低剂量螺旋CT机会性筛查随诊肺孤立性结节患者的临床研究

目的探讨低剂量螺旋CT(LDCT)机会性筛查随诊肺小结节患者的临床应用价值。方法应用LDCT或标准剂量CT(SDCT)机会性筛查肺孤立性结节(SPN)患者884例,分为试验组和对照组。试验组440例,男303例,女137例,行LDCT检查;对照组444例,男299例,女145例,行SDCT检查。2组随诊及后续治疗策略相同。结果试验组依从性为98.4%(433/440),对照组为96.2%(427/444),差异有统计学意义;试验组发现肺癌68例,阳性率为15.7%(68/433),其中Ⅰa期肺癌60例,Ⅱa期肺癌8例,术后5年总生存率为86.7%(59/68);有创性过度检查或治疗率为11.7%(9/77)。对照组发现肺癌62例,阳性率为14.5%(62/427),其中Ⅰa期肺癌58例,Ⅱa期肺癌4例,术后5年总生存率90.3%(56/62)。有创性过度检查或治疗率11.4%(8/70)。2组均无统计学差异。结论 LDCT机会性筛查随诊SPN患者切实可行,患者的依从性高,诊断效率与SDCT相当。     

肺内恶性孤立性小结节的CT征像特征分析与诊断

目的通过对肺内恶性孤立性小结节CT影像特征的分析,不断提高CT对恶性孤立性肺结节的检出率。方法全面、系统地回顾、分析134例肺内孤立性小结节患者的临床资料。结果 134例肺内孤立性小结节患者中,病检恶性80例(59.70%);病检和CT均诊断为恶性者78例,CT与病检符合率为97.5%,病检确诊为恶性而CT征像不支持者2例(2.50%),CT诊断为恶性,而首次病检不支持,再次病检支持者1例(1.25%);81例结节≥2.0 cm者,恶性75例(92.59%);53例结节2 cm者,恶性3例(5.66%);右肺结节恶性率为73.21%,明显高于左肺的43.59%(P0.05);恶性结节CT影像表现中胸膜凹陷征、引流线征、血管集束征、毛刺征、棘突征、分叶征、空泡和细支气管充气征,征像所占比例明显高于良性结节(P0.05);85.90%的恶性结节病例表现为3种以上基本影像征像并存。结论肺内孤立性结节恶性率高,其发病的部位和影像表现均具有其一定的特征性,CT诊断具有较高的检出率,在CT诊断过程中,要紧紧围绕结节的部位和影像征像进行仔细分析鉴别,对一时难以定论的结节要积极开展动态观察,以提高恶性孤立性肺结节的检出率,减少误诊和漏诊。     

分析肺部影像人工智能诊断系统鉴别诊断肺结节性质

目的探讨肺部影像人工智能诊断系统对肺结节性质及肺癌病理类型的鉴别诊断价值。方法回顾性分析医院2018年3月～2019年3月收治的178例肺结节患者的临床资料,经肺部影像人工智能诊断系统鉴别肺结节性质及肺癌病理类型,所有患者均经手术治疗,肺结节均经病理检查明确良恶性,恶性结节也均明确病理类型。统计肺部影像人工智能诊断系统的鉴别诊断结果;分析该方法与病理检查结果的一致性。结果本组患者中恶性结节占比38.78%,肺癌患者占比17.98%,且腺癌、小细胞癌、鳞癌、大细胞癌占比分别为71.88%、18.75%、6.25%、3.13%;经肺部影像人工智能诊断系统鉴别有152个良性肺结节,有93个恶性肺结节,有148例患者被诊断为良性肺结节病,有30例患者被诊断为肺癌,其中有21例被诊断为腺癌,有6例被诊断为小细胞癌,有2例被诊断为鳞癌,有1例被诊断为大细胞癌;经Kappa一致性检验,肺部影像人工智能诊断系统鉴别肺结节良恶性、肺癌病理类型结果与病理检查结果的一致性良好(Kappa值=0.801,P=0.015;Kappa值=0.763,P=0.024)。结论肺部影像人工智能诊断系统鉴别诊断肺结节性质及肺癌病理类型结果与病理检查结果一致性均较高,效能良好,值得推广。     

1cm以下外围微小肺癌的CT诊断

CT技术的快速进展,尤其是多层CT的广泛应用,发现1cm以下外围微小肺结节并需要作出良、恶性鉴别的机会越来越多。日常工作中如选择合理的CT检查技术并正确把握良、恶性外围微小肺结节的CT征象便可早期确诊。笔者曾于2010年7月26日～2011年3月21日拟诊4例1cm以下外围微小肺癌,后经手术病理证实,现回顾性分析该4例CT征象,以期提高此类肺癌的术前确诊率。     

