Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8062, USA.
Ann Thorac Surg. 2010 Mar;89(3):998-1005. doi: 10.1016/j.athoracsur.2009.07.097.
Primary bronchopulmonary carcinoids comprise a significant proportion of carcinoid tumors. The clinical presentation allows prediction of the diagnosis and cell type and directs evaluation and treatment. Young age, central tumor, and no nodal enlargement are highly suggestive of typical carcinoid. These patients require no further diagnostic or staging tests beyond chest computed tomography and bronchoscopy before resection using parenchyma-sparing techniques. All bronchopulmonary carcinoids are malignant (though indolent), and surgical intervention is the mainstay of treatment. Mediastinoscopy is suggested when there is moderate suspicion of atypical carcinoid (central cN1 or peripheral cN0), with lobectomy and lymphadenectomy if the mediastinal nodes are benign. For a high suspicion of atypical carcinoid (central cN2, peripheral cN1, 2), imaging for distant metastases and mediastinoscopy is suggested, with multimodality treatment for an atypical carcinoid with N2 involvement.
原发性支气管肺类癌占类癌肿瘤的很大比例。临床表现有助于预测诊断和细胞类型，并指导评估和治疗。年轻、中央肿瘤和无淋巴结肿大高度提示典型类癌。这些患者在使用保留实质的技术切除前，除了胸部计算机断层扫描和支气管镜检查外，不需要进一步的诊断或分期检查。所有支气管肺类癌都是恶性的（尽管惰性），手术干预是治疗的主要方法。当怀疑为非典型类癌（中央 cN1 或周围 cN0）时，建议进行纵隔镜检查，如果纵隔淋巴结为良性，则进行肺叶切除术和淋巴结切除术。对于高度怀疑为非典型类癌（中央 cN2、周围 cN1、2），建议进行远处转移的影像学检查和纵隔镜检查，并对有 N2 受累的非典型类癌进行多模式治疗。
