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    早期中央型肺癌的筛查及光动 早期中央型肺癌的筛查及光动

    力治疗 力治疗

    第二军医大学长海医院呼吸内科 第二军医大学长海医院呼吸内科

    姚 姚 小 小 鹏 鹏

    早期肺癌的概念 早期肺癌的概念

    ? Peripheral-type early stage lung cancer(PELC)：

    A tumor located in an airway more peripheral than

    the subsegmental bronchi, with the longest

    dimension of the tumor being 2 cm or less and with

    no recognized lymph node or distant metastases.

    Tatsuo Ohira, et al. Int J Clin Oncol (2006) 11:9–12

    ? Plain chest X-ray films, tomography and CT scans are normal

    ? No lymph node metastasis or distant metastasis is observed in routine

    clinical screening, such as chest X-ray, CT scans, abdominal CT,abdominal echo, brain CT, or bone scintigraphy

    Clinical criteria of central-type early stage lung

    cancer(CELC) Bronchoscopic criteria of CELC

    ? Squamous cell carcinoma is identified histologically

    ? The tumor size is less than 2 cm in greatest dimension

    ? The peripheral margin of the tumor is visible bronchoscopically

    ? Location in subsegmental or more proximal bronchi or trachea

    Ikeda ,et al. lung cancer. 2007(3)295-302

    CELC is classified into five categories

    according to features: polypoid, nodular,thickened, invisible and mixed

    CELC CELC的解剖类型 的解剖类型

    ? ? CIS CIS includes malignant cellular changes throughout the full thicknes includes malignant cellular changes throughout the full thickness of s of

    the mucosa but an intact basement membrane. CIS is usually the mucosa but an intact basement membrane. CIS is usually squamous squamous cell cell

    carcinoma. carcinoma.

    ? ? Microinvasive Microinvasive carcinoma carcinoma is described as a few millimeters of is described as a few millimeters of

    bronchial invasion but not involving the muscle or cartilage. bronchial invasion but not involving the muscle or cartilage.2

    ? ? Disease Disease- -free survival after surgical resection of lung free survival after surgical resection of lung

    CIS has been reported as over CIS has been reported as over 90% 90%. For . For

    " "microinvasive microinvasive" lung cancer it may be similar. After " lung cancer it may be similar. After

    resection of stage IA non resection of stage IA non- -small cell lung cancer, small cell lung cancer,survival at 5 years is approximately survival at 5 years is approximately 60 to 70% 60 to 70%. .

    早期诊断 早期诊断

    一、荧光支气管镜 一、荧光支气管镜autofluorescence autofluorescence

    bronchoscopy bronchoscopy (AFB) (AFB)

    Absorption of

    haemoglobin

    AF intensity

    Excitation light

    Xenon Lamp

    Reflected light

    Auto fluorescence light

    CCD

    +

    Video Processor

    RGB Rotary Filter

    Barrier Filter

    G B R

    A F I

    (Autofluorescence imaging bronchovideoscope system)3

    Squamous dysplasia (moderate)

    Squamous dysplasia (severe)

    Squamous cell carcinoma

    (Early hilar lung cancer)

    2006 90 65 154 Ikeda

    2005 85 62 32 Chiyo

    2005 95 63 151 Chhajet

    2002 86 36 244 Moro-Sibilot

    1999 87 67 600 Ikeda

    2001 73 18 55 Hirsch

    2005 61 11 293 Ernst

    1999 NA 25 34 Vermylen

    2005 71 71 589 Hauzinger

    1998 56 9 173 Lam

    Year of

    references

    Sensitivity

    (%) AFB

    Sensitivity

    (%) WLB

    No. of No. of

    patient patient

    Author Author

    Comparison of diagnostic performance of WLB versus AFB 4

    二、支气管内超声 二、支气管内超声Endobronchial Endobronchial

    Ultrasound Ultrasound(EBUS (EBUS) ) ......