Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Pulmonary and Critical Care Medicine, Punan Hospital, Shanghai, China.
Clin Respir J. 2020 Sep;14(9):829-838. doi: 10.1111/crj.13215. Epub 2020 Jun 30.
It is intractable to differentiate the malignancy from benignancy of cancer-suspected pulmonary nodules less than 8 mm.
The patients with small pulmonary nodules less than 8 mm which were suspected to be primary lung cancer underwent bronchoscopy and bronchoalveolar lavage. The level of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β) and hepatocyte growth factor (HGF) in bronchoalveolar lavage fluid (BALF) were assayed. Then, all patients underwent histopathological examination by means of surgical resection of nodules to determine their benignancy or malignancy. The nodules' benignancy and malignancy suggested by the biomarker panel consisted of VEGF, TGF-β and HGF in BALF were validated by the histopathological results to determine their screening efficiency.
Among 405 patients with pulmonary nodules less than 8 mm, 252 and 153 were predicted to be malignant and benignant, respectively, by using the biomarker panel in BALF. Finally, 180 (71.4%) of 252 and 114 (74.5%) of 153 were validated to be truly malignant and benignant, respectively, according to the histopathological results. In a receiver operating characteristic curve analysis of screening efficiency for pulmonary nodules less than 8 mm, the results demonstrated that the AUC [0.807 (0.658-0.882)] of the biomarker panel in BALF was higher compared with that [0.605 (0.433-0.738)] of the biomarker panel in blood (P = .001).
For patients with cancer-suspected pulmonary nodules less 8 mm, a biomarker panel of VEGF, TGF-β and HGF in BALF demonstrated more eligible screening efficiency for the preliminary differentiation of malignancy from benignancy, by contrast with their level in blood as well as PET/CT.
小于 8 毫米的疑似肺癌结节的良恶性鉴别具有一定难度。
对直径小于 8 毫米的疑似原发性肺癌的肺小结节患者进行支气管镜及肺泡灌洗，检测支气管肺泡灌洗液（BALF）中血管内皮生长因子（VEGF）、转化生长因子-β（TGF-β）和肝细胞生长因子（HGF）的水平。然后，所有患者均通过手术切除结节进行组织病理学检查，以确定其良恶性。BALF 中 VEGF、TGF-β 和 HGF 等生物标志物联合预测结节的良恶性，并与组织病理学结果相验证，以确定其筛查效率。
在 405 例直径小于 8 毫米的肺结节患者中，BALF 生物标志物联合预测为恶性和良性的患者分别为 252 例和 153 例。最后，根据组织病理学结果，252 例中 180 例（71.4%）和 153 例中 114 例（74.5%）被证实为真正的恶性和良性。在用于直径小于 8 毫米肺结节的筛查效率的受试者工作特征曲线分析中，BALF 生物标志物联合的 AUC[0.807（0.658-0.882）]高于血液生物标志物联合的 AUC[0.605（0.433-0.738）]（P=.001）。
对于直径小于 8 毫米的疑似肺癌结节患者，BALF 中 VEGF、TGF-β 和 HGF 的生物标志物联合在良恶性初步鉴别方面显示出更高的筛查效率，优于血液生物标志物联合及 PET/CT。
