Rivera M Patricia, Mehta Atul C
University of North Carolina at Chapel Hill, 4133 Bioinformatics Building, CB No. 7020, Chapel Hill, NC 27599, USA.
Chest. 2007 Sep;132(3 Suppl):131S-148S. doi: 10.1378/chest.07-1357.
Lung cancer is usually suspected in individuals who have an abnormal chest radiograph finding or have symptoms caused by either local or systemic effects of the tumor. The method of diagnosis of suspected lung cancer depends on the type of lung cancer (ie, small cell lung cancer [SCLC] or non-SCLC [NSCLC]), the size and location of the primary tumor, the presence of metastasis, and the overall clinical status of the patient.
To determine the test performance characteristics of various modalities for the diagnosis of suspected lung cancer.
To update previous recommendations on the initial diagnosis of lung cancer, a systematic search of MEDLINE, Healthstar, and Cochrane Library databases to July 2004, and print bibliographies was performed to identify studies comparing the results of sputum cytology, bronchoscopy, transthoracic needle aspiration (TTNA), or biopsy with histologic reference standard diagnoses among at least 50 patients with suspected lung cancer. Recommendations were developed by the writing committee, graded by a standardized method, and reviewed by all members of the lung cancer panel prior to approval by the Thoracic Oncology Network, Health and Science Policy Committee, and the Board of Regents of the American College of Chest Physician.
Sputum cytology is an acceptable method of establishing the diagnosis of lung cancer with a pooled sensitivity rate of 0.66 and specificity rate of 0.99. However, the sensitivity of sputum cytology varies by location of the lung cancer. For central, endobronchial lesions, the overall sensitivity of flexible bronchoscopy (FB) for diagnosing lung cancer is 0.88. The diagnostic yield of bronchoscopy decreases for peripheral lesions. Peripheral lesions smaller or larger than 2 cm in diameter showed a sensitivity of 0.34 and 0.63, respectively. In recent years, endobronchial ultrasound (EBUS) has shown potential in increasing the diagnostic yield of FB while dealing with peripheral lesions without adding to the risk of the procedure. In appropriate situations, its use can be considered before moving on to more invasive tests. The pooled sensitivity for TTNA for the diagnosis of lung cancer is 0.90. A trend toward lower sensitivity was noted for lesions < 2 cm in diameter. The accuracy in differentiating between SCLC and NSCLC cytology for the various diagnostic modalities was 0.98, with individual studies ranging from 0.94 to 1.0. The average false-positive rate and FN rate were 0.09 and 0.02, respectively.
The sensitivity of bronchoscopy is high for the detection of endobronchial disease and poor for peripheral lesions < 2 cm in diameter. Detection of the latter can be aided with the use of EBUS in the appropriate clinical setting. The sensitivity of TTNA is excellent for malignant disease. The distinction between SCLC and NSCLC by cytology appears to be accurate.
肺癌通常在胸部X线检查结果异常或出现由肿瘤局部或全身影响所致症状的个体中被怀疑。疑似肺癌的诊断方法取决于肺癌的类型（即小细胞肺癌[SCLC]或非小细胞肺癌[NSCLC]）、原发肿瘤的大小和位置、转移情况以及患者的整体临床状况。
确定各种诊断疑似肺癌方法的检测性能特征。
为更新先前关于肺癌初始诊断的建议，对截至2004年7月的MEDLINE、Healthstar和Cochrane图书馆数据库进行系统检索，并查阅印刷型文献目录，以识别比较痰细胞学、支气管镜检查、经胸针吸活检（TTNA）或活检与组织学参考标准诊断结果的研究，研究对象为至少50例疑似肺癌患者。由写作委员会制定建议，采用标准化方法分级，并在胸肿瘤学网络、健康与科学政策委员会以及美国胸科医师学会理事会批准之前，由肺癌专家小组的所有成员进行审查。
痰细胞学是诊断肺癌的一种可接受方法，合并敏感度为0.66，特异度为0.99。然而，痰细胞学的敏感度因肺癌位置而异。对于中央型支气管内病变，可弯曲支气管镜（FB）诊断肺癌的总体敏感度为0.88。支气管镜检查对周围型病变的诊断率降低。直径小于或大于2 cm的周围型病变的敏感度分别为0.34和0.63。近年来，支气管内超声（EBUS）在处理周围型病变时，在不增加操作风险的情况下，显示出提高FB诊断率的潜力。在适当情况下，在进行更具侵入性的检查之前可考虑使用。TTNA诊断肺癌的合并敏感度为0.90。直径<2 cm的病变的敏感度有降低趋势。各种诊断方法区分SCLC和NSCLC细胞学的准确率为0.98，个别研究范围为0.94至1.0。平均假阳性率和FN率分别为0.09和0.02。
支气管镜检查对支气管内疾病的检测敏感度高，对直径<2 cm的周围型病变敏感度低。在适当的临床环境中，使用EBUS有助于检测后者。TTNA对恶性疾病的敏感度极佳。通过细胞学区分SCLC和NSCLC似乎是准确的。
