摘要目的 评价荧光支气管镜(AFB)判断中央型肺癌浸润范围及指导治疗的价值.方法 对入选患者行白光支气管镜(WLB)和AFB检查,分析WLB和AFB镜下肿瘤浸润范围、阳性表现和病理结果.结果 共入选212例胸部病变患者,确诊肺癌182例;AFB镜下发现肺癌浸润范围比WLB更大者24例(13.2％,24/182),其中18例(9.9％,18/182)改变了治疗方法,15例改变了手术方式,3例终止了手术治疗.多因素回归分析显示,鳞癌、CT影像可见肿瘤侵犯2个以上段支气管是独立预测因素,该两类患者使用AFB评估肿瘤浸润范围较WLB更大的比例更高.AFB诊断肺癌的敏感性为85.7％,特异性为73.3％,阳性预测值为95.1％,阴性预测值为45.8％.WLB诊断肺癌的敏感性为72.5％,特异性为60.0％,阳性预测值为91.7％,阴性预测值为26.5％.结论 临床上AFB利于早期肺癌的诊断,肺癌患者术前应行AFB检查,以辅助制定治疗方案.

abstractsObjective To determine the sensitivity of autofluorescence bronchoscopy (AFB) in the assessment of tumor size and therapeutic strategy.Methods Patients with imaging suspected of malignancy were examined with both white light bronchoscopy (WLB) and AFB.The area of tumor infiltration,imaging information and pathological results were analyzed.Results A total of 212 patients were enrolled,including 180 male and 32 female.In 24 patients (13.2％),greater tumor volume was revealed by AFB than by WLB alone.In these patients,the median diameter of tumor was ＞ 1 cm wider on AFB examination than on WLB.Therapeutic strategy was changed in 18 patients (9.9％) after receiving AFB,including 15 patients with expanded scope of removal and 3 patients with avoidance of surgery.In the univariate analysis,the pathological type of squamous cell carcinoma and tumor invasion in two or more segments of bronchus were independent predictive factors.Diagnostic sensitivity of AFB group was 85.7％,specificity 73.3％,positive predictive value 95.1％,false predictive value 45.8％.Diagnostic sensitivity of WLB group was 72.5％,specificity 60.0％,positive predictive value 91.7％,false predictive value 26.5％.Conclusion Our study suggests that compared with WLB alone,autofluorescence bronchoscopy plus WLB significantly improves the diagnostic value and treatment outcome of central lung cancer.