Agustí C, Xaubet A, Montón C, Solé M, Soler N, Carrión M, Rodriguez Roisín R
Servei de Pneumologia, Institut Clínic de Pneumología i Cirurgía Toràcica, Barcelona, Spain.
Respir Med. 2001 Oct;95(10):822-8. doi: 10.1053/rmed.2001.1173.
The diagnosis of small peripheral lung cancer is difficult to achieve by non-invasive methods. We hypothesized that in these patients induced sputum might ncrease the diagnostic yield over spontaneous sputum, representing a good diagnostic alternative in selected patients. We prospectively evaluated 60 patients with peripheral lung lesions and normal bronchoscopic evaluation. Six samples of sputum (three spontaneous and three induced with nebulization of hypertonic saline) before bronchoscopy and six samples of sputum after bronchoscopy (three spontaneous and three induced) were obtained in each subject. Forty-two out of the 60 patients included were finally diagnosed with lung cancer. Eighteen patients were diagnosed with different benign conditions of the lung. Overall, malignant cells in sputum were observed in 21 patients and in all but one, the final diagnosis of lung cancer was achieved. Only one patient with a pseudoinflammatory tumour of the lung had a false-positive result in one spontaneous sputum sample. The diagnosis of lung cancer was obtained in 18 patients with the induced sputum (43%) and in 14 patients with spontaneous sputum (31%) (P=NS). Samples of induced sputum were more adequate for cytological analysis than samples of spontaneous sputum (P < 0.001). Of 13 patients with peripheral lung neoplasms of 2 cm or less in diameter, five were diagnosed using induced sputum (38%) and only one using spontaneous sputum (8%) (P<0.05). In conclusion, induced sputum is a valuable technique for the diagnosis of peripheral lung cancer. Induced sputum gives better quality specimens and better diagnostic yield in small lesions than the spontaneous sputum and may be indicated in selected patients with disseminated disease, inoperability or severe co-morbities.
通过非侵入性方法很难实现外周型小肺癌的诊断。我们推测，对于这些患者，诱导痰可能比自然咳痰具有更高的诊断阳性率，是特定患者的一种良好诊断选择。我们前瞻性地评估了60例有外周肺病变且支气管镜检查正常的患者。每位受试者在支气管镜检查前获取6份痰样本（3份自然咳痰和3份用高渗盐水雾化诱导咳痰），支气管镜检查后也获取6份痰样本（3份自然咳痰和3份诱导咳痰）。60例纳入患者中42例最终被诊断为肺癌。18例患者被诊断为不同的肺部良性疾病。总体而言，21例患者的痰中观察到恶性细胞，除1例患者外，其余均最终确诊为肺癌。仅1例患有肺假炎性肿瘤的患者在1份自然咳痰样本中出现假阳性结果。18例患者通过诱导痰确诊肺癌（43%），14例患者通过自然咳痰确诊肺癌（31%）（P=无统计学意义）。诱导痰样本比自然咳痰样本更适合进行细胞学分析（P<0.001）。在13例直径2cm或更小的外周肺肿瘤患者中，5例通过诱导痰确诊（38%），仅1例通过自然咳痰确诊（8%）（P<0.05）。总之，诱导痰是诊断外周型肺癌的一项有价值的技术。与自然咳痰相比，诱导痰能提供质量更好的样本，对小病变的诊断阳性率更高，对于患有播散性疾病、无法手术或有严重合并症的特定患者可能适用。
