Minami H, Ando Y, Nomura F, Sakai S, Shimokata K
Department of Internal Medicine, Japanese Red Cross Nagoya First Hospital.
Chest. 1994 Jun;105(6):1658-62. doi: 10.1378/chest.105.6.1658.
We evaluated the interbronchoscopist variability in the diagnosis of lung cancer by flexible bronchoscopy.
A retrospective review of the bronchoscopic records and clinical charts of patients at a university-affiliated hospital.
All records of flexible bronchoscopic procedures performed for the diagnosis of lung cancer were retrospectively reviewed, and procedures that obtained histologic or cytologic evidence of malignancy were considered positive. Rates of positivity were compared according to the following factors: operator, operator experience, bronchoscopic findings, tumor location, and tumor laterality. Factors that affected the positivity rate were evaluated using logistic regression analysis.
Of 384 bronchoscopic procedures performed in 353 patients, 275 (72 percent) were positive. The positivity rate differed significantly depending on the operator (p = 0.003) and the bronchoscopic findings (p < 0.001). A difference between operators was noted in technically difficult cases without epithelial or subepithelial findings and when tumors were located in the upper lobe or the superior segment of the lower lobe. The bronchoscopic findings and the operator also emerged as factors significantly affecting the positivity rate in the logistic analysis.
The diagnostic yield of bronchoscopy for lung cancer is dependent on both the type of bronchial lesion present and the bronchoscopist.
我们评估了通过可弯曲支气管镜诊断肺癌时支气管镜检查医师之间的变异性。
对一所大学附属医院患者的支气管镜检查记录和临床病历进行回顾性研究。
对所有为诊断肺癌而进行的可弯曲支气管镜检查记录进行回顾性审查，获得恶性肿瘤组织学或细胞学证据的检查被视为阳性。根据以下因素比较阳性率：操作者、操作者经验、支气管镜检查结果、肿瘤位置和肿瘤侧别。使用逻辑回归分析评估影响阳性率的因素。
在353例患者中进行的384次支气管镜检查中，275例（72%）为阳性。阳性率因操作者（p = 0.003）和支气管镜检查结果（p < 0.001）的不同而有显著差异。在无上皮或上皮下表现的技术困难病例以及肿瘤位于上叶或下叶上段时，不同操作者之间存在差异。支气管镜检查结果和操作者在逻辑分析中也被证明是显著影响阳性率的因素。
支气管镜检查对肺癌的诊断率取决于所存在的支气管病变类型和支气管镜检查医师。
