低剂量螺旋CT早期检出中央型肺癌的初步研究
摘要
第一部分：肺癌肿瘤发生部位的分析
目的：评价肺癌患者中中央型肺癌所占的比例、组织学类型以及临床分期，
为肺癌筛选方案的制订提供依据。材料与方法：对1999年1月～2001年1
月815例病例资料完整者进行回顾性分析，根据肿瘤发生部位将肺癌分为
中央型、周围型、弥漫型或原因不明型三种，757例病人为病理组织学诊
断，58例为临床诊断。结果：815例肺癌中，有吸烟史者568例(69.7%)，
其中男性547例(96.3%)，>45岁者492例(86.6%)。568例吸烟者肺癌
中，中央型肺癌328例，占58%，其中鳞癌198例(60%)，小细胞癌85
例(26%)：周围型肺癌202例，占36%，其中腺癌118例(（58%)，鳞癌54
例(27%)。中央型肺癌临床分期为1期 16例(4%)Ⅱ期 67例(15%)，ⅢA
期98例(24%)，ⅢB～Ⅳ期234例(57%)。结论：吸烟者肺癌患者中，中
央型肺癌占58%，大多数在诊断时已为晚期，在肺癌筛选试验设计中应注
重中央型肺癌的早期检出。
第二部分：低剂量多层面螺旋CT不同参数对段及亚段支气管显
示的影响
目的：描写薄层MSCT正常亚段支气管解剖及其变异，比较不同层厚、不
同管球电流对段及亚段支气管显示的影响，建立MSCT显示段与亚段支气
管的最什扫描程序。材料与方法：(1)对50例健康志愿者亚段支气管CT
影像进竹分析，检查采用LightSpeed Plus多层面螺旋CT扫描机，螺旋扫
描模式，扫描参数为：120 Kv,50mA,螺距6，床速15mm/转，0.8/转，2.5mm
层厚，2.5mm间隔重建，山两位放射医师在监视器上以电影显示方式对图
像进行观察。(2)将90例健康志愿者随机分为3组，每组30人，分别采
I
解放军总医院 军医进修学院 博十学位论文
用三种扫描程序检查，A组，螺距 3，床速 15mm／转，重建层厚 10mm，
间隔 10mm；B组，螺距 6，床速 30mm／转，重建层厚 smm，间限 smm；
C组，螺距 6，床速 15mm／转，重建层厚 2．smm，间隔 2．smm。对三组段
与亚段支气管显示率采用 SPSS软件包进行X‘检验统计学分析。3）将健
康体检者20人采用不同管球电流（50mA，20mA）分别进行两次检查，其
余参数同（l），山三位放射医师对图像质量进行评价。结果：50例健康者
亚段支气管共2150支，CT显示2038支，显示率95％。A组、B组、C组
段支气管显示率分别为 740、98o、100o，亚段支气管显示率分别为 28o、
65o、95o。B组段支气管显示率明显高于A组（P＜0．of）。C组亚段支气
管显示率明显高于A组及B组（P＜0．O！）。管球电流5 om0mA与20mA相比，
图像质量无显著性差异。结论：采用螺距6，40mAS管球电流，2．smn层
厚重建图像可以清晰显示段及亚段支气管。该方法可用于对咯血病人及肺
癌高危人群筛选检合。
第三部分：低剂量螺旋CT早期肺癌筛选初步研究
日的：评价低剂量螺旋CT肺癌高危人群筛选检查对早期肺癌的检出率。
材料与方法：对无症状300例体检者胸片及CT进行前瞻性研究，纳入标
准为年龄45岁以上，吸烟IO年包以上，或既往有慢性阻塞性肺疾病病史，
以前无癌症史，身体状况适合手术治疗者，低剂量CT扫描采用 Philip SR
7000及 GE Lightspeed Plus多层面 CT扫描机，螺旋扫描力式，120kV， 50mA，
重建层厚smm／25mm，间隔smm／2．smm，图像山两位放射医师在工作站
显示器上以电影显示方式观察，存储至PACS系统，对胸部CT检出病变
进行 3～6个月短期随诊。结果；低剂量 CT共检出 56例 （ 9％）非钙化结
节（其中恶性4例），胸片检出9例（3％）（其中恶性3例），均为1期病变。
低剂量 CT检出D支气管或段支气管病变 9例门％），其中早期中央型肺
二
解放军总＊ 皖 丫 ［X进修学院 博卜于仿论文
癌 3例（l％），病理证实 1例小细胞肺癌，2例鳞癌，胸片均未检出。结论：
初步筛选研究结果表明低剂量多层面螺旋CT明显提高了对肺内非钙化小
结节及支气管细微病变的检出，可检出早期可治愈肺癌。
第四部分：中央型肺癌早期CT诊断与鉴别诊断：与支气管镜及
病理组织学表现对照
目的：研究中央型肋癌早期CT表现及其病理学基础，并评价CT在鉴别诊
断中的作用。材料与方法：对17例病理证实的早期中央型肺癌及10例类
似中央地月癌的良件 病变进行分析，CT采用SR7000及／或Li吵tspeed Plus
Part 1 Analysis of tumor location in lung cancer
Purpose: To assess the frequency of central bronchogenic carcinoma in all lung
cancer, analyze histopathologic type and clinical stage of central lung cancer and
provide evidence for designing clinical trials of screening early lung cancer.
