Nomori H, Horio H, Fuyuno G, Kobayashi R, Morinaga S, Suemasu K
Department of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Chest. 1998 Jul;114(1):40-4. doi: 10.1378/chest.114.1.40.
To examine the characteristics of peripheral lung adenocarcinomas diagnosed by open lung or video-assisted thoracoscopic surgery (VATS) biopsy.
We used retrospective analysis to compare tumor stage, pleural involvement, central tumor fibrosis, and the number of bronchi or vessels involved with tumors of small peripheral lung adenocarcinomas diagnosed by bronchoscopic biopsy.
Subjects had lung adenocarcinomas diagnosed by open lung or VATS (n=22) and those diagnosed by bronchoscopic biopsy (n=22), which were matched by tumor size.
The T1N0M0 tumor was notably more frequent in the open lung or VATS group (77.3%) than in the bronchoscopic biopsy group (36.4%) (p<0.01). Tumors invading beyond the pleural surface were less frequent in the open lung or VATS group (4.5%) than in the bronchoscopic biopsy group (40.9%) (p<0.01). The grade of in-tumor central fibrosis--a malignancy factor and the cause of bronchi or vessel involvement with tumors-was significantly lower in the open lung or VATS group than in the bronchoscopic biopsy group (p<0.01). The number of bronchi or vessels involved with tumors was significantly fewer in the open lung or VATS group than in the bronchoscopic biopsy group (p<0.001).
(1) Lung adenocarcinomas diagnosed by open lung or VATS biopsy were more frequently T1N0M0 than those diagnosed by bronchoscopic biopsy, which was caused by low grade of central tumor fibrosis rather than small tumor size. (2) They were infrequently diagnosed by bronchoscopic biopsy because few bronchi were involved by tumors due to the low grade of central tumor fibrosis. (3) Small pulmonary nodules not diagnosable by bronchoscopic biopsy should be diagnosed aggressively using VATS biopsy to detect early-stage lung cancer.
探讨通过开胸肺活检或电视辅助胸腔镜手术（VATS）活检诊断的周围型肺腺癌的特征。
我们采用回顾性分析，比较经支气管镜活检诊断的小周围型肺腺癌与经开胸肺活检或VATS活检诊断的肿瘤的分期、胸膜受累情况、肿瘤中央纤维化以及受累支气管或血管的数量。
研究对象包括经开胸肺活检或VATS诊断的肺腺癌患者（n = 22）以及经支气管镜活检诊断的肺腺癌患者（n = 22），两组患者根据肿瘤大小进行匹配。
开胸肺活检或VATS组中T1N0M0肿瘤的发生率（77.3%）显著高于支气管镜活检组（36.4%）（p<0.01）。开胸肺活检或VATS组中肿瘤侵犯超过胸膜表面的情况（4.5%）少于支气管镜活检组（40.9%）（p<0.01）。肿瘤中央纤维化程度（一种恶性因素及肿瘤累及支气管或血管的原因）在开胸肺活检或VATS组显著低于支气管镜活检组（p<0.01）。开胸肺活检或VATS组中肿瘤累及的支气管或血管数量显著少于支气管镜活检组（p<0.001）。
（1）通过开胸肺活检或VATS活检诊断的肺腺癌比经支气管镜活检诊断的更常为T1N0M0，这是由于肿瘤中央纤维化程度低而非肿瘤体积小所致。（2）它们很少通过支气管镜活检确诊，因为肿瘤中央纤维化程度低，累及的支气管较少。（3）对于支气管镜活检无法诊断的小肺结节，应积极采用VATS活检进行诊断以检测早期肺癌。
