The diagnosis of lung cancer is the primary condition for the development of a treatment plan. The patient will often ask the doctor what il
The diagnosis of lung cancer is the primary condition for the development of a treatment plan. The patient will often ask the doctor what illness he has suffered during his visit to the clinic and during his stay in hospital How should treat? So, let's look at how clinicians can make a complete diagnosis of lung cancer.
1 histopathological diagnosis
Histopathology and cell pathology are still the gold standard for the diagnosis of lung cancer. Sputum cytology is the most convenient, the most economical and noninvasive method for the lung cancer positive rate reached 50%, but the sensitivity by tumor location (the proportion of the proportion of diagnosis of central lung cancer than peripheral lung cancer, histological type and high) sputum specimens are affected or not, influence at the same time also affected the technical level of science. It is believed that the sensitivity of sputum cytology is 20 to 30%, and its reliability is from 13 to 82%. Sputum cytology test of sputum cytology can greatly improve the diagnostic sensitivity and reliability, are reported to have a sensitivity of 97.2%, specificity of 92.9%, positive predictive value reached 93%. In invasive examination, bronchoscopy is most widely used in clinical, by conventional bronchoscopy derived: transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA), combined with endotracheal ultrasound comes EBUS-TBLB, EBUS-TBNA. The conventional bronchoscopy mainly for central lung cancer, can check sputum in bronchial biopsy and brush biopsy within the bronchial mucosa, washing and inspection methods can be integrated, the positive rate increased to more than 90%. TBLB examination of peripheral lung cancer, as well as lung metastases in the lung, from different reports on the positive rate of the different, the positive rate of 21 ~ 77%. TBNA can be used for the puncture of the adjacent lymph nodes and tracheal cavity is not suitable for biopsy of the masses of the needle aspiration cytology, the positive rate of 15 ~ 85%. The application of EBUS-TBNA improved the sensitivity of TBNA, and it was reported that the sensitivity and accuracy of EBUS-TBNA in the diagnosis of pulmonary masses were 94.1% and 94.3%, respectively.
2 Molecular Biology Diagnosis
Molecular biology diagnosis mainly involves two levels of gene and protein. The tumor is the gene mutation disease, there are also obvious heterogeneity, so the method of molecular biology diagnosis can be a clearer understanding of the characteristics of the tumor, and provide the basis for tumor treatment individualized. The test mainly involves: the expression level of chemotherapy related genes, related to chemosensitivity of tumor cells. For example, the expression level of ERCC1 gene related to platinum drugs is related to the sensitivity of tumor cells to platinum drugs. RRM1 was associated with the efficacy of gemcitabine, and TS was associated with pemetrexed efficacy. The gene mutation and targeted drug efficacy. Because of the mutation status of EGFR gene, it is the key to the curative effect of molecular targeted drugs. Therefore, the mutation detection of EGFR gene is an important and necessary content in the pre clinical diagnosis. With the development and improvement of individualized treatment strategy of lung cancer, the molecular biological diagnosis of lung cancer will be more and more abundant.
3 imaging diagnosis
The imaging diagnostic techniques are mainly related to conventional X-ray examination and chest spiral CT examination, as well as the rapid development of molecular imaging technology in recent years. There are many technical limitations in traditional X-ray examination, which can not meet the needs of early diagnosis and evaluation of lung cancer. As a simple economic examination method, it is more suitable for routine physical examination and exclusion diagnosis. Chest spiral CT examination has high resolution, and the observation of lung structure is not blind, can clearly reflect the lesions and normal tissue at the junction, and thus become in the early detection of lung cancer, the main methods of examination condition assessment etc.. PET-CT is a widely used molecular imaging technique in recent years. The use of tumor cells on the metabolism of glucose uptake rate high characteristic imaging, not only can find lesions, and can find the features of internal lesions, which can differentiate malignant from benign lesions. Many of the current guidelines recommend the use of PET-CT greater than 8mm single nodule in the lungs can be checked. Previous studies have shown that the sensitivity and specificity of PET-CT in the differential diagnosis of solitary pulmonary nodules (SPN) are 96% and 80%, respectively. The negative predictive value of is about 92. The positive predictive value of PET-CT was low due to the high metabolic activity of inflammatory lesions and granulomatous lesions. In 2012 ASCO annual meeting, the authors reported the results of comprehensive analysis. The sensitivity and specificity of PET-CT were 80% and 69%, respectively. Further analysis showed that most of the cases were granulomatous diseases. Therefore, with the application of more extensive, the evaluation of PET-CT will be more objective.
4 staging of lung cancer
The complete diagnosis of lung cancer must include staging, accurate staging is the guarantee of the right treatment strategy. Now the staging of lung cancer or TNM (tumor size, lymph node metastasis, distant metastasis), means a non surgical staging method (noninvasive) method and surgical staging (invasive) two, and the comprehensive use of various techniques is helpful to improve the accuracy of staging. Non surgical staging methods mainly rely on imaging examination: the coincidence rate of X-ray and surgical staging is 62.6%, the accuracy rate is 44.8%. The ordinary CT relies on lymph node size to determine the lymph node metastasis, the sensitivity and specificity were 57.2% and 80.2%, the sensitivity of MRI for the diagnosis of lung cancer N2 lymph node was 71%, the specificity was 84%, the sensitivity and specificity of PET were 94.1% and 79%. The highest sensitivity is PET, but its specificity is close to that of the normal CT, which may lead to an overestimate of the stage, which results in the failure of the operation. Therefore, some scholars believe that PET can not replace the surgical staging method, PET positive cases still need mediastinoscopy, further confirmed. Mediastinoscopy is the most accurate method, sensitivity of 90%, specificity of 100%, while the EBUS-TBNA can achieve the same accuracy, but affected by the operation of the bronchoscope doctor operation level and pathology doctor diagnosis ability. Finally, it is necessary to carry out magnetic resonance imaging, bone scan and PET-CT examination to find out whether there is metastasis in the distance, and to make an accurate staging of lung cancer.
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