Materials and Methods: we retrospectively reviewed the clinical records of 815
inpatients with bronchogenic carcinoma between 1999～2001. According to the
location of tumor origin, lung cancer was classified into three types, including
cenitral, peripheral and diffuse or unknown cause. Rcsults: Among 815 patients
with bronchogenic carcinoma, there were 568(69.7%) patients with history of
smoking, male 547(96.3%), 492 patients(86.6%) older than 45 years old. In
smoking patients, there were 328(58%) patients with central lung cancer
(squamous cell carcinoma 198(60%), small ce1l lung cancer 85(26%)), 202
patiens with peripheral lung cancer(adenocarcinoma 118(58%), squamous cell
carcinoma54(27%)). Clinical stage of central lung cancer included 16 cases with
stage Ⅰ, 67 cases with stage Ⅱ, 98 cases with stage ⅢA and 234 cases with
stageⅢ/Ⅳ. Conclusion: Centhel bronchogenic carcinoma accounted for 58%
of all smoking paients with lung cancer and the majority of these patients were
advanced stage at diagnosis. We put emphasis on the early detection of central
lung cancer in design of clinical screening trial.
Part 2 Visualization of segmental and subsegmental bronchi:
effect of different parameters with low dose multi-slicc CT
Purpose: To delineate normal subsegmenta bronchi anatomy and varation on
thin-section multi-slice CT (MSCT ) and compare the effect of visualization of
bronchi with different thickness and different tube currents so as to establish the
optimal protocol in depicting segrnental and subsegmental bronchi wth low dose
multi-slice CT Method8 and Materials: (l) Thin-section MSCT images of 50
volunteers were evaluated on workstation monitor' CT scans were perfOrmed
with GE Lightspeed Plus multi-slice scanner using spiral mode, l20Kv, 50mA,
l5mm/rotation, 0.8s/rotation, 2.5mm collimation and pitch 6:l to produce
2.5mm thick image at 2.5mm increments. (2) 90 consecutive symPtom-free
volunteers were divided into 3 groups at random. GrouP A(n=30) was scanned
with protocol l, high quality mode, l5mtn/rotation, l0mm thicAness
reconstruction, 40mAs, group B(n=30) with protocol 2, high speed mode,
30mm/rotation, 5mm thickness reconstruction, 40mAs, group C(n=30) with
protocol 3, high speed mode, l5mm/rotation, 2.5mm thickness reconsttuction.
Monitor evalwtion was perfOrmed by three radiologists. Rcsults: 2038
subsegmental bronchi of 50 volunteers were identified, which accounted for 95%
of all subsegmental bronchi. The frequencies of visualization of segmental
bronchi were 74%, 98%, l00% and that of subsegmental bronchi were 28%,
65%. 95% in group A, group B and group C, respectively. Group C has
significantly higher percentage in visualization of subsegmental bronchi
compared with group A and group B (P<0.0l ), Group B with significant higher
percentage in visuaIizing segmefltal bronchi than group A (P<0.0l ).
Conclusion: Low dose MSCT with pitch 6, 40mAs, 2.5mm thick reconstruction
scans can enhance our ability to evaluate the abnorn1ality of the segmental and
subsegmental bronchi wall and lumen, Which has a potential role as a screening
method fOr patients with hemoptysis and people at high risk of lung cancer.
Part 3 Early lung cancer screening: preliminary study with
low-dose spiral CT
Purpose: To evaluate prevalence rate of pulmonary malignant disease detected
by low-dose spiral CT screening in People at high risk of lung cancer. MatcriaIs
and methods: Low-dose MSCT scans and chest radiograPhs of 300 symptom-
free volunteers from an on-going screening Study were prospectively evaluated.
