Fukui Takayuki, Sakakura Noriaki, Mori Shoichi, Hatooka Shunzo, Shinoda Masayuki, Yatabe Yasushi, Mitsudomi Tetsuya
Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
J Thorac Oncol. 2007 Jun;2(6):546-52. doi: 10.1097/JTO.0b013e318060d30d.
In recent years, the clinical use of high-resolution computed tomography has greatly advanced the diagnosis of small lesions of the peripheral lung. Such small lesions are often associated with ground-glass opacity in computed tomography findings. The noninvasive bronchioloalveolar carcinoma component with a replacement growth pattern of alveolar lining cells manifests as ground-glass opacity. Bronchioloalveolar carcinoma is classified as a subset of lung adenocarcinoma, but has a distinct clinical presentation, tumor biology, and favorable prognosis. Most small peripheral lung lesions including bronchioloalveolar carcinoma putatively originate from the peripheral airway epithelium, in which the epidermal growth factor receptor gene is frequently mutated. As with other subsets of non-small cell lung cancer, surgical resection is a potentially curative treatment. For the ground-glass opacity type of tiny lesions, particularly those less than 1 cm in their greatest dimension, the question has been raised whether lobectomy is really needed. Although several authors in Japan suggest the suitability of limited resection including segmentectomy and wedge resection without any nodal dissections for these small lung adenocarcinomas, this procedure should be validated in future clinical trials.
近年来，高分辨率计算机断层扫描的临床应用极大地推动了周围型肺小病灶的诊断。此类小病灶在计算机断层扫描结果中常伴有磨玻璃影。具有肺泡衬里细胞替代生长模式的非侵袭性细支气管肺泡癌成分表现为磨玻璃影。细支气管肺泡癌被归类为肺腺癌的一个亚型，但具有独特的临床表现、肿瘤生物学特性及良好的预后。包括细支气管肺泡癌在内的大多数周围型肺小病灶推测起源于外周气道上皮，其中表皮生长因子受体基因常发生突变。与其他非小细胞肺癌亚型一样，手术切除是一种可能治愈的治疗方法。对于磨玻璃影型微小病灶，尤其是最大径小于1厘米的病灶，人们提出了是否真的需要进行肺叶切除的问题。尽管日本的几位作者认为对于这些小肺腺癌，包括肺段切除术和楔形切除术且不进行任何淋巴结清扫的有限切除是合适的，但该手术应在未来的临床试验中得到验证。