血清Sox2抗体、p53抗体联合检测对肺小结节良恶性的鉴别诊断

目的分析血清干细胞转录因子(Sox2)抗体、抑癌基因53(p53)抗体联合检测对肺小结节良恶性的鉴别及诊断意义。 方法选择2017年1月至2020年1月收治的72例肺部恶性结节患者作为观察组,另将同期收治的81例肺部良性结节患者作为对照组。检测受试者血清Sox2抗体、p53抗体水平。分析Sox2抗体、p53抗体联合检测对早期肺小结节良恶性鉴别诊断的价值以及Sox2抗体、p53抗体与肺癌患者中临床病理特征的关系。 结果对照组与观察组相比Sox2抗体、p53抗体阳性表达率明显较高(P<0.05)。Sox2抗体检查诊断肺癌16例,检出率22.22%(16/72);p53抗体检查诊断肺癌20例,检出率27.78%(20/72)。二者联合抗体检查诊断肺癌检出率41.67%(30/72)。与Sox2抗体、p53抗体单一检测相比,二者联合检测敏感度升高(P<0.05)。Sox2抗体、p53抗体与肺癌患者临床分期及肺癌发展阶段具有相关性(P<0.05)。 结论Sox2抗体、p53抗体联合检测对早期肺小结节良恶性的鉴别,有诊断意义。     

肺结节临床精准诊断的新理念

肺癌患病率及病死率均较高,严重危害人类健康,早诊早治是改善预后的关键[1-4]。随着胸部低剂量薄层CT(low-dose thin-layer CT,LDCT)在临床上广泛应用与体检的大规模实施,肺结节检出率已升至22%~51%,且在随访中每年新增肺结节检出率为3%~13%[3]。多项国际多中心研究报道在普通人群中发现的肺结节,恶性肺结节比例仅为4%。偶发或非高危人群主动体检发现的肺结节中,恶性肺结节占比相对更低[5]。现有的美国胸科医师学会(ACCP)、美国国立综合癌症网络(NCCN)、Fleischner指南、亚太专家共识、我国指南与专家共识对指导肺结节的诊治起了重要作用。但是不同国家、不同地区、不同人群肺结节特征均有不同,医院等级不同,很难对大多数肺结节做出及时正确诊断,临床上尚存在恶性肺结节诊治不足以及良性肺结节的过度诊治问题。及时、正确鉴别肺结节良、恶性、减少漏诊、误诊与过度诊治是当前亟待解决的重要临床问题。     

硫氧还蛋白还原酶联合肺癌标志物对肺结节良恶性的诊断意义

目的分析硫氧还蛋白还原酶(TrxR)联合肺癌标志物对肺结节良恶性的诊断意义。 方法收集2020年2月至2021年9月我院收治的117例肺结节患者为对象,根据肺结节良恶性分为对照组(良性肺结节)42例与观察组(肺癌)75例。比较两组血浆TrxR活性水平与血清肿瘤相关抗原基因(CAGE)、性别决定相关基因簇2(SOX2)、ATP结合RNA解旋酶(GBU4-5)、肿瘤相关抗原基因7(GAGE7)、黑色素瘤抗原A1(MACEA1)、抑癌基因53(p53)、蛋白基因产物9.5(PGP9.5)水平。 结果观察组血浆TrxR水平与血清CAGE、SOX2、GBU4-5、GAGE7、MACEA1、p53、PGP9.5水平高于对照组(P<0.05);不同临床分期患者CAGE、SOX2、GAGE7、MACEA1、p53、PGP9.5阳性率比较(P<0.05)。不同肺癌类型患者GAGE7、MACEA1、p53、PGP9.5阳性比较(P<0.05);血浆TrxR活性水平、CAGE、MACEA1、p53四者联合诊断肺癌的AUC值(95%CI)为0.854(0.712~0.927),(P<0.05),血浆TrxR活性水平联合肺癌7项的肺癌的AUC值(95%CI)为0.829(0.703~0.918),(P<0.05),二者诊断效能比较(P>0.05)。 结论TrxR、CAGE、MACEA1、p53在诊断肺结节良恶性中具有临床意义。     