The study has enrolled 240 smokers, aged 45 years or older, with at least l0
pack-years of cigarettC smoking and 60 individu
目的：评价肺癌患者中中央型肺癌所占的比例、组织学类型以及临床分期，
为肺癌筛选方案的制订提供依据。材料与方法：对1999年1月～2001年1
月815例病例资料完整者进行回顾性分析，根据肿瘤发生部位将肺癌分为
中央型、周围型、弥漫型或原因不明型三种，757例病人为病理组织学诊
断，58例为临床诊断。结果：815例肺癌中，有吸烟史者568例(69.7%)，
其中男性547例(96.3%)，>45岁者492例(86.6%)。568例吸烟者肺癌
中，中央型肺癌328例，占58%，其中鳞癌198例(60%)，小细胞癌85
例(26%)：周围型肺癌202例，占36%，其中腺癌118例(（58%)，鳞癌54
例(27%)。中央型肺癌临床分期为1期 16例(4%)Ⅱ期 67例(15%)，ⅢA
期98例(24%)，ⅢB～Ⅳ期234例(57%)。结论：吸烟者肺癌患者中，中
央型肺癌占58%，大多数在诊断时已为晚期，在肺癌筛选试验设计中应注
重中央型肺癌的早期检出。
第二部分：低剂量多层面螺旋CT不同参数对段及亚段支气管显
示的影响
目的：描写薄层MSCT正常亚段支气管解剖及其变异，比较不同层厚、不
同管球电流对段及亚段支气管显示的影响，建立MSCT显示段与亚段支气
管的最什扫描程序。材料与方法：(1)对50例健康志愿者亚段支气管CT
影像进竹分析，检查采用LightSpeed Plus多层面螺旋CT扫描机，螺旋扫
描模式，扫描参数为：120 Kv,50mA,螺距6，床速15mm/转，0.8/转，2.5mm
层厚，2.5mm间隔重建，山两位放射医师在监视器上以电影显示方式对图
像进行观察。(2)将90例健康志愿者随机分为3组，每组30人，分别采
I
解放军总医院 军医进修学院 博十学位论文
用三种扫描程序检查，A组，螺距 3，床速 15mm／转，重建层厚 10mm，
间隔 10mm；B组，螺距 6，床速 30mm／转，重建层厚 smm，间限 smm；
C组，螺距 6，床速 15mm／转，重建层厚 2．smm，间隔 2．smm。对三组段
与亚段支气管显示率采用 SPSS软件包进行X‘检验统计学分析。3）将健
康体检者20人采用不同管球电流（50mA，20mA）分别进行两次检查，其
余参数同（l），山三位放射医师对图像质量进行评价。结果：50例健康者
亚段支气管共2150支，CT显示2038支，显示率95％。A组、B组、C组
段支气管显示率分别为 740、98o、100o，亚段支气管显示率分别为 28o、
65o、95o。B组段支气管显示率明显高于A组（P＜0．of）。C组亚段支气
管显示率明显高于A组及B组（P＜0．O！）。管球电流5 om0mA与20mA相比，
图像质量无显著性差异。结论：采用螺距6，40mAS管球电流，2．smn层
厚重建图像可以清晰显示段及亚段支气管。该方法可用于对咯血病人及肺
癌高危人群筛选检合。
第三部分：低剂量螺旋CT早期肺癌筛选初步研究
日的：评价低剂量螺旋CT肺癌高危人群筛选检查对早期肺癌的检出率。
材料与方法：对无症状300例体检者胸片及CT进行前瞻性研究，纳入标
准为年龄45岁以上，吸烟IO年包以上，或既往有慢性阻塞性肺疾病病史，
以前无癌症史，身体状况适合手术治疗者，低剂量CT扫描采用 Philip SR
7000及 GE Lightspeed Plus多层面 CT扫描机，螺旋扫描力式，120kV， 50mA，
重建层厚smm／25mm，间隔smm／2．smm，图像山两位放射医师在工作站
显示器上以电影显示方式观察，存储至PACS系统，对胸部CT检出病变
进行 3～6个月短期随诊。结果；低剂量 CT共检出 56例 （ 9％）非钙化结
节（其中恶性4例），胸片检出9例（3％）（其中恶性3例），均为1期病变。
低剂量 CT检出D支气管或段支气管病变 9例门％），其中早期中央型肺
二
解放军总＊ 皖 丫 ［X进修学院 博卜于仿论文
癌 3例（l％），病理证实 1例小细胞肺癌，2例鳞癌，胸片均未检出。结论：
初步筛选研究结果表明低剂量多层面螺旋CT明显提高了对肺内非钙化小
结节及支气管细微病变的检出，可检出早期可治愈肺癌。
第四部分：中央型肺癌早期CT诊断与鉴别诊断：与支气管镜及
病理组织学表现对照
目的：研究中央型肋癌早期CT表现及其病理学基础，并评价CT在鉴别诊
断中的作用。材料与方法：对17例病理证实的早期中央型肺癌及10例类
似中央地月癌的良件 病变进行分析，CT采用SR7000及／或Li吵tspeed Plus
Part 1 Analysis of tumor location in lung cancer
Purpose: To assess the frequency of central bronchogenic carcinoma in all lung
cancer, analyze histopathologic type and clinical stage of central lung cancer and
provide evidence for designing clinical trials of screening early lung cancer.
