最近 5 年間の肺癌 145 例における気管支鏡下診断率の検討 [in Japanese] Diagnostic Yield of Lung Cancer by Transbronchoscopic Procedures [in Japanese]
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気管支鏡検査による肺癌確定診断において, より効率的に診断するためにいかなる気管支鏡下の手技を組み合わせるべきかを検討した。対象145例の内訳は, 扁平上皮癌45例, 腺癌44例, 小細胞癌23例, 大細胞癌6例, 転移性肺癌27例であった。各症例を気管支鏡所見別, 組織型別, 病期別に分類し, 気管支鏡下の各手技別診断率および各手技の組み合わせ診断率を検討した。初回気管支鏡施行時の総合診断率は原発性肺癌で84.7%, 転移性肺癌で74.1%, 両者を合わせると82.8%であった。原発性肺癌では各組織型ともTBBによる診断率が最も高く, Brushing, Washingの順であった。一方転移性肺癌ではBrushingによる診断率が最も高く, TBB, Washingの順であった。いずれもBiopsyにTBAC, Brushing, Washing, 気管支鏡後採痰3日間を追加することにより診断率は上昇した。Stage別の気管支鏡下各手技の組合せ診断率ではStage間に有意差はなかった。以上の結果より, より効率的な肺癌確定診断のために, TBBやTBACにBrushing, Washing, 気管支鏡後採痰3日間を追加することは重要と思われた。
Methods of combining the different transbronchoscopic techniques to increase the diagnostic yield in lung cancer were evaluated. Among the 145 subjects studied there were 118 cases of primary lung cancer and 27 cases of metastatic lung cancer. The histological types of the 118 cases of primary lung cancer were as follows : squamous cell carcinoma 45 cases adenocarcinoma 44 cases, small cell carcinoma 23 cases and large cell carcinoma 6 cases. The cases were classified according to bronchoscopic findings, histological type and clinical stage. The diagnostic yields of each transbronchoscopic procedure as well as the overall diagnostic yield obtained by their combination were assessed. The diagnostic yield obtained during the first bronchoscopic examination was 84.7% in primary lung cancer and 74.1% in metastatic lung cancer with an overall diagnostic yield of 82.2%. In cases of primary lung cancer, transbronchial biopsy was the procedure which provided the highest diagnostic yield followed by bronchial brushing and bronchial lavage procedures, while in cases of metastatic lung cancer the highest diagnostic yield was obtained through bronchial brushing followed by transbronchial biopsy and bronchial lavage procedures. In addition to transbronchial biopsy, carrying out transbronchial aspiration cytology, bronchial brushing, bronchial lavage and cytological study of sputum collected for three consecutive days after the bronchoscopic examination resulted in increased diagnostic yields in all cases. There were no significant differences among the overall diagnostic yields obtained in each clinical stage. It was concluded that in order to increase the diagnostic yield of lung cancer through bronchoscopy, it is very available to carry out all the procedures including transbronchial biopsy, transbronchial aspiration cytology, bronchial brushing, bronchial lavage and three-day pooled sputum cytology.
- The Journal of the Japan Society for Respiratory Endoscopy
The Journal of the Japan Society for Respiratory Endoscopy 13(6), 557-563, 1991
The Japan Society for Respiratory Endoscopy