自發(fā)熒光支氣管鏡在中央型肺癌早期診斷中的研究
發(fā)布時間：2018-08-31 19:19
【摘要】：目的:肺癌目前仍然是一個主要的健康問題,也是全球最常見的惡性腫瘤相關(guān)死因。中央型肺癌約占肺癌的3/4,絕大部分患者在晚期才被發(fā)現(xiàn),此時往往已失去了最佳治療時機。而肺癌的高死亡率、低生存率與是否能夠早期發(fā)現(xiàn)有著密切的相關(guān)。普通白光支氣管鏡(white light bronchoscopy,WLB)是呼吸道疾病最重要的檢查手段之一,并已普遍應(yīng)用于臨床實踐,對肺癌的診斷和分期有著十分重要的作用;但其對在肺癌早期及癌前病變的發(fā)現(xiàn)顯示出不足。隨著光學(xué)和計算機學(xué)的飛速發(fā)展,自發(fā)熒光支氣管鏡(autofluorescence bronchoscopy,AFB)的出現(xiàn)彌補了普通白光支氣管鏡這方面的不足;其利用支氣管黏膜正常組織與異常(癌變)組織之間的不同熒光屬性,來判斷黏膜細(xì)胞是否異常,以指導(dǎo)活檢取材確定病理性質(zhì);通常情況下正常組織顯示為綠色,異常組織顯示為紅色。當(dāng)前國內(nèi)外,已有很多關(guān)于自發(fā)熒光支氣管鏡在肺癌診斷中的研究,并表明其具有一定的優(yōu)勢;但目前對自發(fā)熒光支氣管鏡是否可用于常規(guī)實踐中來提高肺癌和癌前病變的診斷陽性率仍無定論。本研究主要探討自發(fā)熒光支氣管鏡在中央型肺癌早期診斷中的臨床應(yīng)用價值。方法:選取于2015年12月至2017年2月在我院支氣管鏡室,經(jīng)胸部X片或CT檢查疑診為中央型肺癌,并依據(jù)納入標(biāo)準(zhǔn)共納入184例的患者,在白光(WLB)狀態(tài)下和熒光(AFB)狀態(tài)下同步檢查,對兩者鏡下表現(xiàn)異常的部位均進行活檢、刷片及灌洗檢查,并將獲取的標(biāo)本送我院病理檢查。依據(jù)二者鏡下表現(xiàn)及病理結(jié)果,比較AFB與WLB在診斷中央型肺癌中的敏感性、特異性。結(jié)果:納入的184例患者,最終有105例患者病理證實為陽性,79例患者病理證實為陰性;AFB和WLB對中央型肺癌診斷的敏感性分別為94.3%(99/105)、88.6%(93/105)(P0.05);特異性分別63.3%(50/79)、41.8%(33/79)(P0.05)。亞組分析:新生物組,AFB與WLB的對中央型肺癌診斷的敏感性為91.1%(51/56)、89.7%(52/58)(P0.05);黏膜異常組,AFB與WLB的對中央型肺癌診斷的敏感性為67.9%(38/56)、50.6%(41/81)(P0.05)。分別對AFB和WLB的II級、III級進行比較,II級組中,AFB與WLB的對中央型肺癌診斷的敏感性為72%(36/50)、50.6%(41/81)(P0.05);III級組中,AFB與WLB的對中央型肺癌診斷的敏感性為80.8%(63/78)、89.7%(52/58)(P0.05)。結(jié)論:1、在氣道內(nèi)可見新生物生長的患者中AFB與WLB檢查兩者之間敏感性無顯著差異;2、在氣道黏膜異常改變(即表現(xiàn)為明顯充血水腫,肥厚,增生等)的患者中AFB比WLB的敏感度更高;3、在氣道黏膜分別在AFB與WLB鏡下II級組的患者中,AFB比WLB的敏感度更高;4、在氣道黏膜分別在AFB與WLB鏡下III級組的患者中,AFB與WLB之間敏感性無顯著差異;5、AFB在肺癌高危人群且影像學(xué)疑診為中央型肺癌的患者中的特異性比WLB高。AFB在中央型肺癌的早期診斷中有一定的臨床運用價值。
[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.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2
本文編號：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.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2
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