Kennedy Timothy C, Franklin Wilbur A, Prindiville Sheila A, Cook Robert, Dempsey Edward C, Keith Robert L, Hirsch Fred R, Merrick Thomas A, Shroyer Kenneth R, Petty Thomas L, Byers Tim, Bunn Paul A, Miller York E
University of Colorado Comprehensive Cancer Center, University of Colorado Health Sciences Center, Denver, CO, USA.
Lung Cancer. 2005 Aug;49(2):187-91. doi: 10.1016/j.lungcan.2005.02.009. Epub 2005 Apr 14.
Early stage radiographically occult lung cancer has a high cure rate, but comprises a small fraction of all lung cancer. Abnormal sputum cytology is one indication for bronchoscopy in patients with chest imaging that is not suspicious for lung cancer. While there is good evidence that sputum cytologic findings of carcinoma, carcinoma in situ or severe atypia predict high rates of diagnosis of lung cancer, less is known of the frequency in which lung cancer is diagnosed in bronchoscopies carried out for the indication of moderate sputum atypia. One small series, published in abstract form only, reported an 8% rate of diagnosis of lung cancer in subjects bronchoscoped for moderate atypia. We tested the hypothesis that moderate sputum atypia is an indicator of occult central airway cancer in a retrospective analysis of a group of high risk subjects, defined as current or former smokers with >30 pack-years tobacco smoking and airflow obstruction with moderate atypia sputum cytology. Seventy-nine such subjects with no evidence of malignancy on chest radiograph at the time bronchoscopy was scheduled underwent white light and autofluorescence bronchoscopy. Lung cancer was found in five subjects; three had invasive squamous cell carcinomas and two had carcinoma in situ. Seven additional subjects had severe dysplasia found on endobronchial biopsy. Moderate sputum atypia may be an important marker of risk for occult endobronchial malignancy in high risk subjects.
早期影像学隐匿性肺癌的治愈率很高，但在所有肺癌中所占比例较小。痰液细胞学异常是胸部影像学未怀疑肺癌患者进行支气管镜检查的一项指征。虽然有充分证据表明，癌细胞、原位癌或重度异型增生的痰液细胞学检查结果预示着肺癌的高诊断率，但对于因中度痰液异型增生而进行支气管镜检查时肺癌的诊断频率了解较少。仅以摘要形式发表的一个小系列研究报告称，因中度异型增生接受支气管镜检查的受试者中肺癌诊断率为8%。在一项对一组高危受试者的回顾性分析中，我们检验了中度痰液异型增生是隐匿性中央气道癌指标这一假设，这些高危受试者定义为目前或既往吸烟史≥30包年且有气流受限及中度异型增生痰液细胞学检查结果的吸烟者。在计划进行支气管镜检查时胸部X线片无恶性肿瘤证据的79名此类受试者接受了白光和自发荧光支气管镜检查。5名受试者发现患有肺癌；3例为浸润性鳞状细胞癌，2例为原位癌。另外7名受试者经支气管活检发现有重度发育异常。中度痰液异型增生可能是高危受试者隐匿性支气管内恶性肿瘤风险的重要标志物。