Materials and Methods: we retrospectively reviewed the clinical records of 815
inpatients with bronchogenic carcinoma between 1999～2001. According to the
location of tumor origin, lung cancer was classified into three types, including
cenitral, peripheral and diffuse or unknown cause. Rcsults: Among 815 patients
with bronchogenic carcinoma, there were 568(69.7%) patients with history of
smoking, male 547(96.3%), 492 patients(86.6%) older than 45 years old. In
smoking patients, there were 328(58%) patients with central lung cancer
(squamous cell carcinoma 198(60%), small ce1l lung cancer 85(26%)), 202
patiens with peripheral lung cancer(adenocarcinoma 118(58%), squamous cell
carcinoma54(27%)). Clinical stage of central lung cancer included 16 cases with
stage Ⅰ, 67 cases with stage Ⅱ, 98 cases with stage ⅢA and 234 cases with
stageⅢ/Ⅳ. Conclusion: Centhel bronchogenic carcinoma accounted for 58%
of all smoking paients with lung cancer and the majority of these patients were
advanced stage at diagnosis. We put emphasis on the early detection of central
lung cancer in design of clinical screening trial.
Part 2 Visualization of segmental and subsegmental bronchi:
effect of different parameters with low dose multi-slicc CT
Purpose: To delineate normal subsegmenta bronchi anatomy and varation on
thin-section multi-slice CT (MSCT ) and compare the effect of visualization of
bronchi with different thickness and different tube currents so as to establish the
optimal protocol in depicting segrnental and subsegmental bronchi wth low dose
multi-slice CT Method8 and Materials: (l) Thin-section MSCT images of 50
volunteers were evaluated on workstation monitor' CT scans were perfOrmed
with GE Lightspeed Plus multi-slice scanner using spiral mode, l20Kv, 50mA,
l5mm/rotation, 0.8s/rotation, 2.5mm collimation and pitch 6:l to produce
2.5mm thick image at 2.5mm increments. (2) 90 consecutive symPtom-free
volunteers were divided into 3 groups at random. GrouP A(n=30) was scanned
with protocol l, high quality mode, l5mtn/rotation, l0mm thicAness
reconstruction, 40mAs, group B(n=30) with protocol 2, high speed mode,
30mm/rotation, 5mm thickness reconstruction, 40mAs, group C(n=30) with
protocol 3, high speed mode, l5mm/rotation, 2.5mm thickness reconsttuction.
Monitor evalwtion was perfOrmed by three radiologists. Rcsults: 2038
subsegmental bronchi of 50 volunteers were identified, which accounted for 95%
of all subsegmental bronchi. The frequencies of visualization of segmental
bronchi were 74%, 98%, l00% and that of subsegmental bronchi were 28%,
65%. 95% in group A, group B and group C, respectively. Group C has
significantly higher percentage in visualization of subsegmental bronchi
compared with group A and group B (P<0.0l ), Group B with significant higher
percentage in visuaIizing segmefltal bronchi than group A (P<0.0l ).
Conclusion: Low dose MSCT with pitch 6, 40mAs, 2.5mm thick reconstruction
scans can enhance our ability to evaluate the abnorn1ality of the segmental and
subsegmental bronchi wall and lumen, Which has a potential role as a screening
method fOr patients with hemoptysis and people at high risk of lung cancer.
Part 3 Early lung cancer screening: preliminary study with
low-dose spiral CT
Purpose: To evaluate prevalence rate of pulmonary malignant disease detected
by low-dose spiral CT screening in People at high risk of lung cancer. MatcriaIs
and methods: Low-dose MSCT scans and chest radiograPhs of 300 symptom-
free volunteers from an on-going screening Study were prospectively evaluated.
The study has enrolled 240 smokers, aged 45 years or older, with at least l0
pack-years of cigarettC smoking and 60 individu
引文
1．李连弟，等。中国恶性肿瘤死亡率20年变化趋势和近期预测分析。中华肿瘤杂志，19(1)：3—9
2．李连弟，鲁凤珠，张思维等。1990—1992年中国恶性肿瘤死亡流行病分布情况分析。中华肿瘤杂志，18(6)：403—407
3．王启俊，祝伟量，关炜庠等。北京市肺癌发病率、死亡率和生存率分析，中华流行病学，12(4)：205—207
4. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. Cancer J Clin 2000;50:7-33
5. Smith RA, Glynn TJ. Epidemiology of lung cancer, Radiolgic Clinics of North America 2000;38(3):453
6. Jett J, Feins R, Kvale P, et al. Pretreatment evaluation of non-small-cell lung cancer. Am J Respir Crit Care Med 1997;156:320-322
7. Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997;111:1710-1717
8. Naruke T, Tsuchiya R, Kondo H, et al. Implications of staging in lung cancer. Chest 1997;112:242S-248S
