肺癌治疗前诊断程序的探讨

为了探索合理地综合应用各种检查方法及其使用程序,以期达到准确而尽快诊断肺癌的目的,我们对1984.4—1986.4住院的201例原发性肺癌编了下列检查程序:(1)全部病例摄X线片;(2)全部病例查痰找癌细胞三天或以上;(3)痰检阴性属中央型者作支纤镜检查;(4)痰检阴性属外周型者作经皮肺针吸细胞学检查。用此程序诊断本组肺癌的阳性率为95.5％(192/201),较单项痰细胞学检查63.7％(128/201),支纤镜检72.2％(13/18)或经皮肺针吸细胞学检查92.7％(51/55)的阳性率都高,故认为此程序是目前可尽快给肺肿块定性的诊断程序。     

233例小细胞肺癌纤维支气管镜检查分析

我院自1979年9月至1987年9月,在纤支镜检查病例中有1,165例经病理组织学和/或细胞学确诊为肺癌。其中,小细胞肺癌233例(20％),鳞癌549例(47.1％),腺癌291例(25％)和其它型癌92例。本文重点分析小细胞肺癌并以鳞癌和腺癌做对照组。一、纤支镜与病理诊断阳性率本组233例小细胞肺癌,226例纤支镜检查有所见,可做出肺癌之纤支镜检查诊断。该226例全部经纤支镜直接刷检和/或活检。其中142例病理确诊为肺癌。在84例刷、活检阴性病例中71例继续查痰找到癌细胞;13例依X线诊断手术切除肺标本做病理检查确诊为肺癌。7例周边型肺癌术前常规纤支镜检无所见,术后肺标本病理确诊为肺癌。本组之对照组一鳞癌和腺癌也用同样方法和途径获得病理诊断。本组纤支镜检查肺癌诊断阳性率97％(226/233)。对照组鳞癌91.4％(502/549);腺癌72.9％(212/291),差异显著(P<0.05)     

细胞病理学在肺癌诊断中的意义

背景与目的 探讨痰和纤支镜刷片细胞学检查在肺癌诊断中的意义.方法 收集278例同时进行痰和纤支镜检查的肺癌病例.分析痰和纤支镜刷片细胞学检查的敏感性和分型的准确性,评价细胞学在肺癌诊断中的意义.结果 痰细胞学的敏感性为45.8%,纤支镜刷片细胞学的敏感性为61.8%.痰细胞学分型诊断与组织学的符合率鳞癌为93.7%,腺癌为86.2%,小细胞癌为100.0%,痰细胞学区分小细胞癌和非小细胞癌的准确性为100.0%.纤支镜刷片细胞学分型诊断与组织学的符合率鳞癌为94.3%,腺癌为82.9%,小细胞癌为95.5%,纤支镜刷片细胞学区分小细胞和非小细胞癌的准确性为98.0%.结论 纤支镜刷片细胞学具有较高的敏感性,在肺癌的诊断中有重要的应用价值.痰细胞学敏感性较低,但可作为纤支镜检查阴性和不能耐受纤支镜检查的肺癌患者的补充检查手段.两者的细胞学分型具有较高的可信度.     

175例肺部阴影患者的纤支镜检查分析

目的 :了解纤维支气管镜 (纤支镜 )检查对肺部阴影性病变的诊断价值 ,以及支气管肺癌 (肺癌 )的检出率。方法 :采用纤支镜、病理组织学、细胞学及X线胸部摄片等方法 ,对 175例患者进行检查分析。结果 :X线胸片肺部阴影 175例经纤支镜和病理学检查 ,112例有明确的病理结果 ,诊断率 6 4 % ,确诊为肺癌者 92例 (5 2 6 % )。临床诊断可疑肺癌 12 4例经纤支镜检查和病理学检查 ,确诊为肺癌 92例 (74 2 % )。结论 :纤支镜检查是明确肺部阴影性质必不可少的手段 ,凡患者有可疑肺癌的临床指征或X线征象 ,均应及时进行纤支镜检查。     