经皮肺穿刺活检在孤立性肺结节中的临床应用价值

目的:评价CT引导下经皮肺穿刺针吸活检术对肺内直径<3cm的孤立性结节的临床诊断价值。方法:回顾性分析48例经开胸手术细胞学检查确诊的肺部恶性结节患者的临床资料。结果:术前根据临床资料,疑似诊断肺恶性结节者27例(临床疑诊组),检出率56.3%,术前行CT引导下经皮肺穿刺针吸活检涂片细胞学检查(穿刺诊断组),提示肺恶性结节者45例,检出率93.8%,两组比较有显著差异(P<0.05)。48例手术切除结节病灶病理学诊断,腺癌27例,占56.3%,鳞癌18例,占37.5%,小细胞癌3例,6.3%。穿刺诊断组与手术诊断组比较,无显著性差异(P>0.05)。结论:对于直径<3cm肺部结节,在CT定位引导下经皮肺穿刺针吸细胞学检查,准确性高,并发症少,可作为肺内孤立性小结节灶定性诊断的首选方法,具有推广价值。     

肺部孤立性小结节的诊断分析

目的探讨肺小结节的临床诊断。方法自2004年1月至2009年6月本院就诊发现的肺小结节73例,通过不同方法最后明确诊断。结果所有患者中最后确诊为肺癌55例,结核11例,炎性假瘤4例,纤维瘤2例,淋巴瘤1例。结论肺小结节恶性率高,早期诊断和治疗至关重要。     

肺门、纵隔淋巴结肿大19例回顾性分析

目的探讨肺门、纵隔淋巴结肿大疾病的特征,提高临床医生对该疾病的认识。方法回顾性分析了2000年9月～2011年9月我院呼吸科住院的19例肺门、纵隔淋巴结肿大患者的症状、诊疗经过及转归。结果经过组织病理学检查,19例肺门、纵隔淋巴结肿大患者中,肺癌及转移瘤7例(7/19);恶性淋巴瘤4例(4/19);淋巴结结核3例(3/19);结节病2例(2/19);真菌感染2例(2/19);Castleman病1例(1/19);SLE 1例(1/19)。经过治疗获得不同转归。结论肺门、纵隔淋巴结肿大疾病病因复杂,诊断困难,主要依靠组织病理学,早确诊、早治疗。     

Computer-aided diagnosis in lung nodule assessment

Computed tomography (CT) imaging is playing an increasingly important role in cancer detection, diagnosis, and lesion characterization, and it is the most sensitive test for lung nodule detection. Interpretation of lung nodules involves characterization and integration of clinical and other imaging information. Advances in lung nodule management using CT require optimization of CT data acquisition, postprocessing tools, and computer-aided diagnosis (CAD). The goal of CAD systems being developed is to both assist radiologists in the more sensitive detection of nodules and noninvasively differentiate benign from malignant lesions; the latter is important given that malignant lesions account for between 1% and 11% of pulmonary nodules. The aim of this review is to summarize the current state of the art regarding CAD techniques for the detection and characterization of solitary pulmonary nodules and their potential applications in the clinical workup of these lesions.     

Molecular signatures in biopsy specimens of lung cancer

Gene expression profiles of resected tumors may predict treatment response and outcome. We hypothesized that profiles derived from lung tumor biopsies would discriminate tumor-specific gene signatures and provide predictive information about outcome. Lung carcinoma specimens were obtained from 23 patients undergoing computed tomography-guided transthoracic biopsy or endobronchial brushing for undiagnosed nodules. Excess tissue was processed for gene profiling. We built class prediction models for lung cancer histology and for cancer outcome. The histology model used an F test to identify 99 genes that were differentially expressed among lung cancer subtypes. The histology validation set class prediction accuracy rate was 86%. The outcome model used the maximum difference subset algorithm to identify 42 genes associated with high risk for cancer death. The outcome training set class prediction accuracy rate was 87%. In conclusion, gene expression profiles of biopsy specimens of lung cancers identify unique tumoral signatures that provide information about tissue morphology and prognosis. The use of specimens acquired from lung biopsy procedures to identify biomarkers of clinical outcome may have application in the management of patients with lung cancer. The procedures are safe and feasible; the efficacy and utility of this strategy will ultimately be determined by prospective clinical trials.     