9. Lam S, Shibuya H. Early diagnosis of lung cancer. Clin Chest Med 1999;20:53-61
10. Shah R, Sabanathan S, Richardson J, Means AJ, Goulden C. Results of surgical treatment of stage Ⅰ and Ⅱ lung cancer. J Cardiovasc Surg 1996;37:169-172
11. Nesbitt JC, Putnam JB Jr, Walsh GL, Roth JA, Mountain CF. Survival
in early-stage lung cancer. Ann Thorac Surg 1995;60:466-472
12． Flehinger BJ, Melamed MR, Zaman MB, et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial-Sloan Kettering study. Am Rev Respir Dis 1984;130:555-560
13． Fontana RS, Sanderson DR, Taylor WF. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. Am Rev Respir Dis 1984; 130:561-565
14． Fontana R, Sanderson DR, Woolner LB, et al. Lung cancer screening: the Mayo program. J Occup Med 1986;28:746-750
15． Tockman M. Survival and mortality from lung cancer in a screened population: the John Hopkins study. Chest 1986;89:325S-326S
16． Saraceno J, Spivack SD. Strategies for early detection of lung cancer, Clin Pulm Med 1999;6:66-72
17． Miettinen OS. Screening for lung cancer. Radiolgic Clinics of North America 2000;38(3) :479
18． Strauss GM, Gleason RE, Sugarhaker DJ. Screening for lung cancer: another look, a different view. Chest 1997;111:754-768
19． Henschke Cl, Yankelevitz DF. CT screening for lung cancer. Radiol Clin North Am 2000;38:487-495
20． Kaneko M, Eguchi K, Ohmatsu H, et al. Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. Radiology 1996;201:798-802
21． Rusinek H, Naidich DP, McGuinness G, et al. Pulmonary nodule
detection: low-dose versus conventional CT. Radiology 1998;209:243-249
22． llenschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999;354:99-105
23． Itoh S, Ikeda M, Isomura T, et al. Screening helical CT for mass screening of lung cancer: application of low-dose and single-breath-hold scanning. Radiol Med 1998;16:75-83
24． Sone S, Takashima S, Li F, et al. Mass screening for lung cancer with mobile spiral computed tomography scanner. Lancet 1998:351:1242-1245
25． Tillich M, Kammerhuber F, Reittner P, et al. Detection of pulmonary nodules with helical CT: comparison of cine and film-based viewing. AJR 1997;169:1611-1614
26． Henschke CI, Miettinen OS, Yankelevitz DF, et al. Radiographic screening for cancer: proposed paradigm for requisite research. Clin Imaging 1994;18:16-20
27． Gohagan JK, Prorok PC, Krame BS, et al. The prostate, lung, colorectal, and ovarian screening trial of the National Cancer Institute. Cancer 1995;75[suppl 7] :1869-1873
28． Kobayashi T, Xu XW, MacMahon H, et al. Effect of a computer-aided diagnosis scheme on radiologists' performance in detection of lung nodules on radiographs. Radiology 1996:199:843-848
29． MacMahon H, Engelmann RM, Behlen FM, et al. Computer-aided diagnosis of pulmonary nodules: results of a large-scale observer
test. Radiology 1999;213:723-726
30． Vermylen P, Pierard P, Roufosse C, et al. Detection of bronchial preneoplastic Lesions and early lung cancer with fluorescence bronchoscopy: a study about its ambulatory feasibility under local anaesthesia. Lung Cancer 1999;25:161-168
31． Ahrendt SA, Chow JT, Xu LH, et al. Molecular detection of tumor cells in bronchoalveolar lavage fluid from patients with early stage lung cancer. J Natl Cancer Inst 1999;91:332-339
32． Kennedy TC, Proudfoot SP, Franklin WA, et al. Cytopathological analysis of sputum in patients with airflow obstruction and significant smoking histories. Cancer Res 1996;56:4673-4768
33． Payne PW, Sebo TJ, Doudkine A, et al. Sputum screening by quantitative microscopy: reexamination of a portion of the National Cancer Institute cooperative early lung cancer study. Mayo Clin Proc 1997;72:697-704
34． Alexander W. Autofluorescence for bronchial imaging. J Clin Laser Med Surg 1991;Oct:331-333
35． Prakash UBS. Advances in bronchoscopic procedures. Chest 1999;116:1403-1408
36． Zhou J, Mulshine JL, Unsworth EJ, et al. Identification of a heterogeneous nuclear ribonucleoprotein (hnRNP) as an early lung cancer detection marker. J Biol Chem 1996;27l:10760-10766
37． Smith RA, Mettlin CJ, David KJ, Eyre H. American Cancer Society guidelines for early detection of cancer. CA Cancer J Clin 2000;50:34-49
38． Wo 1 paw DR. Early detection in lung cancer: case finding and screening. Med Clin North Am 1996; 80: 63-82
