clinical data in patients with different type groups, including gender, age, smoking history and smoking index, preoperative CYFRA21-1 level, preoperative predictive lymph nodes metastasis, tumor diameter, tumor type (keratotic and non-keratotic), pleura invasion, tumor embolism and postoperative lymph node metastasis. Results There were 47 cases with lymph node metastasis in 147 patients, including 31 cases of central type metastasis, and 16 cases of peripheral type metastasis. Single factor analysis showed that gender, smoking history, smoking index, preoperative lymph node metastasis assessment, tumor diameter, and non-keratotic type were related to the metastasis of central type of lung squamous cell carcinoma. Pleural invasion and non-keratotic type were associated with peripheral type of pulmonary squamous cell carcinoma. Multivariate Logistic regression analysis showed that more smoking, large tumor diameter and non-keratotic type were independent risk factors for lymph node metastasis of central type of lung squamous cell carcinoma. The non-keratotic type was an independent risk factor for lymph node metastasis of peripheral pulmonary squamous carcinoma. Conclusion Non-keratotic type of squamous cell carcinoma is related to lymph node metastasis especially N1 lymph node metastasis. It is suggested that such patients should be actively treated and colsely followed up after the operation. Patients with more smoking may be more likely to have N2 lymph node metastasis.
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Objective To explore the diagnostic value of non-real-time radial probe endobronchial ultrasound (RP-EBUS) guided transbronchial lung biopsy (TBLB) for peripheral lung cancer and analysis of false negative results. Methods A retrospective analysis of the clinical and imaging data of 256 patients with peripheral lung cancer between March 2013 and December 2016, all the cases underwent non-real-time RP-EBUS guided TBLB, then evaluate its significance in the diagnosis of peripheral lung cancer and analyze the reasons of false negative results. Result In 256 patients who received non-real-time RP-EBUS examinations, 73.83% (189/256) of peripheral lung cancer were detected by RP-EBUS and the positive rate of RP-EBUS guided TBLB was 61.33% (157/256). The positive rate of non-real-time RP-EBUS guided TBLB was correlated with lesions >2 cm in diameter, lesions close to visceral pleura, ultrasonic image characteristics and the RP-EBUS probe surrounding by lesion (P < 0.05). The positive rate of non-real-time RP-EBUS guided TBLB was not correlated with RP-EBUS probe passed through lesions and times of biopsy (P > 0.05). Complications including bleeding, chest pain and pneumothorax recovered spontaneously. Conclusion Non-real-time RP-EBUS guided TBLB was a practical technology for diagnosis of peripheral lung cancer with high diagnostic rate and good safety. Lesion size, connection to visceral pleura, ultrasonic image characteristics and the RP-EBUS probe surrounding by lesion influenced the diagnostic yield. Improvement of operative skills can reduce false negative results.
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Objective:To analyze the curative effects of resection by traditional thoracotomy and thoracoscopy for senile peripheral lung cancer.Methods:65 patients with peripheral lung cancer were randomly divided into traditional thoracotomy surgical group and thoracoscope group.Operation protocol are in accordance with established grouping scheme,compare two groups of patients with general attribute data.indicators related to the operation.Postoperative follow-up last to June 2016,Kaplan Meier-method is used to evaluate patients' 5 year overall survival (OS) and relapse-free survival (RFS).Results:The thoracoscope surgery group operating time significantly longer than thoracotomy group (p＜0.05).The time of intrathoracic drain in thoracoscope group was obviously shortened (p＜0.05).The loss of blood in thoracoscope group is less than thoracotomy group (p＜0.05).Postoperative complications such as VAS score decreased,and the hospitalization time is shorter than thoracotomy group (p＜0.05).But the thoracoscope hospitalization expenditure is more expensive than thoracotomy group (p＜ 0.05).RFS of thoracotomy group for five years was 65.27％,and the thoracoscope group was 67.13％:there was no statistically significant difference (p＞0.05).Thoracotomy patients OS for 5 years was 53.73％,the thoracoscope group was 55.34％,the difference was statistically significant (p＜0.05).Conclusion:Compared with the traditional thoracotomy surgery,blood loss is more than lung cancer resection under thoracoscope.Thoracoscope make the patient recover faster.
