肺结节无创诊断技术研究进展
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摘要
随着螺旋CT在常规查体中的应用,肺结节的检出数量日益增加,但是肺结节良恶性的鉴别诊断,是困扰临床医师的关键问题。本综述对肺结节无创诊断方法进行了总结。利用中国知网、PubMed中英文数据库,以"肺结节""诊断""影像学""生物标志物"为关键词,检索2012-01-2017-12相关文献。纳入标准:(1)肺结节无创诊断方法及进展;(2)肺结节良恶性鉴别方法及进展。剔除标准:研究资料缺失或质量较差。结果表明,目前,肺结节良恶性诊断唯一金标准是病理学诊断,组织标本获取主要依靠气管镜、经皮肺穿刺活检及手术获取,但是有创途径是对医疗资源极大的浪费,同时也让患者身心经受着痛苦。肺结节无创诊断可节约医疗资源,同时减轻患者的痛苦。提示肺结节无创诊断在良恶性鉴别中,有重要作用,可以作为常规筛查项目。
With the application of low-dose spiral CT in routine examination increasing,the detection number of pulmonary nodules is increasing day by day.However,the differential diagnosis of benign and malignant pulmonary nodules is a key issue for clinicians.This review makes a summary of the ways of noninvasive diagnosis of pulmonary nodules.Using China National Knowledge Infrastructure(CNKI)and PubMed,the literatures were searched about"pulmonary nodule","diagnosis","imaging"and"biomarkers".Inclusion criteria included:(1)the method and progress of noninvasive diagnosis to pulmonary nodules;(2)the method and progress of differential diagnosis of benign and malignant pulmonary nodules.Exclusion criteria was:the research data was missing or poor quality.At present,the only gold standard for the diagnosis of benign and malignant pulmonary nodules is pathological diagnosis.The acquisition of tissue specimens mainly depends on bronchoscopy,percutaneous lung biopsy and surgery.However,the invasive approach is a great waste of medical resources,and patients suffer physical and mental pain.The non-invasive ways can save medical resource and reduce the pain of patients.Non-invasive diagnosis plays an important role in the differential diagnosis of benign and malignant pulmonary nodules and can be used as a routine screening program.
With the application of low-dose spiral CT in routine examination increasing,the detection number of pulmonary nodules is increasing day by day.However,the differential diagnosis of benign and malignant pulmonary nodules is a key issue for clinicians.This review makes a summary of the ways of noninvasive diagnosis of pulmonary nodules.Using China National Knowledge Infrastructure(CNKI)and PubMed,the literatures were searched about"pulmonary nodule","diagnosis","imaging"and"biomarkers".Inclusion criteria included:(1)the method and progress of noninvasive diagnosis to pulmonary nodules;(2)the method and progress of differential diagnosis of benign and malignant pulmonary nodules.Exclusion criteria was:the research data was missing or poor quality.At present,the only gold standard for the diagnosis of benign and malignant pulmonary nodules is pathological diagnosis.The acquisition of tissue specimens mainly depends on bronchoscopy,percutaneous lung biopsy and surgery.However,the invasive approach is a great waste of medical resources,and patients suffer physical and mental pain.The non-invasive ways can save medical resource and reduce the pain of patients.Non-invasive diagnosis plays an important role in the differential diagnosis of benign and malignant pulmonary nodules and can be used as a routine screening program.
引文
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[2]Atwater T,Cook CM,Massion PP.The Pursuit of Noninvasive Diagnosis of Lung Cancer[J].Semin Respir Crit Care Med,2016,37(5):670-680.
[3]Chen W,Zheng R,Zhang S,et al.Cancer incidence and mortality in China in 2013:An analysis based on urbanization level[J].Chin J Cancer Res,2017,29(1):1-10.
[4]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[5]Chansky K,Sculier JP,Crowley JJ,et al.The international association for the study of lung cancer staging project:Prognostic factors and pathologic TNM stage in surgically managed nonsmall cell lung cancer[J].J Thorac Oncol,2009,4(7):792-801.
[6]周清华,范亚光,王颖,等.中国肺部结节分类、诊断与治疗指南(2016年版)[J].中国肺癌杂志,2016,19(12):793-798.
[7]刘春全,崔永.肺结节评估四大指南比较分析[J].中国肺癌杂志,2017,20(7):490-498.
[8]Gould MK,Tang T,Liu IL,et al.Recent trends in the identification of incidental pulmonary nodules[J].Am J Respir Crit Care Med,2015,192(10):1208-1214.
