自发荧光支气管镜在中央型肺癌早期诊断中的研究
发布时间：2018-08-31 19:19
【摘要】：目的:肺癌目前仍然是一个主要的健康问题,也是全球最常见的恶性肿瘤相关死因。中央型肺癌约占肺癌的3/4,绝大部分患者在晚期才被发现,此时往往已失去了最佳治疗时机。而肺癌的高死亡率、低生存率与是否能够早期发现有着密切的相关。普通白光支气管镜(white light bronchoscopy,WLB)是呼吸道疾病最重要的检查手段之一,并已普遍应用于临床实践,对肺癌的诊断和分期有着十分重要的作用;但其对在肺癌早期及癌前病变的发现显示出不足。随着光学和计算机学的飞速发展,自发荧光支气管镜(autofluorescence bronchoscopy,AFB)的出现弥补了普通白光支气管镜这方面的不足;其利用支气管黏膜正常组织与异常(癌变)组织之间的不同荧光属性,来判断黏膜细胞是否异常,以指导活检取材确定病理性质;通常情况下正常组织显示为绿色,异常组织显示为红色。当前国内外,已有很多关于自发荧光支气管镜在肺癌诊断中的研究,并表明其具有一定的优势;但目前对自发荧光支气管镜是否可用于常规实践中来提高肺癌和癌前病变的诊断阳性率仍无定论。本研究主要探讨自发荧光支气管镜在中央型肺癌早期诊断中的临床应用价值。方法:选取于2015年12月至2017年2月在我院支气管镜室,经胸部X片或CT检查疑诊为中央型肺癌,并依据纳入标准共纳入184例的患者,在白光(WLB)状态下和荧光(AFB)状态下同步检查,对两者镜下表现异常的部位均进行活检、刷片及灌洗检查,并将获取的标本送我院病理检查。依据二者镜下表现及病理结果,比较AFB与WLB在诊断中央型肺癌中的敏感性、特异性。结果:纳入的184例患者,最终有105例患者病理证实为阳性,79例患者病理证实为阴性;AFB和WLB对中央型肺癌诊断的敏感性分别为94.3%(99/105)、88.6%(93/105)(P0.05);特异性分别63.3%(50/79)、41.8%(33/79)(P0.05)。亚组分析:新生物组,AFB与WLB的对中央型肺癌诊断的敏感性为91.1%(51/56)、89.7%(52/58)(P0.05);黏膜异常组,AFB与WLB的对中央型肺癌诊断的敏感性为67.9%(38/56)、50.6%(41/81)(P0.05)。分别对AFB和WLB的II级、III级进行比较,II级组中,AFB与WLB的对中央型肺癌诊断的敏感性为72%(36/50)、50.6%(41/81)(P0.05);III级组中,AFB与WLB的对中央型肺癌诊断的敏感性为80.8%(63/78)、89.7%(52/58)(P0.05)。结论:1、在气道内可见新生物生长的患者中AFB与WLB检查两者之间敏感性无显著差异;2、在气道黏膜异常改变(即表现为明显充血水肿,肥厚,增生等)的患者中AFB比WLB的敏感度更高;3、在气道黏膜分别在AFB与WLB镜下II级组的患者中,AFB比WLB的敏感度更高;4、在气道黏膜分别在AFB与WLB镜下III级组的患者中,AFB与WLB之间敏感性无显著差异;5、AFB在肺癌高危人群且影像学疑诊为中央型肺癌的患者中的特异性比WLB高。AFB在中央型肺癌的早期诊断中有一定的临床运用价值。
[Abstract]:Objective: lung cancer is still a major health problem and the most common malignant tumor-related cause of death in the world. Central lung cancer accounts for about 3 / 4 of lung cancer. The high mortality and low survival rate of lung cancer are closely related to early detection. White light bronchoscopy (white light bronchoscopy,WLB) is one of the most important examination methods for respiratory tract diseases and has been widely used in clinical practice. It plays an important role in the diagnosis and staging of lung cancer. However, the findings of early and precancerous lesions in lung cancer are inadequate. With the rapid development of optics and computer science, the appearance of autofluorescence bronchoscopy (autofluorescence bronchoscopy,AFB) makes up for the deficiency of ordinary white bronchoscopy, which utilizes the different fluorescence properties between normal and abnormal (cancerous) tissues of bronchial mucosa. To determine whether the mucosal cells are abnormal or not, to guide the biopsy to determine the pathological properties; normally, normal tissues show green, abnormal tissues show red. At home and abroad, there have been many studies on the diagnosis of lung cancer with autofluorescence bronchoscopy, and it shows that it has some advantages. However, whether autofluorescence bronchoscopy can be used in routine practice to improve the positive rate of lung cancer and precancerous lesions is still uncertain. The purpose of this study was to evaluate the clinical value of autofluorescence bronchoscopy in the early diagnosis of central lung cancer. Methods: from December 2015 to February 2017, 184 patients suspected of central lung cancer by chest X ray or CT were selected in our hospital from December 2015 to February 2017. According to the inclusion criteria, 184 patients were examined synchronously under the condition of white light (WLB) and fluorescent (AFB). Biopsy, brushing and lavage were performed on the abnormal parts under microscope, and the specimens were sent to our hospital for pathological examination. The sensitivity and specificity of AFB and WLB in the diagnosis of central lung cancer were compared. Results: the sensitivity of AFB and WLB in the diagnosis of central lung cancer was 94.3% (99 / 105) and 88.6% (93 / 105) respectively (P0.05), and the specificity was 63.3% (50 / 79) 41.8% (33 / 79) (P0.05). Subgroup analysis: the sensitivity of AFB and WLB to the diagnosis of central lung cancer was 91.1% (51 / 56) and 89.7% (52 / 58) respectively (P0.05), and the sensitivity of WLB and WLB to the diagnosis of central lung cancer was 67.9% (38 / 56) (41 / 81) (P0.05). The sensitivity of AFB and WLB to the diagnosis of central lung cancer was 72% (36 / 50) or 50.6% (41 / 81) (P0.05) respectively. The sensitivity of AFB and WLB to the diagnosis of central lung cancer was 80.8% (63 / 78) and 89.7% (52 / 58) (P0.05) respectively. Conclusion there is no significant difference in sensitivity between AFB and WLB examination in patients with new biological growth in the airway. Abnormal changes of airway mucosa (i.e., obvious hyperemia, edema, hypertrophy) are found in the airway mucosa. The sensitivity of AFB was higher than that of WLB. The sensitivity of AFB was higher than that of WLB in patients with AFB and WLB grade II under AFB and WLB, and the sensitivity of AFB was higher than that of III under AFB and WLB in the airway mucosa under AFB and WLB endoscopy. There was no significant difference in sensitivity among WLB patients. The specificity of AFB in patients with high risk of lung cancer and suspected central lung cancer was higher than that of WLB in the early diagnosis of central lung cancer.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