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Objective To retrospectively design an intensity?modulated radiotherapy ( IMRT) plan with split field and fixed jaw techniques for peripheral lung cancer with mediastinal lymph node metastasis, to compare dosimetric characteristics between the IMRT plans with fixed jaw and dynamic jaw, and to study lung protection by the plan with split field and fixed jaw. Methods Treatment plans were collected from 12 patients with peripheral lung cancer and mediastinal lymph node metastasis who were treated with IMRT in our hospital. All plans used the dynamic jaw technique. The plans with split field and fixed jaw were designed based on the identical computed tomography images and planning target volume ( PTV) . Each jaw position in split field depended on each separate PTV. The prescription dose was 60 Gy in 30 fractions. 95%PTV was planned to receive 100% of the prescription dose. Dosimetric parameters of PTV, conformity index ( CI) , heterogeneity index ( HI) , number of monitor units ( MUs) , and dose?volume values of the lung and heart were obtained from dose?volume histogram. Comparison between the two plans was made by paired t test. Results Both plans met clinical requirements. There were no significant differences in D2 , D98 , CI, or HI of PTV between the two plans ( all P>005) . Compared with the dynamic jaw plan, the fixed jaw plan had MUs increased by 15%?20%( P=0010) . The V5 , V10 , V20 , V30 , and mean dose for the whole lungs were significantly lower in the fixed jaw plan than in the dynamic jaw plan ( P=0000, 0000, 0000, 0002,0000) . The V5 , V20 , and mean dose for the healthy lung were also significantly lower in the fixed jaw plan than in the dynamic jaw plan ( P=0000,0017,0000) . There were no significant differences in dose?volume values for the spinal cord or heart between the two plans ( all P>005) . Conclusions IMRT with split field and fixed jaw is recommended for patients with peripheral lung cancer and mediastinal lymph node metastasis. The therapy to a certain extent reduces low?dose volume for the lung and the incidence of radiation?induced pneumonitis.
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Objective To evaluate multi-detector computed tomography(MDCT)features of lung cancer associated with cystic airspace,and to improve diagnostic accuracy.Methods 21 pathologically or clinically confirmed lung cancer associated with cystic airspace were retrospectively analyzed with regard to clinical data,pathological types and TNM stage,SUMmax and MDCT features.For dynamic follow-up CT scans,the lesion dynamic change was evaluated.Results There were 21 cases (1 1 adenocarcinoma,6 squamous carcinoma)in total. The lesion was predominant cysts in 2 cases(9.52%),cysts with GGO mixed lesions in 3 cases(14.29%),cysts with solid mixed lesions in 14 cases(66.67%),cysts with GGO and solid mixed lesions in 2 cases(9.52%).Four morphological patterns,20 cases had solid nodules,solid nodule protruding externally from the cyst wall was in 5 cases (23.81%),solid nodule protruding internally from the cyst wall was in 1 case (4.76%),solid tissue intermixed within clusters of cysts was in 14 cases(66.67%),the lesion presenting as circumferential thickening of the cyst wall was in 1 case (4.76%).The frequency of following features accounted for more than 60% of all MDCT signs,including round shape (66.67%),lobulation (80.95%),blood vessel passing through the cyst (76.1 9%),pleural indentation (80.95%);while the frequency of multiple cysts,irregular inner wall and septum in cyst in 19 lesions(90.48%)was more than 90%.With respect to the relationship between lesion and bronchus,bronchus passing through the cyst was the most common sign,accounting for 38.10%(8/21).Average CT enhancement value was 28.27 HU±7.27 HU(range 14.2-40 HU).Average SUVmax was 6.05(range 4.5-9.8),indicating marked FDG uptake.Two lesions manifested as progressive wall thickening and increased size of the cyst,and one lesion showed decreased size of the cyst and enlarged nodules in follow up CT.Conclusion The irregular inner wall,septum in cyst and blood vessel passing through the cyst are the most three important signs for the diagnosis of malignant lesions.