[9]Erasmus JJ,Connolly JE,McAdams HP.Solitary pulmonary nodules:Part I Morphologic evaluation for differentiation of benign and malignant lesions[J].Radiographics,2000,20(1):43-58.
[10]Gierada DS,Pinsky P,Nath H,et al.Projected outcomes using different nodule sizes to define a positive CT lung cancer screening examination[J].J Natl Cancer Inst,2014,106(11):dju284.
[11]Wahidi MM,Govert JA,Goudar RK,et al.Evidence for the treatment of patients with pulmonary nodules:When is it lung cancer?[J].Chest,2007,132(3):94S-107S.
[12]Korst RJ.Systematic approach to the management of the newly found nodule on screening computed tomography:Role of dedicated pulmonary nodule clinics[J].Thorac Surg Clin,2013,23(2):141-152.
[13]李梦琦,韩融城,宋文静,等.CT三维容积分析在实性肺结节恶性风险度评估中的价值[J].中国肺癌杂志,2016,19(5):279-285.
[14]Swensen SJ,Silverstein MD,IIstrup DM,et al.The probability of malignancy in solitary pulmonary nodules[J].Arch Intern Med,1997,157(8):849-855.
[15]杨德松,李运,姜冠潮,等.孤立性肺结节良恶性判断数学预测模型的临床验证及应用[J].中华胸心血管外科杂志,2012,28(2):82-85.
[16]李运,陈克终,隋锡朝,等.孤立性肺结节良恶性判断数学预测模型的建立[J].北京大学学报(医学版),2011,43(3):450-454.
[17]Silvestri GA,Vachani A,Whitney D,et al.A bronchial genomic classifier for the diagnostic evaluation of lung cancer[J].N Engl J Med,2015,373(3):243-251.
[18]Chapman CJ,Murray A,McElveen JE,et al.Autoantibodies in lung cancer:Possibilities for early detection and subsequent cure[J].Thorax,2008,63(3):228-233.
[19]Murray A,Chapman CJ,Healey G,et al.Technical validation of an autoantibody test for lung cancer[J].Ann Oncol,2010,21(8):1687-1693.
[20]Jett JR,Peek LJ,Fredericks L,et al.Audit of the autoantibody test,EarlyCDT(R)-lung,in 1600patients:An evaluation of its performance in routine clinical practice[J].Lung Cancer,2014,83(1):51-55.
[21]Hammarstrom S.The carcinoembryonic antigen CEA family:Structures,suggested functions and expression in normal and malignant tissues[J].Semin Cancer Biol,1999,9(2):67-81.
[22]Li X,Kang J,Qi W.Advances in the study of serum tumor markers of lung cancer[J].J Cancer Res Ther,2014,10(7):95.
[23]Iwasaki A,Shirakusa T,Yoshinaga Y,et al.Evaluation of the treatment of non-small cell lung cancer with brain metastasis and the role of risk score as a survival predictor[J].Eur J Cardiothorac Surg,2004,26(3):488-493.
[24]Barlési F,Gimenez C,Torre J-P,et al.Prognostic value of combination of Cyfra 21-1,CEA and NSE in patients with advanced non-small cell lung cancer[J].Respiratory Medicine,2004,98(4):357-362.
[25]Molina R,Marrades RM,Auge JM,et al.Assessment of a combined panel of six serum tumor markers for lung cancer[J].Am J Respir Crit Care Med,2016,193(4):427-437.
[26]Jung M,Kim SH,Lee YJ,et al.Prognostic and predictive value of CEA and CYFRA 21-1levels in advanced non-small cell lung cancer patients treated with gefitinib or erlotinib[J].Exp Ther Med,2011,2(4):685-693.
[27]Wang R,Wang G,Zhang N,et al.Clinical evaluation and cost-effectiveness analysis of serum tumor markers in lung cancer[J].Biomed Res Int,2013,2013(4):195692.
[28]Kanemoto K,Satoh H,Ishikawa H,et al.Neurone-specific enolase and liver metastasis in small cell lung cancer[J].Clinical Oncology,2006,18(6):505.
[29]Yang H,Mi R,Wang Q,et al.Expression of neuron-specific enolase in multiple myeloma and implications for clinical diagnosis and treatment[J].PLoS One,2014,9(5):e94304.
[30]Petrovic M,Bukumiric Z,Zdravkovic V,et al.The prognostic significance of the circulating neuroendocrine markers chromogranin A,pro-gastrin-releasing peptide,and neuron-specific enolase in patients with small-cell lung cancer[J].Med Oncol,2014,31(2):823.
[31]Shibayama T,Ueoka H,Nishii K,et al.Complementary roles of pro-gastrin-releasing peptide(ProGRP)and neuron specific enolase(NSE)in diagnosis and prognosis of small-cell lung cancer(SCLC)[J].Lung Cancer,2001,32(1):61-69.
