自发荧光支气管镜在中央型肺癌早期诊断中的价值

Autofluorescence bronchoscopy in early diagnosis of central lung cancer

目的评价自发荧光支气管镜在中央型肺癌的早期诊断中的价值。方法应用自发荧光支气管镜系统(LIFE系统),对符合入选标准的患者进行普通支气管镜和荧光支气管镜检查,统计镜下阳性表现和病理检查结果。结果 82例患者入选,取得180个标本,经病理检查明确诊断为肺癌或中至重度不典型增生42例。自发荧光支气管镜诊断敏感度为95.2%,特异度为25.0%,假阳性率为75.0%,假阴性率为4.8%,阳性预测值为57.1%,阴性预测值为83.3%。与普通支气管镜比较,自发荧光支气管镜的敏感度显著升高(P<0.01),特异度显著降低(P<0.05),假阳性率显著升高(P<0.05),假阴性率显著降低(P<0.01);阳性预测值降低,阴性预测值升高,但差异均无统计学意义(P值均>0.05)。结论应用自发荧光支气管镜检查利于早期肺癌的诊断,所有自发荧光支气管镜下的阳性部位均应行活组织检查,同时结合普通支气管镜的表现决定活组织检查的部位。

Objective To evaluate the role of autofluorescence bronchoscopy in early diagnosis of central lung cancer.Methods Patients with sputum cytology suspicious of or imaging abnormalities for malignancy were examined with both white light（control group） and autofluorescence bronchoscopy（Olympus,LIFE group）.Biopsy specimens were taken from all abnormal areas discovered by white light or autofluorescence bronchoscopy examination for pathological examinations.Results Eighty-two patients were enrolled and a total of 180 samples were obtained.Forty-two biopsies were found to have lung cancers or moderate to severe dysplasia.In LIFE group,the diagnostic sensitivity was 95.2%,specificity was 25.0%,false positive rate was 75.0%,false negative rate was 4.8%,positive predictive value was 57.1%,and negative predictive value was 83.3%. Compared with the control group,sensitivity of LIFE group increased by 33.1%（P0.01）,specificity decreased by 50.0%（P = 0.037）,false positive rate increased by 50.0%（P = 0.037）,false negative rate decreased by 83.2%（P0.01）.positive predictive value decreased by 4.8%（P = 0.87）,and negative predictive value increased by 33.3%（P = 0.282）.The diagnosis of pre-invasive bronchial lesions was greatly enhanced in the LIFE group.Conclusions Our study suggests that autofluorescence bronchoscopy is beneficial to the early diagnosis of lung cancer;all the positive areas detected by autofluorescence bronchoscopy should be subjected to biopsy;and the biopsy site should be determined with the help of white light bronchoscopy.