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Objective To study the short-time outcome and adverse effect of cyberknife in treatment of peripheral non-small cell lung cancer, so as to evaluate the safety and efficacy of cyberknife in treatment of peripheral lung cancer. Methods A total of 66 patients with peripheral non-small cell lung cancer completed their cyberknife radiosurgery, with real-time target tracking through fiducial marker implantation in 25 cases, X-sight lung synchrony in 35 cases, and X-sight spine tracking in 6 cases. Total prescribed dosage ranged from 42 to 60 Gy, with 4 to 6 fractions prescribed to the 65%-75% isodose lines for planning target volume. The biological effective dose (BED) was 71.4-150.0 Gy. The follow-up time was 11-29 months and the median time was 18 months. Results A total of 31 patients had complete radiographic responses, 28 had partial response, 5 patients had stable disease and 2 had progressive disease. The response rate was 89.4%. Tumor size and BED were the significant factors affecting the result of treatment (P=0.019, P=0.007). Conclusion Cyberknife radiosurgery treatment is effective and safe for peripheral non-small cell lung cancer. It can achieve satisfactory tumor control rate, while the long term outcome needs further follow-up.
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Objective To investigate the clinical value of heat shock protein 90α (HSP90α), glutathione S-transferase P1 (GSTP1), ubiquitin specific peptidase 8 (USP8) and chitinase 3-like 1 (CHI3L1) in bronchoalveolar lavage fluid (BALF) and serum for diagnosis and evaluation of the extent of peripheral lung cancer. Methods The levels of HSP90α, GSTP1, USP8 and CHI3L1 of in BALF and serum were measured and compared among 100 patients with peripheral lung cancer (PLC) and 50 patients with benign lung diseases (BLD) by ELISA. The results were compared and analyzed. Results The average content of HSP90α and CHI3L1 in BALF of PLC patients were higher than that in BLD patients (P0.05). The levels of HSP90α and CHI3L1 in BALF of the patients with small nodular lung cancer group (primary focus diameter ≤1cm) and BLD patients showed no significant difference (P>0.05). The levels of GSTP1 and USP8 in BALF and serum of PLC patients and that of BLD patients showed no significant difference (P>0.05). The levels of HSP90α, GSTP1, USP8 and CHI3L1 in BALF and serum showed no significant correlation with other factors, such as the patient's age, pathological classification (adenocarcinoma or squamous carcinoma) and stage of lung cancer (phase to ). The level of CHI3L1 in BALF was correlated to the diameter of the primary foci (P<0.05), while the levels of other lung cancer markers in BALF and serum showed no significant correlation with diameter of primary focus. Conclusion Detection of tumor markers such as HSP90α and CHI3L1 from patients' BALF has a diagnostic value for PLC, and is superior to the examinations of patients' serum specimens. The measurement of HSP90α in BALF shows better clinical value, and it may contribute to the diagnosis of peripheral pulmonary carcinoma.