本文编号：2215921
[Abstract]:Objective: lung cancer is still a major health problem and the most common malignant tumor-related cause of death in the world. Central lung cancer accounts for about 3 / 4 of lung cancer. The high mortality and low survival rate of lung cancer are closely related to early detection. White light bronchoscopy (white light bronchoscopy,WLB) is one of the most important examination methods for respiratory tract diseases and has been widely used in clinical practice. It plays an important role in the diagnosis and staging of lung cancer. However, the findings of early and precancerous lesions in lung cancer are inadequate. With the rapid development of optics and computer science, the appearance of autofluorescence bronchoscopy (autofluorescence bronchoscopy,AFB) makes up for the deficiency of ordinary white bronchoscopy, which utilizes the different fluorescence properties between normal and abnormal (cancerous) tissues of bronchial mucosa. To determine whether the mucosal cells are abnormal or not, to guide the biopsy to determine the pathological properties; normally, normal tissues show green, abnormal tissues show red. At home and abroad, there have been many studies on the diagnosis of lung cancer with autofluorescence bronchoscopy, and it shows that it has some advantages. However, whether autofluorescence bronchoscopy can be used in routine practice to improve the positive rate of lung cancer and precancerous lesions is still uncertain. The purpose of this study was to evaluate the clinical value of autofluorescence bronchoscopy in the early diagnosis of central lung cancer. Methods: from December 2015 to February 2017, 184 patients suspected of central lung cancer by chest X ray or CT were selected in our hospital from December 2015 to February 2017. According to the inclusion criteria, 184 patients were examined synchronously under the condition of white light (WLB) and fluorescent (AFB). Biopsy, brushing and lavage were performed on the abnormal parts under microscope, and the specimens were sent to our hospital for pathological examination. The sensitivity and specificity of AFB and WLB in the diagnosis of central lung cancer were compared. Results: the sensitivity of AFB and WLB in the diagnosis of central lung cancer was 94.3% (99 / 105) and 88.6% (93 / 105) respectively (P0.05), and the specificity was 63.3% (50 / 79) 41.8% (33 / 79) (P0.05). Subgroup analysis: the sensitivity of AFB and WLB to the diagnosis of central lung cancer was 91.1% (51 / 56) and 89.7% (52 / 58) respectively (P0.05), and the sensitivity of WLB and WLB to the diagnosis of central lung cancer was 67.9% (38 / 56) (41 / 81) (P0.05). The sensitivity of AFB and WLB to the diagnosis of central lung cancer was 72% (36 / 50) or 50.6% (41 / 81) (P0.05) respectively. The sensitivity of AFB and WLB to the diagnosis of central lung cancer was 80.8% (63 / 78) and 89.7% (52 / 58) (P0.05) respectively. Conclusion there is no significant difference in sensitivity between AFB and WLB examination in patients with new biological growth in the airway. Abnormal changes of airway mucosa (i.e., obvious hyperemia, edema, hypertrophy) are found in the airway mucosa. The sensitivity of AFB was higher than that of WLB. The sensitivity of AFB was higher than that of WLB in patients with AFB and WLB grade II under AFB and WLB, and the sensitivity of AFB was higher than that of III under AFB and WLB in the airway mucosa under AFB and WLB endoscopy. There was no significant difference in sensitivity among WLB patients. The specificity of AFB in patients with high risk of lung cancer and suspected central lung cancer was higher than that of WLB in the early diagnosis of central lung cancer.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
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