39． Tockman MS, Mulshine JL, Piantadosi S, et al. Prospective detection of preclinical lung cancer: results from two studies of heterogeneous nuclear ribonucleoprotein A2/B1 overexpression. Clin Cancer Res 1997; 3:2237-2246
40． Gazdar AF, Minna JD. Molecular detection of early lung cancer. (editorial) .] Nat Cancer Inst 1999; 91: 299-301
41． Erasmus JF, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules. II. Evaluation of the indeterminate nodule. RadioGraphics 2000; 20: 59-66
42． Yankelevitz D, Gupta R, Zhao B, Henschke C. Small pulmonary nodules: evaluation with repeat CT-preliminary experience. Radiology 1999;212:561-566
43． Yankelevitz DF, Henschke CI. Small solitary pulmonary nodules. Radio 1 Clin North Am 2000; 38: 471
44． Logan PM, Miller RR, Evans K, Muller NL. Bronchogenic carcinoma and coexistent bronchioloalveolar cell adenomas: assessment of radiology detection and follow-up in 28 patients. Chest 1996;109:713-717
45． Swenscn SJ, Viggiano RW, Midthun DE, et al. Lung nodule enhancement at CT: multicenter study. Radiology 2000; 214: 273-280
46． Al-Sugair A, Coleman RE. Applications of PET in lung cancer. Semin Nucl Med 1998:28:303-319
47． Coleman RE. PET in lung cancer. J Nucl Med 1999;40:814-820
48． Gupta NC, Maloof J, Gunel E. Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET. J Nucl Med 1996;37:943-948
49． Lam S, Kennedy T, Unger M, et al. Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. Chest 1998;113:696-702
50． Vining DJ, Liu K, Choplin RH, Haaponik EF. Virtual bronchoscopy: relationships of virtual reality endobronchial simulations to actual bronchoscopic findings. Chest 1996;109:549-553
51． Summers RM, Selbie WS, Malley JD, et al. Polypoid lesions of airways: early experience with computer-assisted detection by using virtual bronchoscopy and surface curvature. Radiology 1998;208:331-337
52． Fleiter R, Markle EM, Aschoff AJ, et al. Comparison of real-time virtual and fiberoptic bronchoscopy in patients with bronchial carcinoma: opportunities and limitations. AJR 1997;169:1591-1595
53． Heitzman ER. The lung: Radiologic-pathologic correlation. 2nd ed, Mosby: St Louis, 1984;353-421
54． Bannkier AA, Fleischmann D, Mallek R, et al. Bronchial wall thickness: appropriate window settings for thin-section CT and radiologic-anatomic correlation. Radiology 1996;199:831-836
55． Osborne D, Vock P, Godwin JD, et al. CT identification of bronchopulmonary segments: 50 normal subjects. AJR 1984; 142:47-52
56． Lee KS, Bae WK, Lee BH, et al. Bronchovascular anatomy of the upper
lobes: evaluation with thin-section CT. Radiology 1991;181:765-772
57． Lee KS, Im J, Bae WK, et al. CT anatomy of the lingular segmental bronchi. JCAT 1991:15:86-91
58． Naidich DP, ZinnWL, Ettenger NA, et al. Basilar segmental bronchi: thin-section CT evaluation. Radiology 1988;169:11-16
59． Newmark GM, Conces DM, Kopecky KK. Spiral CT evaluation of the trachea and bronchi. JCAT 1994;18:552-554
60． Perhomma M, Lahde S, Rossi 0, et al. Helical CT in evaluation of the bronchia] tree. Acta Radiologica 1997;38:83-91
61． Quint LE, Whyte RI, Kazerooni EA, et al. Stenosis of the central airways: evaluation by helical CT with multiplanar reconstructions. Radiology 1995;194:871-877
62． Curtin JJ, Innes NJ, Harrison BDW. Thin-section spiral volumetric CT for the assessment of lobar and segmental bronchial stenoses. Clinical Radiology 1998;53:110-115
63． Padhani AR, Fishman EK, Heitmiller RF, et al. Multiplanar dispay of spi ral CT data of the pulmonary hi la in patients with lung cancer. Clinical Imaging 1995;19:252-257
64． Summers RM, Feng DH, Holland SM, et al. Virtual bronchoscopy: segmentation method for real-time display. Radiology 1996;200:857-862
65． Naidich DP, Harkin TJ. Airways and lung: correlation of CT with fiberoptic bronchoscopy. Radiology 1995;197:1-12
66． Mayr BM, Ingrisch H, Haussinger K, et al. Tumors of the bronchi:
role of evaluation with CT. Radiology 1989;172:647-652
67． Set PAK, Flower CDR, Smith IE, et al. Hemoptysis: comparative study of the role of CT and fiberoptic bronchoscopy. Radiology 1993; 189:677-680
68． Marshall TJ, Flower CDR, Jackson JE. The role of radiology in the investigation and management of patients with haemoptysis. Clinical Radiology 1996;51:391-400
69． SaidaY, KujiraokaY, Akaogi E, et al. Early squamous cell carcinma of the lung: CT and pathologic correlation. Radiology 1996;201:61-65
