CAJ | 학술논문

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。
목적：평개착보성상（ NBI）지기관경대평고중앙형폐암침윤범위급제정치료방안적개치。방법사용일본오림파사공사적EVIS LUCERA광보지기관경，대2012년6월지2014년6월상해시제십인민의원부합입선표준적환자진행백광지기관경（ WLB）화NBI검사，통계병비교량충방법경하종류침윤범위、양성표현화병이학결과。결과공196례환자입선，남152례，녀44례，년령（58±10）세。분석학진중앙형폐암적168례환자중，NBI 발현22례（13．1％）적폐암침윤범위비WLB경엄（ NBI하침윤비WLB하＞1 cm），기중19례（점폐암환자적11．3％）개변치료방안，포괄개변수술방식14례，종지수술5례。다인소회귀분석현시，병조≥30 mm화병리류형위린암위2개독립적예측인소，차류환자사용NBI평고종류침윤범위교WLB경엄적비례경고（ OR＝3．13，95％ CI：1．06～9．21， P＝0．038；OR＝4．68，95％ CI：1．02～21．58， P＝0．048）；NBI화WLB진단폐암민감도、특이도、양성예측치、음성예측치분별위88．2％、83．3％、98．1％、41．7％화80．3％、55．6％、94．7％、22．2％。결론림상상사용NBI리우조기중앙형폐암적진단，편우경준학적판단폐암적침윤범위，방조림상의사제정최가적치료방안。
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.