血清肿瘤标志物与肺癌高危因素的临床分析

目的探讨血清肿瘤标记物在高危及肺癌人群中的应用价值,及肺癌高危因素的检测方法。方法选取成都市第三人民医院2013年1月至2014年2月住院患者230例;依据纳入标准进入高危因素组随访观察;对照人群为70例良性疾病患者;采用电化学发光免疫法分析血清肿瘤标志物CEA、细胞角蛋白19片段、神经特异性烯醇化酶、鳞状上皮细胞癌抗原及铁蛋白的水平。结果纳入高危因素的患者230例,其中经气管镜或胸腔镜即确诊肺癌160例,6~22个月期间随访病例70例,后期确诊肺癌12例;因肺部结节病变入院,确诊肺癌88例,占位病变中有8例随访观察中确诊肺癌;多项肿瘤标志物联合铁蛋白增高,能有效判定肺部结节的良恶性(P0.05)。胸部结节合并铁蛋白增高对诊断肺癌具有显著意义(P=0.021)。结论肿瘤标志物和铁蛋白增高是肺癌的独立危险因素。单纯铁蛋白增高对判定肺部占位的良恶性并无意义,如联合肺部占位结节检测肿瘤良恶性,其诊断意义可大为提高。     

Operative indications for lung cancer with satellite lesions

In deciding the surgical treatment for lung cancer, it is important to differentiate between a small satellite lesion that is probably benign, a pulmonary metastatic lesion, or a double cancer. The operative indications for lung cancer with small satellite lesions detected on preoperative helical computed tomography were retrospectively examined. We collected 43 small nodules < or = 1 cm in diameter from 32 patients. A definitive diagnosis was made by follow-up computed tomography in 3 of 19 ipsilateral lesions and in 9 of 24 contralateral lesions. The final diagnosis of the satellite lesions was malignant in 13 and benign in 30. The 13 malignant lesions consisted of 2 pulmonary metastases and 11 double cancers. Two patients with stage IIb and IIIb disease on clinical staging of the main tumor had pulmonary metastases. Patients with clinical stage I disease had a higher probability that the small lesions were benign or double cancers than those with advanced disease beyond clinical stage I.     

Evaluation of fluorine-18-fluorodeoxyglucose whole body positron emission tomography imaging in the clinical diagnosis of lung cancer]

In recent years the use of positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (FDG) has become a valuable tool in the detection of a variety of tumors including lung cancer. To determine its role in the diagnosis of patients with suspected lung cancer, we compared the results of FDG-PET with those of the other scintigraphic imaging techniques (67Ga-planar image, 201Tl-SPECT and 99mTc-bone scintigraphy) used worldwide in patients with lung cancer. The analysis group consists of 178 patients, 159 malignant pulmonary diseases and 19 benign pulmonary diseases. FDG-PET was performed in 65 patients (51 malignant pulmonary diseases, 14 benign pulmonary diseases). FDG-PET had a sensitivity, specificity and accuracy of 98.0%, 78.6% and 93.8%, respectively, in detecting malignant pulmonary nodules. In N staging, sensitivity, specificity and accuracy were 66.7%, 81.3% and 76.0%, respectively. In M staging, the accuracy was 100%. Thus, FDG-PET imaging was more accurate than the other types of scintigraphic imaging. In our observations, whole-body 18FDG-PET images improved diagnostic accuracy in the evaluation of lung lesions and the staging of lung cancer.     

液体活检在肺癌诊治中的应用和挑战

肺癌是全球病死率居首位的恶性肿瘤。由于早诊不足使得80%的肺癌患者确诊时处于晚期,而晚期肺癌患者又由于无法耐药组织病理活检而失去精准治疗的机会,极大地影响了肺癌患者的生存期。以安全微创和可重复动态检测为特点的液体活检在肺癌患者的早期诊断、靶点检测、耐药监测和预后评估中均发挥了重要作用。同样,液体活检在肺癌诊疗中也面临一系列的挑战:如何挑选合适的样本类型,如何利用液体活检的多种检测成分,如何选择有效的检测方法,以及如何提高液体活检在免疫治疗中的应用价值等。本文就液体活检在肺癌诊治中的相关应用进展和目前临床应用中面临的相关挑战作一综述。     