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Objective To evaluate the detection rate of multi-slice spiral CT (MSCT)signs and the clinical value of multi-planar reconstruction (MPR)in T1a and T1b peripheral lung cancer patients.Methods Eighty-seven cases with peripheral lung cancer proved by pathology were collected.The cases were divided into T1a and T1b group based on the TNM classification.The MSCT and MPR images were compared between the two groups.Results (1)Detection rate of the deep sublobe sign,spinous process sign, short spiculated sign,pleural indentation sign,vascular convergence sign,multi-nodule accumulation sign,vacuole sign and air bron-chogram sign,were 1 1.4%,20.0%,31.4%,60.0%,25.7%,45.7%,42.9% in T1a group and 42.3%,36.5%,57.7%, 80.8%,5 1.9%,25.0%,21.2% in T1b group,respectively.The difference were all statistically significant (P < 0.05)between T1a and T1b group except that of the spiculated sign (P = 0.098).(2)The detection rate of the sublobe sign,spinous process sign, spiculated sign,pleural indentation sign and vascular convergence sign were higher on MPR images than on axial thin-slice images in both T1a and T1b group.Conclusion The detection rate of the tumor-lung interface’s signs are lower in T1a than in T1b,the detec-tion rate of internal structure signs of the tumor are higher in T1a than in T1b in peripheral lung cancer patients.MPR has important value in early diagnosis of peripheral lung cancer.
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[Objective] To discuss the nursing to the common complications in perioperational period of lung cancer treated with ultrasonic guidance transdermal radiofrequency ablation(RFA). [Method] 12 cases of peripheral lung cancer treated with ultrasonic guidance transdermal RFA, took active mental nursing, closely cooperated in operation, strictly observed the disease condition after operation, had good nursing of perioperational period, and were strengthened on observation of complications and prevention. [Result] 12 cases had smooth operation, part of them had pain at puncture spot, fever, little aerothorax and hydrops, with blood in sputum at cough, and were relieved timely with active observation and clinical nursing, without other severe complications, final y they were discharged from hospital upon recovery, without death in perioperational period. [Conclusion] The ultrasonic guidance RFA is a safe and effective method to treat peripheral lung cancer with little invasion; the nursing point is to closely observe disease condition before and after operation, and do wel general nursing.
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Objective To investigate the impact of delineator and delineating criteria on the target delineation of the peripheral lung cancer based on four-dimensional computed tomography (4D-CT).Methods The 4D simulation CT images of twelve patients with peripheral lung cancer were selected.Before and after the establishment of the target delineation criteria,six radiation oncologists were asked to delineate the targets based on 4D-CT images at the end-inhalation phase (0％),end-exhalation phase (50％),and three-dimensional computed tomography (3D-CT) images respectively.The delineated targets were denominated as GTV0,GTV50,GTV3D.IGTVIN+Ex was created by combining GTV0 and GTV50.IGTVMIP was delineated based on the maximum intensity projection (MIP) of 4D-CT.The interand intra-observer variability before and after the establishment of the delineation criteria was compared.Results The mean coefficients of variation of GTV0,GTV50,GTV3D,IGTVMIP and IGTVIN+Ex delineated by the six delineators before and after the establishment of the delineation criteria were 0.50 ± 0.25 vs 0.24 ±0.10,0.52 ±0.38 vs 0.26 ±0.12,0.45 ±0.19 vs 0.20 ±0.07,0.54 ±0.27 vs 0.23 ±0.09 and 0.44±0.23 vs 0.26 ±0.09,respectively.The differences were statistically significant(t =3.38,2.44,3.60,4.20,3.11,P ＜ 0.05).No statistically significant difference was found in the volume of the same target for GTV0,GTV50,GTV3D,IGTVMIP and IGTVIN+Ex delineated by the six oncologists before and after the establishment of the delineation criteria.For delineator 3 and 6,the differences of GTV0,GTV50,IGTVIN+EX before and after establishment of the delineation criteria were statistically significant(t =2.46,2.91,3.28,P ＜0.05 ;t =2.40,2.79,3.22,P ＜0.05).For delineator 4,the differences of GTV0,GTV50,IGTVIN+EX,IGTVMIP,GTV3D before and after establishment of the delineation criteria were statistically significant (t =2.70,3.21,3.04,3.99,3.00,P ＜ 0.05).Conclusions The unified delineation criteria can significantly reduce the inter-observer variability in delineating the GTVs based on 3D-CT or 4D-CT images,and in delineating the IGTVMIP based on 4D-CT images of peripheral lung cancer patients.However,regarding the same delineator,various influences of the unified delineation criteria on the target delineation are observed.