纤维支气管镜下50例肺癌图像的分析

纤维支气管镜(纤支镜)下各型肺癌均有其独特的表现,对临床诊断、治疗和推测预后有一定的意义。我院在1986年中,共检查128例,其中50例在检查时拍摄了纤支镜图像,并经痰脱落细胞、活检、刷检或手术等证实为肺癌,现将50例镜下表现作一分析。 一、受检指征 1.有重度吸烟史的男性患者,     

肺结核并存肺癌84例临床分析

为探索肺结核合并肺癌的确诊手段及临床特征 ,回顾分析 84例经纤维支气管镜 (纤支镜 )及痰细菌学 ,手术病理确诊的肺结核合并肺癌患者临床表现、影像学特征、纤支镜、痰检及手术后病理检查结果。 84例主要症状包括咳嗽、咳痰 5 8例 ,痰中带血 5 4例 ,骨关节肥大和秤状指 (趾 ) 5例 ,声嘶 3例。纤支镜示 :刷检癌细胞及结核菌阳性率 13 4% ,痰涂片阳性率 40 5 % ,癌细胞学检查阳性率 36 9%。手术后病理阳性率 (10 0 % )。研究结果显示 ,当结核患者出现不寻常的症状和体征时 ,应行胸部X线 ,痰细胞及纤支镜检查 ,必要时行手术探查并病理以确诊     

纤维支气管镜检查在肺癌诊断中的临床价值

目的　了解纤支镜对肺癌的检出率及镜下特征,以探讨其诊断价值。　方法　回顾分析1986年～1999年的324例纤支镜检查结果。　结果　经纤支镜检查,病理证实肺癌118例,占同期纤支镜检查的364%。其中鳞癌63例(534%),腺癌29例(246%),未分化癌9例(76%),肺泡癌3例(25%),未分型癌14例(119%)。　结论　纤支镜检查对肺癌的确诊具有重要的临床价值     

流式细胞术DNA含量分析对肺癌诊断的价值

目的　探讨流式细胞术DNA含量测定对肺癌诊断的价值。方法　应用流式细胞仪 (FCM )对41例肺癌纤维支气管镜 (简称纤支镜 )活检标本及 2 1例非癌性病变的活检标本中DNA含量 (DI)和S期细胞比率 (SPF)进行测定 ,并与同期纤支镜活检、刷检、及纤支镜术后痰检对比分析。结果　 ( 1)肺癌组织中DNA含量、SPF均显著高于非癌性病变组织 (P <0 .0 1)。肺癌组异倍体率为 78.0 4% ,而肺良性病变组仅为 4.8%。FCMDNA含量分析对肺癌诊断的敏感性为 78.0 4% ( 3 2 /4 1) ,特异性为 95 .2 4% ( 1/2 1) ;( 2 )肺癌组织中DNA含量与肺癌组织学类型和临床分期无明显关系 (P >0 .0 5 ) ;( 3 )肺癌异倍体组的SPF高于二倍体组 (P <0 .0 5 ) ;肺癌SPF与肿瘤分期、转移有正相关关系 (P <0 .0 5 )。结论　应用FCM检测纤支镜小标本DNA含量可作为检测肺组织癌变的一种辅助手段。肺活检组织的FCMDNA含量及细胞增殖活性分析有助于进一步研究肺癌的生物学行为。     

细支气管肺泡细胞癌34例临床分析

目的：对细支气管肺泡细胞癌的临床表现、诊断和治疗方法进行分析讨论。方法：自１９８１年￣１９９７年共收治细支气管肺泡细胞癌３４例，采用Ｘ线胸片、痰脱落细胞学、纤支镜检查、经皮肺穿刺，血ＣＥＡ测定等方法诊断，治疗主要采用手术及化疗等方法。结果：纤支镜检查、血ＣＥＡ、经皮肺穿刺对本病确诊最为重要，病灶局限者手术治疗的效果较好。结论：早期诊断甚为重要，对凝为肺泡细胞癌患者均应测定血ＣＥＡ，无绝对禁忌症者纤     