70． White CS, Romney BM, Mason AC, et al. Primary carcinoma of the lung overlooked at CT: analysis of finding in 14 patients. Radiology 1996;199:109-115
71． Gurney JW. Missed lung cancer at CT: imaging finding in nine patients. Radiology 1996;199:117-122
72． 周清华主编.肿癌基础研究与临床治疗进展.北京:科学出版社. 1999, 1-33
73． 徐昌文,吴善芳,孙燕主编.肺癌.第二版.上海:上海科学技术出版社, 1993, 43-45
74． Roth JA, Cox JD, Hong WK. Lung cancer, 2~(nd). Maiden: Black well science. 1-161
75． Naidich DP, Webb WR, Muller NL, et al. Computed tomography and magnetic resonance of the thorax, 3~(rd). Philadelphia: Lippincott-Raven,161-251．
2．李连弟，鲁凤珠，张思维等。1990—1992年中国恶性肿瘤死亡流行病分布情况分析。中华肿瘤杂志，18(6)：403—407
3．王启俊，祝伟量，关炜庠等。北京市肺癌发病率、死亡率和生存率分析，中华流行病学，12(4)：205—207
4. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. Cancer J Clin 2000;50:7-33
5. Smith RA, Glynn TJ. Epidemiology of lung cancer, Radiolgic Clinics of North America 2000;38(3):453
6. Jett J, Feins R, Kvale P, et al. Pretreatment evaluation of non-small-cell lung cancer. Am J Respir Crit Care Med 1997;156:320-322
7. Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997;111:1710-1717
8. Naruke T, Tsuchiya R, Kondo H, et al. Implications of staging in lung cancer. Chest 1997;112:242S-248S
9. Lam S, Shibuya H. Early diagnosis of lung cancer. Clin Chest Med 1999;20:53-61
10. Shah R, Sabanathan S, Richardson J, Means AJ, Goulden C. Results of surgical treatment of stage Ⅰ and Ⅱ lung cancer. J Cardiovasc Surg 1996;37:169-172
11. Nesbitt JC, Putnam JB Jr, Walsh GL, Roth JA, Mountain CF. Survival
in early-stage lung cancer. Ann Thorac Surg 1995;60:466-472
12． Flehinger BJ, Melamed MR, Zaman MB, et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial-Sloan Kettering study. Am Rev Respir Dis 1984;130:555-560
13． Fontana RS, Sanderson DR, Taylor WF. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. Am Rev Respir Dis 1984; 130:561-565
14． Fontana R, Sanderson DR, Woolner LB, et al. Lung cancer screening: the Mayo program. J Occup Med 1986;28:746-750
15． Tockman M. Survival and mortality from lung cancer in a screened population: the John Hopkins study. Chest 1986;89:325S-326S
16． Saraceno J, Spivack SD. Strategies for early detection of lung cancer, Clin Pulm Med 1999;6:66-72
17． Miettinen OS. Screening for lung cancer. Radiolgic Clinics of North America 2000;38(3) :479
18． Strauss GM, Gleason RE, Sugarhaker DJ. Screening for lung cancer: another look, a different view. Chest 1997;111:754-768
19． Henschke Cl, Yankelevitz DF. CT screening for lung cancer. Radiol Clin North Am 2000;38:487-495
20． Kaneko M, Eguchi K, Ohmatsu H, et al. Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. Radiology 1996;201:798-802
21． Rusinek H, Naidich DP, McGuinness G, et al. Pulmonary nodule
detection: low-dose versus conventional CT. Radiology 1998;209:243-249
22． llenschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999;354:99-105
23． Itoh S, Ikeda M, Isomura T, et al. Screening helical CT for mass screening of lung cancer: application of low-dose and single-breath-hold scanning. Radiol Med 1998;16:75-83
24． Sone S, Takashima S, Li F, et al. Mass screening for lung cancer with mobile spiral computed tomography scanner. Lancet 1998:351:1242-1245
25． Tillich M, Kammerhuber F, Reittner P, et al. Detection of pulmonary nodules with helical CT: comparison of cine and film-based viewing. AJR 1997;169:1611-1614
26． Henschke CI, Miettinen OS, Yankelevitz DF, et al. Radiographic screening for cancer: proposed paradigm for requisite research. Clin Imaging 1994;18:16-20
27． Gohagan JK, Prorok PC, Krame BS, et al. The prostate, lung, colorectal, and ovarian screening trial of the National Cancer Institute. Cancer 1995;75[suppl 7] :1869-1873
28． Kobayashi T, Xu XW, MacMahon H, et al. Effect of a computer-aided diagnosis scheme on radiologists' performance in detection of lung nodules on radiographs. Radiology 1996:199:843-848
29． MacMahon H, Engelmann RM, Behlen FM, et al. Computer-aided diagnosis of pulmonary nodules: results of a large-scale observer
test. Radiology 1999;213:723-726
30． Vermylen P, Pierard P, Roufosse C, et al. Detection of bronchial preneoplastic Lesions and early lung cancer with fluorescence bronchoscopy: a study about its ambulatory feasibility under local anaesthesia. Lung Cancer 1999;25:161-168
31． Ahrendt SA, Chow JT, Xu LH, et al. Molecular detection of tumor cells in bronchoalveolar lavage fluid from patients with early stage lung cancer. J Natl Cancer Inst 1999;91:332-339