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Objective To evaluate the value of post-processing techniquos of multi-slice spiral CT(MSCT) in diagnosis of small peripheral lung cancer. Methods 36 patients with small peripheral lung cancer(≤20mm in di-ameter) who had been proved by pathology were eoueeted. After MSCT scanning ,3D reconstruction images were made by MPR,SSD and VR,then compared with axial thin-slice images. Results The sensitivity of MPR on vascularnotch sign,lobulation and spiculated sign was higher than that of axial thin-slice images. The sensitivity of SSD on peural sign was higher than that of axial thin-slice images. The sensitivity of VR on vascularnotch sign and lobulation was higher than that of axial thin-slice images. Conclusion The post-processing techniques of MSCT have high value on diagnosis of small peripheral lung cancer. More information could be collected when many kinds of post-processing techniques were used.
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Objective To analyze features and diagnostic value of imageology of the early peripheral lung carcinoma.Methods The dynamic changes of early peripheral lung carcinoma confirmed pathologically in 21 cases were retrospectively analysed.The imaging features in combination with pathological data were also analysed.Results All of 21 cases,16 cases were the tubercle type(76.1%),3 cases were the spot type(14.3%) and 2 cases were the vacuole type(9.6%).Conclusion The typical imaging features of early peripheral lung carcinoma are few,the dynamic observation of the disease is of relatively high value in diagnosis.
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50%),3 cases speculate that tubecavity didn′t change obviously between cancer lesion and bronchus.The main appearance of bronchiole near lesion distribution was presented as expressed,displacement,going round.There was not constriction obviously or blockage in tubecavity.The main appearance of histology near lesion border was presented as degenerated fibrous tissue envelope and collapse alveoli tissue by lesion expressed.Conclusion The pathological base of interface imaging asymmetry distribution in PLC is bronchial tube emphraxis,lymphatic vessel refluent obstruction,pulmonary interstitial fibrous tissue proliferation,carcinoma infiltration in cancer nodules and lung interface that cancer lesion resulted.
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Objective To study the imaging distribution feature and diagnostic value of high resolution computed tomography(HRCT)in peripheral lung cancer(PLC).Methods The feature of imaging distribution was analysed in 37 patients with PLC by pathological proved,which compared with those in 23 cases with lung benign nodules by selected randomly.A double blind method was taken on the manifestations of HRCT about lung nodules tumor-lung interface in near heart side and far heart side.①cloudy or/and shaggy②spiculate③smooth.To search and define the correlation between its distributing feature;manifestations of 3 kinds HRCT;alteration of segment level bronchus and lung benign malignancy nodules.Results Cloudy,or shaggy,spiculalte departing from heart side in lung-tumor interface by HRCT were observed in peripheral lung cancer(79%) and benign nodules(22%);smooth was observed in peripheral lung cancer(14%) and benign nodules(74%).Some cases possed simultaneously two or more than two kinds HRCT's signs.Incidence rate of emphraxis and stenosis signs of segment level bronchus in PLC was higher than that in benign nodules.Conclusion Asymmetry apo-tip dominant position distribution of cloudy or shaggy,and spiculate change of tumor-lung interface by HRCT played an important role in qualitative diagnosis of peripheral lung cancer(≤3.5 cm).The appearance reason relates with the bronchial ventilation that the lesion results in occlusion.