老年人肺癌284例分析

 我院自1979年9月至1987年2月,经纤支镜检查并经病理和/或细胞学确诊之老年人(60岁以上)肺癌284例。其中,92例(32.4%)手术治疗。同时期,经同样途径确诊之中年人(36—50岁)肺癌249例。其中,96例(38.6%)手术治疗。两组各种数据相近,故选定中年人肺癌组为对照组,重点分析老年人肺癌的特点。     

Two cases of intrapulmonary lymph node presenting as a peripheral nodular shadow: Diagnostic differentiation from lung cancer

We present two cases of intrapulmonary lymph node. The patients were a 44-year-old woman and a 71-year-old man each with a small peripheral nodule in the lung. On computed tomography (CT) scans, both nodules were spiculated. Since histological diagnosis could not be obtained by bronchoscopic examination or CT-guided needle biopsy, they underwent video-assisted thoracoscopic surgery. Histological examination of the resected material revealed that both nodules were composed of lymph node. Intrapulmonary lymph node has until recently been assigned no clinical significance; however, differential diagnosis of this lesion from lung cancers and other metastatic tumors is now clinically important.     

Radiological, Bronchoscopic and Histopathologic Characteristics of Patients with Primary Lung Cancer in Turkey (2006-2009)

Aim: The aim of this study was to evaluate the radiological, bronchoscopic and histopathological features of patients with primary lung cancer. Materials and Methods: 485 patients who were hospitalized in our clinic between July 2006 and December 2009 and diagnosed with lung cancer (LC) were evaluated. Results: The final diagnoses, established using various methods, were small cell LC for 62 patients, NSCLC of undetermined cell type for 191, epidermoid carcinoma for 148 patients, adenocarcinoma for 81 patients, and large cell LC for 3 patients. The mass was identified to be centrally located in 283 cases (58.3%) and peripherally in 202 cases (41.7%), and was found in the right lung in 51.5% of cases and mostly in the upper lobes bilaterally on radiological examination. The rate of hilar fullness, consolidation and atelectasis were higher in SCLC and epidermoid carcinoma with radiological examination. Diagnostic FOB (fiberoptic bronchoscopy) was performed in 466 of 485 patients. Endobronchial pathology was not obtained 140 patients. Endobronchial mass lesion, mucosal-submucosal lesions and signs of external pressure were observed in 152, 186 and 140 patients, respectively. Diagnostic material was obtained in 274 of 466 FOB examinations. A total of 211 patients underwent TTNA (transthoracic needle aspiration) and diagnosis was established in 204 cases. Pleural biopsy and/or fluid cytology were/was positive (+) for malignancy in 25 of the 47 cases with pleurisy. One patient, who could not be diagnosed by any of FOB or TTNA was diagnosed by pleural biopsy. Diagnostic results were obtained by thoracotomy in six patients who could not be diagnosed by other methods. 137 (28.2%) of 485 patients were considered to be operable. Conclusion: NSCLCs (especially epidermoid) account for the majority of lung cancers in Turkey, gender and smoking influencing the histopathology. TTNA and FOB are diagnostic procedures providing best results, and more than 2/3 of patients are inoperable at diagnosis.     

Bronchoscopy for bevacizumab-related hemoptysis

Bevacizumab is the first anti-angiogenic agent inhibiting vascular endothelial growth factor (VEGF) for treatment of patients suffering from cancer. Life-threatening hemoptysis is the most serious adverse effect of bevacizumab. The inhibition of VEGF is a possible mechanism involved in the destruction of normal lung tissue and subsequent hemoptysis. We report a case of bevacizumab-related hemoptysis and associated bronchoscopic findings that were successfully treated with rigid bronchoscopy and laser photocoagulation.     