Management strategy of solitary pulmonary nodules

Solitary pulmonary nodules (SPNs) are increasingly detected with the widespread use of chest computed tomography (CT) scans. The management of patients with SPN should begin with estimating the probability of cancer from the patient’s clinical risk factors and CT characteristics. The decision-making process need to incorporate the probability of cancer, the potential benefits and harms of surgery, the accuracy of the available diagnostic tests and patient preferences. For patients with a very low probability of cancer, careful observation with serial CT is warranted. For patients in the intermediate range of probabilities, either CT-guided fine-needle aspiration biopsy (FNAB) or positron emission tomography (PET), is recommended. For those with a high probability of cancer, surgical diagnosis is warranted.KEYWORDS : Solitary pulmonary nodule (SPNs), ground-glass opacity (GGO), subcentimeter nodules, management strategyLung cancer is currently the leading cause of cancer deaths worldwide (1). Clinically, most patients are diagnosed at an advanced stage, with only about 15% have the opportunity of surgical resection. Early detection followed by surgical resection of stage I lung cancer may lead to a 5-year survival rate of 54-73%, while those with stage IV diseases have a 5-year survival rate of only 2% (2,3). With the established role of low-dose helical computed tomography (CT) screening for lung cancer (4-6), and the wide application of high-resolution CT, solitary pulmonary nodules (SPNs) are increasingly detected (7). Accurate assessment, proper treatment and timely surgical resection of malignant pulmonary nodules will be highly beneficial to the survival of patients with lung cancer. By reviewing the latest literature, combined with our experience in the clinical management of SPNs, we summarized the relevant clinical problems and treatment strategies in this review.     

肺功能及哮喘控制测试(ACT)在哮喘患者管理中的价值

目的探讨肺功能及哮喘控制测试在支气管哮喘患者管理中的价值。方法将肺功能及ACT应用于支气管哮喘患者136例。每月填写1次ACT,在哮喘患者应用ACT前药物治疗时、应用ACT 6个月结束时测定第1秒用力呼气量(FEV1)、FEV1占预计值百分比(FEV1%预计值)和用力肺活量(FVC)、FVC占预计值百分比(FVC%预计值),同时测定ACT评分观察哮喘患者在药物治疗、肺功能检查,应用ACT 6个月末时ACT使用率、治疗的依从性、哮喘控制情况。结果每月1次坚持应用ACT 132例,使用率97%;坚持使用规范的治疗128例,治疗依从性达94%;症状完全控制率达47%,良好控制率达74.2%。ACT评分治疗6个月后较入选时升高,肺功能指标亦有明显改善,FEV1与ACT评分呈正相关(r=0.82,P<0.01)。结论肺功能及ACT用于支气管哮喘患者的管理能提高患者对治疗的依从性和哮喘控制率。     

Diagnostic percutaneous transthoracic needle biopsy does not affect survival in stage I lung cancer

RATIONALE: Lung cancer dissemination has been cited as a potential adverse consequence of diagnostic percutaneous transthoracic needle biopsy (PTNB) of lung nodules. Despite multiple reports in the literature of malignant spread along the needle track, the potential effect of lung cancer dissemination after PTNB on survival is unknown. OBJECTIVE: To evaluate whether diagnostic PTNB is associated with increased risk of lung cancer death. METHODS: This study included 8,607 cases of surgically resected stage I non-small cell lung cancer diagnosed between 1991 and 1999 from the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare records. Overall and lung cancer-specific survival of patients who had and did not have PTNB was compared using Kaplan-Meier curves. Stratified survival analyses and Cox regression were used to compare survival with adjustment for potential confounders. RESULTS: Approximately 36% of patients underwent diagnostic PTNB. Overall and lung cancer-specific survival did not differ in patients that underwent PTNB as part of their cancer diagnostic work-up and those who did not (p = 0.57 and 0.46, respectively). In stratified and multivariate analysis, PTNB was not associated with an increased risk of death after controlling for age, race, income, access to care, comorbidities, tumor histology and size, and type of treatment received. CONCLUSIONS: In this large national sample, preoperative PTNB was not associated with increased risk of death. These data suggest that PTNB can be safely used for the work-up of pulmonary nodules when there is a suspicion of lung cancer.     

Thoracoscopic resection of a solitary pulmonary nodule in patients with a known history of malignancy

BACKGROUND: Solitary pulmonary nodules found during the follow-up of cancer patients are generally considered to be lung metastases. However, a definite diagnosis should be established. METHODS: Between 1995 and 2005, all patients with a solitary lung nodule considered removable by a thoracoscopic approach and with a history of malignancy were included in this study. Lung wedge resection was performed to establish the morphological diagnosis. During follow-up further metastases and local recurrences were registered. Survival data were obtained in February 2007. RESULTS: Among our 34 patients (17 male and 17 female with a median age of 67.5 years), the most common primary cancers were colorectal (n = 12) and kidney (n = 6). Two patients had a history of 2 cancers. Twenty-two patients (65 %) had lung metastases and 12 (35 %) had benign nodules. During follow-up (median 2.4 years) 7 patients (21 %) developed further lung metastases. Overall postoperative five-year survival was 50 % (95 % CI: 35 - 73 %). CONCLUSION: Not all solitary lung nodules in patients with previous malignancy are metastases. According to our survival results the thoracoscopic removal of a single lung metastasis was curative in many patients.