Jin Fa-Guang, Li Wang-Ping, Mu De-Guang, Chu Dong-Ling, Fu En-Qing, Xie Yong-Hong, Lu Jing-Li, Sun Ya-Ni
Department of Respiratory Diseases, Tangdu Hospital, Forth Military Medical University, Xi'an 710038, China.
Zhonghua Yi Xue Za Zhi. 2009 Jun 23;89(24):1667-71.
To evaluate the combination of 7 interventional pulmonology methods in early diagnosis of lung cancer.
A total of 467 patients with thoracic and pulmonary lesions (include hilum pulmonis lymphadenectasis, mediastinal lymphadenectasis, pulmonary scobination, lump, lamellar infiltration, small amount of pleural fluid and pleural scobination) had negative results via exfoliative cytology, bacteriology and routine bronchoscopy. All these patients had ultrathin bronchoscopy with biopsy and brushing. For those 155 cases whose foci were located at porta pulmonis, inner zone or median zone, the authors applied ultrathin bronchoscopy with biopsy and brushing guided by X-ray. For those 95 cases whose foci were located at median zone or outer zone and unconnected with chest wall, per cutem lung puncture needle aspiration was employed under the guidance of X-ray. For those 102 cases whose foci were tightly connected with pleural membrane, per cutem lung puncture biopsy was employed under the guidance of type-B ultrasonic. For those 59 cases with suspected central airway foci, auto-fluorescence bronchoscopic biopsy and brushing were employed. For those 67 cases with hilum pulmonis or mediastinal lymphadenectasis, endobronchial ultrasonic transbronchial needle aspiration (EBUS-TBNA) was employed. For those 23 cases with small amount of pleural fluid or pleural scobination, electronic thoracoscopic biopsy and brushing were employed.
It was found that 118 cases were diagnosed by ultrathin bronchoscopic biopsy and brushing with a positive rate of 25.3% (118/467), 105 cases by ultrathin bronchoscopy with biopsy and brushing guided by X-ray with a positive rate of 67.7% (105/155), 63 cases by per cutem lung puncture needle aspiration under the guidance of X-ray with a positive rate of 66.3% (63/95), 69 cases by per cutem lung puncture biopsy under the guidance of type-B ultrasound with a positive rate of 67.6% (69/102), 18 cases by auto-fluorescence bronchoscopic biopsy and brushing with a positive rate of 35.3% (18/51), 52 cases by EBUS-TBNA with a positive rate of 77.6% (52/67), 12 cases by electronic thoracoscopic biopsy and brushing with a positive rate of 52.2% (12/23). The total positive diagnostic rate was 93.6% (437/467). And the diagnostic rate of < or = stage II lung cancer (3 cases carcinoma in situ, 84 stage I a, 63 stage Ib, 65 stage IIa and 44 stage IIb) was 82.7% (259/313).
Joint application of these 7 interventional bronchoscopic techniques can significantly boost the rate of early diagnosis of lung cancer.
评估7种介入肺脏病学方法联合应用于肺癌早期诊断的效果。
467例胸肺部病变患者（包括肺门淋巴结肿大、纵隔淋巴结肿大、肺部合并症、肿块、片状浸润、少量胸腔积液及胸膜合并症），经脱落细胞学、细菌学及常规支气管镜检查结果均为阴性。所有患者均接受了超细支气管镜活检及刷检。对于155例病灶位于肺门、内带或中带的患者，采用X线引导下的超细支气管镜活检及刷检；对于95例病灶位于中带或外带且与胸壁无关联的患者，采用X线引导下经皮肺穿刺针吸活检；对于102例病灶与胸膜紧密相连的患者，采用B型超声引导下经皮肺穿刺活检；对于59例疑似中央气道病灶的患者，采用自发荧光支气管镜活检及刷检；对于67例肺门或纵隔淋巴结肿大的患者，采用支气管内超声引导下经支气管针吸活检（EBUS-TBNA）；对于23例少量胸腔积液或胸膜合并症的患者，采用电子胸腔镜活检及刷检。
发现经超细支气管镜活检及刷检确诊118例，阳性率为25.3%（118/467）；X线引导下超细支气管镜活检及刷检确诊105例，阳性率为67.7%（105/155）；X线引导下经皮肺穿刺针吸活检确诊63例，阳性率为66.3%（63/95）；B型超声引导下经皮肺穿刺活检确诊69例，阳性率为67.6%（69/102）；自发荧光支气管镜活检及刷检确诊18例，阳性率为35.3%（18/51）；EBUS-TBNA确诊52例，阳性率为77.6%（52/67）；电子胸腔镜活检及刷检确诊12例，阳性率为52.2%（12/23）。总阳性诊断率为93.6%（437/467）。Ⅱ期及以下肺癌（3例原位癌、84例Ⅰa期、63例Ⅰb期、65例Ⅱa期和44例Ⅱb期）的诊断率为82.7%（259/313）。
联合应用这7种介入支气管镜技术可显著提高肺癌的早期诊断率。
