背景:肺癌的CT检查已经开展了20多年,在肺癌的早期发现方面取得了很大的成就。然而,在临床工作中,支气管镜检查仍发现大量晚期中央型肺鳞癌。同时,部分CT隐匿性中央型肺鳞癌及鳞状上皮癌前病变也可通过支气管镜意外检出。
方法:本研究回顾性收集2014年1月至2018年12月浙江省肿瘤医院内镜科支气管镜室患者的病历资料。患者的纳入标准包括:1.完成病人医疗记录,2.诊断前无肺癌病史,首次病理诊断为原发性肺癌,3.有同期肺部CT资料,4.有支气管镜检查记录及相关病理诊断,5.接受根治性手术治疗的患者必须有完整的术后病理诊断。最后,共有10,851例原发性肺癌患者被纳入研究,包括7175名男性和3676名女性,年龄22-98岁。首先,抽取130例CT隐匿性病灶患者并对其临床特征进行分析。然后,抽取604例单发中央型鳞癌和3569例周围型腺癌,比较其术后肿瘤直径和淋巴结转移情况。
结果:发现CT隐匿性中央型肺鳞癌115例,鳞状上皮癌前病变15例。在总的肺癌中,CT隐匿性病变的比例为130/10,851(1.20%)。同时,所有这些患者均为中老年男性,有大量吸烟史。术后肿瘤直径中位数有统计学差异(3.65cmvs.1.70cm,P<0.0001)和淋巴结转移率(50.99%vs.13.06%,P<0.0001)在604例可手术的单发中央型肺鳞癌患者和3569例可手术的周围型肺腺癌患者之间。604例鳞状细胞癌患者中,96.52%(583/604)为男性,有大量吸烟史,年龄40-82岁,中位年龄64岁。
结论:本研究表明,目前肺癌的肺部CT检查对中央鳞状细胞癌和鳞状上皮癌前病变的早期诊断确实不足。对有大量吸烟史的中老年男性进行进一步的支气管镜检查可以弥补常规肺部CT检查的不足。
BACKGROUND: CT examination for lung cancer has been carried out for more than 20 years and great achievements have been made in the early detection of lung cancer. However, in the clinical work, a large number of advanced
central lung squamous cell carcinoma are still detected through bronchoscopy. Meanwhile, a part of CT-occult
central lung squamous cell carcinoma and squamous epithelial precancerous lesions are also accidentally detected through bronchoscopy.
METHODS: This study retrospectively collects the medical records of patients in the bronchoscopy room of the Endoscopy Department of Zhejiang Cancer Hospital from January 2014 to December 2018. The inclusion criteria for patients includes: 1.Patient medical records completed, 2.Without history of lung cancer before the diagnosis and first pathological diagnosis of primary lung cancer, 3.Have the lung CT data of the same period, 4.Have the bronchoscopy records and related pathological diagnosis, 5.The patients undergoing radical surgical treatment must have a complete postoperative pathological diagnosis. Finally, a total of 10,851 patients with primary lung cancer are included in the study, including 7175 males and 3676 females, aged 22-98 years. Firstly, 130 patients with CT-occult lesions are extracted and their clinical features are analyzed. Then, 604 cases of single
central squamous cell carcinoma and 3569 cases of peripheral adenocarcinoma are extracted and compares in postoperative tumor diameter and lymph node metastasis.
RESULTS: 115 cases of CT-occult
central lung squamous cell carcinoma and 15 cases of squamous epithelial precancerous lesions are found. In the total lung cancer, the proportion of CT-occult lesions is 130/10,851 (1.20%). Meanwhile, all these patients are middle-aged and elderly men with a history of heavy smoking. There are statistically significant differences in postoperative median tumor diameter (3.65 cm vs.1.70 cm, P < 0.0001) and lymph node metastasis rate (50.99% vs.13.06%, P < 0.0001) between 604 patients with operable single
central lung squamous cell carcinoma and 3569 patients with operable peripheral lung adenocarcinoma. Of the 604 patients with squamous cell carcinoma, 96.52% (583/604) are male with a history of heavy smoking and aged 40-82 years with a median age of 64 years.
CONCLUSIONS: This study indicates that the current lung CT examination of lung cancer is indeed insufficiency for the early diagnosis of central squamous cell carcinoma and squamous epithelial precancerous lesions. Further bronchoscopy in middle-aged and elderly men with a history of heavy smoking can make up for the lack of routine lung CT examination.