56例循环肿瘤细胞检测阳性的亚厘米肺结节患者术后病理分析  

Postoperative Pathological Analysis of 56 Patients with Subcentimetre Pulmonary Nodules with Positive Detection of Circulating Tumor Cells

作　　者：苏雷[1] 支修益[1] 张毅[1] 高艳[2] 滕梁红[3] 许庆生[1] 胡牧[1] 钱坤[1] 李元博[1] 刘灵逸 Su Lei;Zhi Xiuyi;Zhang Yi(Department of Thoracic Surgery,Xuan wu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院胸外科,北京100053 [2]首都医科大学宣武医院放射科,北京100053 [3]首都医科大学宣武医院病理科,北京100053

出　　处：《医学研究杂志》2019年第5期51-54,共4页Journal of Medical Research

基　　金：国家重点基础研究发展计划(“973”计划)项目(2011CB510100)

摘　　要：目的探讨叶酸受体循环肿瘤细胞检测在亚厘米孤立性肺结节(solitary pulmonary nodule,SPN)临床诊断和外科治疗策略的应用。方法对笔者医院2017年9月~2018年6月期间56例术前叶酸受体循环肿瘤细胞检测阳性的亚厘米SPN病历进行回顾性分析。所有患者术前均行2次以上胸部CT扫描,随访观察时间1~6个月(平均4.2个月)。52例患者行术前病变定位。术式包括胸腔镜肺叶切除术7例,亚肺叶切除49例,包括肺楔形切除术41例,肺段切除术8例。结果术前胸部CT肺窗测定,病变直径≤5mm22例,6~9mm34例。实性结节9例,半实性结节36例,纯磨玻璃样病变11例。术后病理证实恶性结节54例(96.4%),良性结节2例(3.6%)。均为原发肺恶性肿瘤,包括非典型性腺瘤样增生(AAH)5例,原位腺癌(AIS)22例,微浸润腺癌(MIA)21例,贴壁生长为主的浸润腺癌(LPA)4例,肺鳞癌1例,类癌1例。结论亚厘米SPN影像学静态特征相对缺乏,需要通过随访观察确定诊疗策略。叶酸受体循环肿瘤细胞检测有助于弥补亚厘米SPN在影像学特征相对缺乏的不足,有希望成为提高早期肺癌诊断率的新辅助手段。Objective To investigate the diagnostic value of folate receptor-positive circulating tumor cell(FR+CTCs)in patient with subcentimetre solitary pulmonary nodules (SPN).Methods A retrospective analysis was performed on 56 cases of subcentimetre SPN patients with positive detection of preoperative FR+CTCs in our hospital from September 2017 to June 2018.All patients underwent chest CT scan more than 2 times before operation.The follow-up time was 1-6 months (average 4.2 months).Preoperative lesion localization was performed in 52 patients.In the 56 patients,resection was lobectomy in 7 and sublobectomy in 49,including pulmonary wedge resection in 41,segmentectomy in 8.Results According to the preoperative chest CT lung window,the diameter of the lesion was ≤5mm in 22 cases,and 6-9mm in 34 cases.Solid nodule was seen in 9 cases,semisolid nodule in 36 cases,pure grinding glass lesions in 11 cases.Postoperative pathological examination confirmed malignant nodules in 54 cases (96.4%),benign nodules in 2 cases (3.6%).All of them were primary lung malignant tumors,including 5 cases of atypical adenomatoid hyperplasia (AAH),22 cases of adenocarcinoma in situ (AIS),21 cases of minimally invasive adenocarcinoma (MIA),4 cases of lepidic predominant adenocarcinoma (LPA),1 case of lung squamous cell carcinoma and 1 case of carcinoid.Conclusion Due to the lack of imaging features in chest CT scan,we have to follow up the subcentimetre SPN to determine the diagnosis and treatment strategy.The detection of FR+CTCs would remedy for the deficiency of subcentimetre SPN in imaging features,which was expected to be a new auxiliary means to improve the diagnosis rate of early lung cancer.

关 键 词：亚厘米肺结节 循环肿瘤细胞 胸腔镜外科 诊断 治疗 

分 类 号：R734.2[医药卫生—肿瘤]