[32]Hanada S,Nishiyama N,Mizuguchi S,et al.Clinicopathological significance of combined analysis of cytokeratin19expression and preoperative serum CYFRA21-1levels in human lung squamous cell carcinoma[J].Osaka City Med J,2013,59(1):35-44.
[33]Tomita M,Shimizu T,Ayabe T,et al.Prognostic significance of tumour marker index based on preoperative CEA and CYFRA21-1in non-small cell lung cancer[J].Anticancer Res,2010,30(7):3099-3102.
[34]Liu L,Liu B,Zhu LL,et al.CYFRA21-1as a serum tumor marker for follow-up patients with squamous cell lung carcinoma and oropharynx squamous cell carcinoma[J].Biomarkers Med,2013,7(4):591-599.
[35]Hanagiri T,Sugaya M,Takenaka M,et al.Preoperative CYFRA21-1and CEA as prognostic factors in patients with stage I nonsmall cell lung cancer[J].Lung Cancer,2011,74(1):112-117.
[36]Fiala O,Pesek M,Finek J,et al.Predictive role of CEA and CYFRA 21-1in patients with advanced-stage NSCLC treated with erlotinib[J].Anticancer Res,2014,34(6):3205-3210.
[37]Song W,Liu X,Tian X,et al.Utility of squamous cell carcinoma antigen,carcinoembryonic antigen,Cyfra 21-1and neuron specific enolase in lung cancer diagnosis:A prospective study from China[J].Chin Med J,2011,124(20):3244-3248.
[38]Molina R,Filella X,Auge JM,et al.Tumor markers(CEA,CA125,CYFRA 21-1,SCC and NSE)in patients with non-small cell lung cancer as an aid in histological diagnosis and prognosis.Comparison with the main clinical and pathological prognostic factors[J].Tumour Biol,2003,24(4):209-218.
[39]Zou Y,Wang L,Zhao C,et al.CEA,SCC and NSE levels in exhaled breath condensate--possible markers for early detection of lung cancer[J].J Breath Res,2013,7(4):047101.
[40]Mitchell PS,Parkin RK,Kroh EM,et al.Circulating microRNAs as stable blood-based markers for cancer detection[J].Proc Natl Acad Sci USA,2008,105(30):10513-10518.
[41]Boeri M,Verri C,Conte D,et al.MicroRNA signatures in tissues and plasma predict development and prognosis of computed tomography detected lung cancer[J].Proc Natl Acad Sci USA,2011,108(9):3713-3718.
[42]Sozzi G,Boeri M,Rossi M,et al.Clinical utility of a plasma-based miRNA signature classifier within computed tomography lung cancer screening:A correlative MILD trial study[J].J Clin Oncol,2014,32(8):768-773.
[43]Xing L,Su J,Guarnera MA,et al.Sputum microRNA biomarkers for identifying lung cancer in indeterminate solitary pulmonary nodules[J].Clin Cancer Res,2015,21(2):484-489.
[44]Li X,Zhang Q,Jin X,et al.Combining serum miRNAs,CEA,and CYFRA21-1with imaging and clinical features to distinguish benign and malignant pulmonary nodules:A pilot study[J].World J Surg Oncol,2017,15(1):107.
[45]Zeng GQ,Yi H,Zhang PF,et al.The function and significance of SELENBP1downregulation in human bronchial epithelial carcinogenic process[J].PLoS One,2013,8(8):e71865.
[46]Lehtonen ST,Svensk AM,Soini Y,et al.Peroxiredoxins,a novel protein family in lung cancer[J].Int J Cancer,2004,111(4):514-521.
[47]Li XJ,Hayward C,Fong PY,et al.A blood-based proteomic classifier for the molecular characterization of pulmonary nodules[J].Sci Transl Med,2013,5(207):207ra142.
[48]Seder CW,Kubasiak JC,Pithadia R,et al.Angiogenesis biomarkers may be useful in the management of patients with indeterminate pulmonary nodules[J].Ann Thorac Surg,2015,100(2):429-436.
[49]Xu C,Wang W,Wang Y,et al.Serum angiopoietin-2as a clinical marker for lung cancer in patients with solitary pulmonary nodules[J].Ann Clin Lab Sci,2016,46(1):60-64.
[50]Ignatiadis M,Lee M,Jeffrey SS.Circulating tumor cells and circulating tumor DNA:Challenges and opportunities on the path to clinical utility[J].Clin Cancer Res,2015,21(21):4786-4800.
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