Greining illkynja æxla í lungum með berkjuspeglun

Abstract

Objective: To assess the diagnostic yield of fiberoptic bronchoscopy in patients with a variety of radiographic findings suspected of malignancy. Material and methods: The study group was composed of all patients who underwent bronchoscopy in our hospital over a seven year period (1986-1993) where cytologic samples were obtained. Schematic drawings of endobronchial and radiographic findings done at the time of bronchoscopy were reviewed and the results of cytologic and histologic samples were compared for sensitivity and diagnostic accuracy. Results: Bronchoscopy and cytologic sampling was performed on 189 patients. Tissue samples were obtained in 109 patients from visible endobronchial abnormalities or peripheral lesions using the transbronchial approach with fluoroscopic guidance. A total of 64 malignancies were diagnosed, 43 by bronchoscopy (67%). Among 58 patients who had primary malignancy of the lung, adenocarcinoma was the most frequent histologic type (50%) followed by squamous cell carcinoma (22%) and small cell carcinoma (17%). The diagnostic sensitivity of cytology was 30% whereas that of tissue biopsy was 70% among those patients where both tests were obtained. The two methods complemented each other to give a joint sensitivity of 76%. Among 13 patients with malignancy and normal endobronchial appearance, transbronchial biopsy was performed in 10 of which seven were diagnostic. Patients with primary malignancy who underwent surgery had a five year survival of 37% while the overall five year survival was 15.5%. Conclusions: In this study histology was much more sensitive than cytology as a sampling technique during bronchoscopy (p< 0.01). Adenocarcinoma has become the most frequent histologic type of primary lung malignancy in Iceland and overall survival among patients with primary tumors compares with recent international trends.

Markmið: Að meta greiningarárangur af berkjuspeglun hjá sjúklingum sem grunaðir voru um illkynja sjúkdóm í lungum. Efniviður og aðferðir: Þeir sjúklingar sem rannsakaðir voru með berkjuspeglun og töku sýna til frumurannsóknar á sjö ára tímabili (1986-1993) á Landakotsspítala mynduðu rannsóknarhópinn. Upplýsingar um útlit berkja og röntgenmynda skráðar við speglun voru flokkaðar og greiningarárangur af frumu- og vefjarannsókn borinn saman. Niðurstöður: Berkjuspeglun og taka frumusýnis með burstatækni voru framkvæmdar hjá 189 sjúklingum. Vefjasýni voru einnig tekin frá 109 þessara sjúklinga úr sjáanlegu æxli eða með sýnistöku í gegnum berkju í skyggningu. Alls fundust illkynja æxli hjá 64 sjúklingum þar af voru 43 greindir við berkjuspeglun (67%). Meðal 58 sjúklinga með frumæxli í lungum voru kirtilmyndandi krabbamein algengasta vefjagerðin (50%), en næst komu flöguþekjukrabbamein (22%) og smáfrumukrabbamein (17%). Næmi frumurannsóknar var 30% en vefjarannsóknar 70%. Aðferðirnar bættu hvor aðra upp þannig að samanlagt næmi þeirra var 76%. Meðal 13 sjúklinga með illkynja æxli og eðlilegt berkjuútlit var vefsýni tekið í gegnum berkju hjá 10 og gaf það greininguna hjá sjö. Meðal sjúklinga með frumæxli í lungum sem fóru í skurðaðgerð var fimm ára lifun 37% en í öllum hópnum 15,5%. Ályktanir: Vefjarannsókn reyndist mun næmari aðferð en frumurannsókn (p<0,01) við greiningu illkynja æxla í berkjuspeglun. Kirtilmyndandi krabbamein eru orðin algengasta vefjagerð lungnakrabbameina á Íslandi og lifun er sambærileg við nýlega birtar erlendar tölur.