摘要
目的：评价窄谱成像（ NBI）支气管镜对评估中央型肺癌浸润范围及制定治疗方案的价值。方法使用日本奥林巴斯公司的EVIS LUCERA光谱支气管镜，对2012年6月至2014年6月上海市第十人民医院符合入选标准的患者进行白光支气管镜（ WLB）和NBI检查，统计并比较两种方法镜下肿瘤浸润范围、阳性表现和病理学结果。结果共196例患者入选，男152例，女44例，年龄（58±10）岁。分析确诊中央型肺癌的168例患者中，NBI 发现22例（13．1％）的肺癌浸润范围比WLB更广（ NBI下浸润比WLB下＞1 cm），其中19例（占肺癌患者的11．3％）改变治疗方案，包括改变手术方式14例，终止手术5例。多因素回归分析显示，病灶≥30 mm和病理类型为鳞癌为2个独立的预测因素，此类患者使用NBI评估肿瘤浸润范围较WLB更广的比例更高（ OR＝3．13，95％ CI：1．06～9．21， P＝0．038；OR＝4．68，95％ CI：1．02～21．58， P＝0．048）；NBI和WLB诊断肺癌敏感度、特异度、阳性预测值、阴性预测值分别为88．2％、83．3％、98．1％、41．7％和80．3％、55．6％、94．7％、22．2％。结论临床上使用NBI利于早期中央型肺癌的诊断，便于更准确的判断肺癌的浸润范围，帮助临床医师制定最佳的治疗方案。
Objective To determine the sensitivity of narrow-band imaging bronchoscopy （ NBI） in the assessment of tumor extent and therapeutic strategy .Methods A total of 196 patients with imaging abnormalities for malignancy were examined with both white light bronchoscopy （WLB） and NBI （Olympus, EVIS LUCERA）.Record the tumor infiltration , image and pathological results .Results There were 152 male and 44 female with a mean age of 58 years.In 22 patients （ 13.1%） , NBI revealed greater tumor extent than WLB alone.And tumor margins were 〉1 cm wider on NBI examination than on WLB .In 19 patients （11.3%）, that finding influenced further therapeutic course , leading to greater resection level （n=14） or avoidance of surgery （n=5）.According to univariate analysis, tumor size 〉30 mm and pathological type of squamous cell carcinoma were independent predictive factors （ OR 3.13, 95% CI：1.06-9.21, P=0.038;OR 4.68, 95%CI：1.02-21.58, P=0.048）.The diagnostic sensitivity of NBI group was 88.2%, specificity 83.3%, positive predictive value 98.1%and false predictive value 41.7%. And the diagnostic sensitivity of WLB group was 80.3%, specificity 55.6%, positive predictive value 94.7%and false predictive value 22.2%.Conclusions The combined use of NBI bronchoscopy and conventional white-light examination has greater sensitivity and specificity for assessing tumor margins .And this technique also significantly improves the assessment of central lung cancer infiltration and influences the therapeutic strategy.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第44期3497-3500,共4页
National Medical Journal of China
基金
上海市科研计划项目（14411971200）
关键词
肺肿瘤
支气管镜检查
窄谱成像
肿瘤浸润
肿瘤治疗方案
Lung neoplasms Bronchoscopy Narrow band imaging Tumor-infiltrating Antineoplastic protocols