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BACKGROUND: Bronchoscopy has been widely used for a histologic diagnosis through a transbronchial lung biopsy or for staging of patients with peripheral lung cancer. However a transthoracic needle aspiration (TTNA) has been used more widely for a histologic diagnosis in patient with a small size nodule or a nodule located in the outer portion of the lung because of the low diagnostic yield of bronchoscopy in these cases. The role of bronchoscopy for staging is not well established in patients with peripheral lung cancer diagnosed by a TTNA or patients who are undergoing surgery without a histologic diagnosis. METHOD: To evaluate the role of bronchoscopy for the staging in patients with peripheral lung cancer, who were diagnosed by TTNA, the medical records of 86 patients with peripheral lung cancer who underwent bronchoscopy at Kyungpook National University Hospital between January 1995 and May 1997 were reviewed. RESULTS: While 53 cases had normal bronchoscopic findings, 33 cases had abnormal bronchoscopic findings comprising 9 cases of tumor, 10 cases of infiltration and 14 cases of compression of which there were 25 cases of T1 and 8 T2 endoscopically. The bronchoscopic staging did not influence the changes of the clinical stage of lung cancer. The frequencies of bronchial involvement tended to increase as the sizes of the nodule increased. Among the 42 patients who underwent surgery, 9 patient staged higher after operation because of lymph node involvement in 8 patients and the involvement of the pulmonary artery in 1 patient. No case staged above after operation due to a bronchial invasion. CONCLUSION: These findings suggests that bronchoscopy is not useful for staging in patients with peripheral lung cancer diagnosed by a TTNA.
Subject(s)
Humans , Biopsy , Bronchoscopy , Diagnosis , Lung Neoplasms , Lung , Lymph Nodes , Medical Records , Needles , Pulmonary ArteryABSTRACT
Objective To analyse the dynamic changes of peripheral small lung cancer on CT images in different periods and to summarize its morphological features so that improving the diagnosis level.Methods The CT images of 30 cases with peripheral lung cancer confirmed by pathology and cytology were analysed retrospectively.Results Most peripheral small lung cancer appeared as nodule,their average diameter was 17 mm.9 cases showed homogeneous density and another 9 cases were appeared as aggregation by small multi-nodule.6 cases were slight lobulated and another 6 cases had short spiculation.A few of the cases revealed nontypical lobular shadows which were easily diagnosed inflammations.With dynamic observation,all the lesions showed typical peripheral lung cancer features including like nodule,growth gradually,lobulated and speculate brim and pleura retraction.Conclusion If the small nodules (diameter
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Objective To understand the bronchovascular nodule notch sign based on pathology and to evaluate the potential role in detecting this "sign"by multiplanar reconstruction(MPR).Methods ① 91 cases of small peripheral lung cancer (SPLC) and 55 cases of benignant nodule,confirmed by pathology were analysed.11 fresh lobectonic specimens including 9 cases with SPLC and 2 cases with benignant nodule were collected to make the gross pathologyical sections.The bronchovascular convergences in benign and malignant nodule were analysed comparatively.② MPR in 20 cases with malignant nodule and 13 cases with benign nodle were performed in order to observe the bronchovascular convergences.Results ① The specialty of nodule notch sign was 95.2% for malignant tumors.② The detecting rate of nodule notch sign on MPR in malignant nodule was 70%,which was of significant difference between MPR and plain CT scan.Conclusion "Notch sign" is of important value in the diagnosis of SPLC associated with BVC.The detected rate of "notch sign"will be improved by spiral CT MPR.
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Objective:To study correlation of degree spiral CT enhancement and ultrastruction and density microvessel in peripheral lung cancer.Methods:31 cases of peripheral lung cancer comfirmed by operatien and pthology were examined with spiral computed tomography of enhancement with iodiated contrast meaterial before operaton.Ultrastructure and density microvessels were observed by transmission electron microscope and immunohistochemical method by factor Ⅷ on the specimens of the resected tumors.Results:①A increase in microvessel permeability of lung cancer resulted from gap between endotheliums of microvessel,lack of basement membrane of cracking,large cancer cell space.②The degree of spiral CT enhancement was correlated with microvessel density in peripheral lung cancer(r=0.926,?