肺癌术后支气管胸膜瘘致死性大咯血经验(附7例报告)

背景与目的大咯血是肺癌术后少见但严重的并发症。本研究旨在探讨致死性大咯血的发生机制、危险因素、先兆症状及预防和治疗措施。方法 2007年4月-2011年5月四川大学华西医院共行肺癌手术1,737例,围手术期死亡20例,其中死于大咯血7例,复习7例患者的临床资料并结合文献进行分析。结果大咯血是肺癌术后第2位死亡原因。7例中6例直接死于大咯血,1例因大咯血行二次手术,最终死于肺部感染、呼吸衰竭。4例发生过先兆出血症状。4年大咯血发生率为0.4%(7/1,737)。结论支气管胸膜瘘引起的支气管血管瘘是大咯血发生的机制,糖尿病为高危因素,早期诊断、早期外科治疗支气管胸膜瘘或支气管血管瘘可避免大咯血死亡的发生。     

Bronchial capillary hemangioma in adults

Two cases with capillary hemangioma of the trachea and the left upper lobe bronchus are presented. The adult patients were referred to the hospital because of hemoptysis and cough. The chest radiographs were normal in both cases. The bronchoscopic examination revealed circumscribed lesions with a capillarized surface protruding into the lumen of the trachea and the left upper lobe bronchus, respectively. The lesions were excised in toto with flexible bronchoscopic forceps. The specimens contained typical capillary hemangiomas without any signs of malignancy. Capillary hemangioma in the bronchial tree is an extremely rare benign lesion in adults. Nevertheless, it should be considered as a possible cause of hemoptysis and cough.     

纤维支气管镜下大剂量腔内放疗治疗癌性支气管阻塞

目的　应用后装设备在纤维支气管镜引导下将192Ir导入支气管内进行腔内放疗,治疗癌性支气管阻塞。方法　常规纤维支气管镜检后,将施源器导管经活检孔导入病变部位,接后装机进行放疗,每次6～8Gy,每周1次,连续3周为1疗程。疗程结束后第1、4周复查。结果　胸部X线检查示:CR15例(23.08%),PR28例(43.08%),MR12例(18.46%),总有效率(CR+PR+MR)为84.62%。纤支镜检查示:CR25例(38.46%),PR28例(43.08%),MR9例(13.85%),总有效率为95.38%。结论　该方法对肺癌引起的支气管阻塞具有良好的再通效果,作用快,疗效好,副作用少。     

Pulmonary cytologic examination in the identification of the second primary carcinoma of the lung

Multiple primary carcinomas of the lung were histologically confirmed in 23 male patients. Five were synchronous neoplasms. Seventeen of the second pulmonary cancers originated in the contralateral lung. The major cell type was epidermoid (17/23), and in 11 patients the tumor was similar in histologic features to the first lesion. Examination of pulmonary secretions as a diagnostic aid in the identification of the second malignant neoplasm was employed for 73.9% (17/23) of the patients. With a single exception, these were obtained at the second diagnostic hospitalization rather than as an outpatient monitoring procedure. Only nine patients had a series of cytologic preparations consisting of three consecutive early morning sputa, bronchial washings/brushings, and a postbronchoscopy sputum. A cytodiagnosis of cancer was established in 82.4% (14/17) of the cases and preceded histologic verification in ten. Radiologic evidence of a second primary was noted in only 56.5% (13/23) of the patients. Pulmonary cytologic examination as a monitoring procedure was not employed in the outpatient follow-up for 64 patients surviving pulmonary cancer for 18 months or longer. Posttherapeutic studies were obtained on 39.1% (25/64) of the hospitalized patients. Thirty-two percent (8/25) were collected concurrently with tissue biopsies for the confirmation of recurrence or metastasis. Patients with primary pulmonary cancers resected for cure should be monitored on a regular basis to include the cytologic examination of three consecutive early morning sputa and a chest radiograph.     

DETECTION OF p53 GENE MUTATION OF BRONCHOSCOPIC SAMPLIES IN THE PATIENTS SUSPECTED TO LUNG CANCER

As other malignant tumors, lung cancer is a disease with alteration of genetic materials. P53 gene mutation is the most common and the early genetic alteration in lung cancer. Previous studies about the p53 gene mutation in lung cancer were mainly focused on the resected tumor tissues, it was not useful to the early diagnosis of lung cancer. In this paper, point mutation of the exon 5 to 8 of p53 gene were detected using PCR-single strand conformation polymorphism(PCR-SSCP) in bronchoscopi…     

Detection of p53 gene mutation of bronchoscopic samples in the patients suspected to lung cancer

