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目的 探讨以骨转移症状为首发表现的肺癌误诊原因及影像学特征。方法 回顾分析2022年1月至2024年1月曾误诊为骨关节炎、椎体骨质增生、原发性骨肿瘤的8例肺癌骨转移患者的病例资料。结果 8例中男5例、女3例，年龄45～72岁。4例以持续性骨痛伴活动受限为主要表现，疼痛部位涉及肋骨2例、髂骨1例及股骨1例，根据影像学检查结果，初诊为骨关节炎，经非甾体抗炎药治疗2～3个月无效；后因症状加重行胸部CT检查均发现肺内结节，直径1.2～3.5 cm，经CT引导下穿刺活检证实为肺腺癌伴骨转移。2例表现为胸腰椎持续性钝痛，直立活动时加重，经X线及磁共振成像检查初诊为椎体骨质增生，经3个月保守治疗无改善；正电子发射体层摄影（PET）-CT显示椎体代谢增高伴右肺上叶直径2.1 cm高代谢结节，在超声支气管镜引导下经支气管针吸活检术确诊为肺鳞癌椎体转移。2例以局部骨性肿块就诊（1例肱骨近端、1例髂骨），X线示溶骨性破坏伴软组织影，初诊为原发性骨肿瘤；术中冰冻切片病理检查提示转移性腺癌，术后经支气管镜活检及免疫组化确诊为肺腺癌骨转移。8例误诊时间2～6个月，确诊后均接受原发灶靶向/化疗联合骨转移灶放疗的综合治疗，随访6～12个月，2例获得部分缓解，4例病情稳定，2例进展（其中1例因多器官转移死亡）。结论 肺癌骨转移早期易误诊为骨关节炎、椎体骨质增生及原发性骨肿瘤等骨病。临床遇及不明原因骨痛或骨质破坏患者，应完善胸部影像学检查，以提高早期诊断率。
Abstract：Objective To investigate misdiagnosis causes and imaging features of lung cancer with bone metastasis symptoms as the initial manifestation. Methods A retrospective analysis was conducted on the case data of 8 patients with lung cancer and bone metastases who were initially misdiagnosed as having osteoarthritis, vertebral osteophytes, or primary bone tumors from January 2022 to January 2024. Results Among the 8 patients, there were 5 males and 3 females, aged from 45 to 72 years. Four cases presented mainly with persistent bone pain accompanied by limited movement. The pain sites involved the ribs in 2 patients, the ilium in 1 patient and the femur in 1 patient. According to the imaging examination results, the initial diagnosis was osteoarthritis, and the treatment with non-steroidal anti-inflammatory drugs for 2 to 3 months was ineffective. Later, due to the aggravation of symptoms, chest CT examinations were performed, and nodules in the lungs were all detected, with diameters ranging from 1.2 to 3.5 cm. CT-guided biopsy confirmed lung adenocarcinoma with bone metastasis. Two patients presented with persistent dull pain in the thoracolumbar spine, which worsened during upright activities. They were initially diagnosed as vertebral osteophyte hyperplasia through X-ray and magnetic resonance imaging examinations, and there was no improvement after 3 months of conservative treatment. Positron emission tomography-computed tomography(PET-CT) showed increased vertebral metabolism accompanied by a hypermetabolic nodule measuring 2.1 cm in diameter in the upper lobe of the right lung. The diagnosis of vertebral metastasis from lung squamous cell carcinoma was confirmed by transbronchial needle aspiration biopsy guided by ultrasound bronchoscopy. Two patients presented with local bony masses(one in the proximal humerus and one in the ilium). X-rays showed osteolytic destruction accompanied by soft tissue shadows, and the initial diagnosis was primary bone tumors. Intraoperative freezing section pathology suggested metastatic adenocarcinoma, and postoperative bronchoscopic biopsy and immunohistochemistry confirmed it as bone metastasis of lung adenocarcinoma. The misdiagnosis duration of 8 patients was 2 to 6 months. After diagnosis, all of them received comprehensive treatment of targeted/chemotherapy of the primary lesion combined with radiotherapy of bone metastases. They were followed up for 6 to 12 months. Of them, 2 patients achieved partial remission, 4 patients had stable conditions, and 2 patients showed disease progression(including 1 death due to multiple organ metastases). Conclusion Early-stage bone metastasis of lung cancer is often misdiagnosed as osteoarthritis, vertebral osteophytes, primary bone tumors and other bone diseases. When encountering patients with unexplained bone pain or bone destruction in clinical practice, chest imaging examinations should be completed to improve the early diagnosis rate.
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基本信息:
中图分类号:R734.2
引用信息:
[1]杨淇茗,刘林稳,刘基,等.以骨转移症状为首发表现的肺癌误诊原因及影像学特征分析[J].临床误诊误治,2026,39(01):17-23.
基金信息:
四川省医院协会青年药师科研专项资金项目(YP2202419)
2026-01-13
2026-01-13