窄带成像联合自体荧光支气管镜在重度吸烟人群中筛查早期中央型肺癌的研究

目的为了提高中央型肺癌的早期检出率改善预后,寻找一种补充检查方案。方法选取我院2016年1月～2019年12月符合本研究要求的重度吸烟者1821例,使用窄带成像联合自体荧光支气管镜技术与常规低剂量CT检查,比较两者早期中央型肺癌的检出率;同时比较普通白光支气管镜与自体荧光支气管镜(AFB)、窄带成像(NBI)联合自体荧光支气管镜三者间的阳性率与病理学阳性率的差别。结果 (1)共入组患者1821例。入组患者中,胸部CT报告气道可疑结节或占位者共69例,经气管镜检查后68例未发现CT提示部位新生物,1例为气道异物;16例病理阳性的患者,胸部CT检查均为阴性结果。(2)入组患者中发现普通白光支气管镜下黏膜异常9例(0.49%),AFB异常27例(1.48%),AFB、NBI均异常19例(1.04%),病理阳性16例(0.88%)。在27例AFB异常患者中,病理阳性16例,病理阴性11例,阳性率为59.30%;在19例AFB、NBI均异常患者中,病理阳性15例,阴性4例,阳性率为78.95%,因阳性例数少,统计学未得到显著性差异。结论低剂量螺旋CT对于早期中央型肺癌及癌前病变的筛查效能低,自体荧光支气管镜联合窄带成像技术应能弥补CT的不足,提高中央型肺癌的早期诊断率。

Study of narrow band imaging combined with autofluorescence bronchoscopy in screening early central lung cancer among severe smokers

Objective To find a supplementary examination scheme so as to improve the early detection rate of central lung cancer and ameliorate the prognosis.Methods 1,821 heavy smokers who met the requirements of this study received by our hospital from January 2016 to December 2019 were selected, and the detection rate of early central lung cancer was compared between narrow band imaging(NBI) combined with autofluorescence bronchoscopy(AFB) and conventional low-dose CT examination.Meanwhile, the positive rate and pathological positive rate of common white light bronchoscope, AFB, and NBI combined with AFB were compared.Results (1) 1,821 patients were enrolled in the group.Among the patients in the group, chest CT reported 69 cases of suspected airway nodules or space-occupying.After tracheoscopy, 68 cases were not found any new organisms at CT-suggested sites, and 1 case was airway foreign body.Chest CT examination of 16 pathologically positive patients showed negative results.(2)Among the enrolled patients,9 cases(0.49%) were found abnormal mucosa under ordinary white light bronchoscope, 27 cases(1.48%) were found abnormal AFB,19 cases(1.04%)were found abnormal AFB and NBI,and 16 cases(0.88%)were found pathologically positive.Among the 27 patients with abnormal AFB, 16 were pathologically positive and 11 were pathologically negative, with a positive rate of 59.30%.Among the 19 patients with abnormal AFB and NBI, 15 were pathologically positive and 4 were pathologically negative, with a positive rate of 78.95%.Due to the small number of positive cases, there was no statistically significant difference.Conclusion Low dose spiral CT has low screening efficiency for early central lung cancer and precancerous lesions.AFB combined with NBI technology could make up for the deficiency of CT and improve the early diagnosis rate of central lung cancer.