Objective: To determine the feasibility of detecting p53 gene mutations for early diagnosis of lung cancer using the samples from bronchoscopic examination. Methods: Point mutations of the exon 5 – 8 of p53 gene were detected in 85 bronchoscopic samples of 35 patients suspected to be lung cancer using silver staining PCR-SSCP. Results: p53 gene mutations were founded in 10 of 35 patients(28.6%). The incidence of p53 gene mutations (14.9%) was obviously higher than the cytological positive incidence(2.9%) in samples of sputum, bronchoalveolar lavage and brush, especially for the sputum(27.7%). In the bronchoscopic biopsy specimens, the incidence of p53 gene mutations (12.5%) was lower than that of pathologic positive result (50.0%). However, in view of all the bronchoscopic samples, there was no statistically difference between cytopathologic positive results (11.8%) and the incidence of p53 gene mutations (14.1%). Although the p53 mutations were most common in the samples from the patients bronchoscopically manifested as neoplasm compared with other manifestations, there was no statistical difference. It is valuable to notice that 3 patients with p53 gene mutation merely presented as bronchial inflammation in bronchoscope. Conclusion: Results indicated that the value of detecting p53 gene mutation for the diagnosis of lung cancer using the bronchoscopic samples was more superior to cytological examination and detection of p53 gene mutations in post-bronchoscopic sputum was easy and effective, may be used as a valuable method for early diagnosis of lung cancer. This work was supported by the Research Foundation of the Ministry of Public Health of PR China (No. 94-1-316).     

Attributable risk of lung cancer in lifetime nonsmokers and long-term ex-smokers (Missouri,United States)

A population-based, case-control study of incident lung cancer among women in Missouri (United States) who were lifetime nonsmokers and long-term ex-smokers was conducted between 1986 and 1992. The study included 618 lung cancer cases and 1,402 population-based, age matched controls. Information on lung-cancer risk factors was obtained by interviewing cases, next-of-kin of cases (36 percent and 64 percent of the cases, respectively) and controls. Year-long radon measurements also were sought in every dwelling occupied for the previous five to 30 years. Population attributable risks (PAR) for specific risk factors were computed for all subjects, for lifetime nonsmokers, for long-term ex-smokers, by histologic cell type (i.e., adenocarcinoma cf nonadenocarcinoma) and for direct interviews with case (for living cases) and for next-of-kin interviews (for dead cases or cases too ill to complete an interview). The mean age at lung cancer diagnosis was 71 years, and nearly 50 percent of the lung cancers were histologically confirmed adenocarcinomas. Almost 40 percent of all lung cancers among lifetime nonsmokers and almost 50 percent of lung cancers among all subjects could be explained by the risk factors under study. Dietary intake of saturated fat and nonmalignant lung disease were the two leading identified risk factors for lung cancer among the lifetime nonsmokers, followed by environmental tobacco smoke, and occupational exposures to known carcinogens. A small nonsignificant risk was found for study subjects exposed to median domestic radon concentration of 4 pCi/l (25-year time-weight average). Since only a small fraction of the population is exposed at this level, it is estimated that the PAR for domestic radon was less than two percent in Missouri. The risk for saturated fat intake was similar for lifetime nonsmokers, ex-somkers, adenocarcinoma cases, and nonadenocarcinoma cases; however, the increased risk was much more pronounced for next-of-kin interviews (PAR=31 percent) than for interviews with the study subjects (PAR = nine percent). A similar pattern of PAR was identified among ex-smokers but, in this group, the lingering effect of a history of smoking was also very important. Along with saturated fat intake (PAR=20 percent), the combined effect of previous active and passive smoking even after 15 years of cessation of active smoking was responsible for more lung cancer than any other risk factor under study (PAR=59 percent).Drs Alavanja, Benicbou, Swanson, and Boice are with the Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD, USA. Dr Brownson is with the Department of Community Health, Saint Louis University School of Public Health, St Louis, MO, USA. Address correspondence to Dr Alavanja, Epidemiology and Biostatistics Program, National Cancer Institute, EPN/543, 6130 Executive Blvd, Bethesda, MD 20892, USA.