32． Kennedy TC, Proudfoot SP, Franklin WA, et al. Cytopathological analysis of sputum in patients with airflow obstruction and significant smoking histories. Cancer Res 1996;56:4673-4768
33． Payne PW, Sebo TJ, Doudkine A, et al. Sputum screening by quantitative microscopy: reexamination of a portion of the National Cancer Institute cooperative early lung cancer study. Mayo Clin Proc 1997;72:697-704
34． Alexander W. Autofluorescence for bronchial imaging. J Clin Laser Med Surg 1991;Oct:331-333
35． Prakash UBS. Advances in bronchoscopic procedures. Chest 1999;116:1403-1408
36． Zhou J, Mulshine JL, Unsworth EJ, et al. Identification of a heterogeneous nuclear ribonucleoprotein (hnRNP) as an early lung cancer detection marker. J Biol Chem 1996;27l:10760-10766
37． Smith RA, Mettlin CJ, David KJ, Eyre H. American Cancer Society guidelines for early detection of cancer. CA Cancer J Clin 2000;50:34-49
38． Wo 1 paw DR. Early detection in lung cancer: case finding and screening. Med Clin North Am 1996; 80: 63-82
39． Tockman MS, Mulshine JL, Piantadosi S, et al. Prospective detection of preclinical lung cancer: results from two studies of heterogeneous nuclear ribonucleoprotein A2/B1 overexpression. Clin Cancer Res 1997; 3:2237-2246
40． Gazdar AF, Minna JD. Molecular detection of early lung cancer. (editorial) .] Nat Cancer Inst 1999; 91: 299-301
41． Erasmus JF, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules. II. Evaluation of the indeterminate nodule. RadioGraphics 2000; 20: 59-66
42． Yankelevitz D, Gupta R, Zhao B, Henschke C. Small pulmonary nodules: evaluation with repeat CT-preliminary experience. Radiology 1999;212:561-566
43． Yankelevitz DF, Henschke CI. Small solitary pulmonary nodules. Radio 1 Clin North Am 2000; 38: 471
44． Logan PM, Miller RR, Evans K, Muller NL. Bronchogenic carcinoma and coexistent bronchioloalveolar cell adenomas: assessment of radiology detection and follow-up in 28 patients. Chest 1996;109:713-717
45． Swenscn SJ, Viggiano RW, Midthun DE, et al. Lung nodule enhancement at CT: multicenter study. Radiology 2000; 214: 273-280
46． Al-Sugair A, Coleman RE. Applications of PET in lung cancer. Semin Nucl Med 1998:28:303-319
47． Coleman RE. PET in lung cancer. J Nucl Med 1999;40:814-820
48． Gupta NC, Maloof J, Gunel E. Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET. J Nucl Med 1996;37:943-948
49． Lam S, Kennedy T, Unger M, et al. Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. Chest 1998;113:696-702
50． Vining DJ, Liu K, Choplin RH, Haaponik EF. Virtual bronchoscopy: relationships of virtual reality endobronchial simulations to actual bronchoscopic findings. Chest 1996;109:549-553
51． Summers RM, Selbie WS, Malley JD, et al. Polypoid lesions of airways: early experience with computer-assisted detection by using virtual bronchoscopy and surface curvature. Radiology 1998;208:331-337
52． Fleiter R, Markle EM, Aschoff AJ, et al. Comparison of real-time virtual and fiberoptic bronchoscopy in patients with bronchial carcinoma: opportunities and limitations. AJR 1997;169:1591-1595
53． Heitzman ER. The lung: Radiologic-pathologic correlation. 2nd ed, Mosby: St Louis, 1984;353-421
54． Bannkier AA, Fleischmann D, Mallek R, et al. Bronchial wall thickness: appropriate window settings for thin-section CT and radiologic-anatomic correlation. Radiology 1996;199:831-836
55． Osborne D, Vock P, Godwin JD, et al. CT identification of bronchopulmonary segments: 50 normal subjects. AJR 1984; 142:47-52
56． Lee KS, Bae WK, Lee BH, et al. Bronchovascular anatomy of the upper
lobes: evaluation with thin-section CT. Radiology 1991;181:765-772
57． Lee KS, Im J, Bae WK, et al. CT anatomy of the lingular segmental bronchi. JCAT 1991:15:86-91
58． Naidich DP, ZinnWL, Ettenger NA, et al. Basilar segmental bronchi: thin-section CT evaluation. Radiology 1988;169:11-16
59． Newmark GM, Conces DM, Kopecky KK. Spiral CT evaluation of the trachea and bronchi. JCAT 1994;18:552-554
60． Perhomma M, Lahde S, Rossi 0, et al. Helical CT in evaluation of the bronchia] tree. Acta Radiologica 1997;38:83-91
61． Quint LE, Whyte RI, Kazerooni EA, et al. Stenosis of the central airways: evaluation by helical CT with multiplanar reconstructions. Radiology 1995;194:871-877
62． Curtin JJ, Innes NJ, Harrison BDW. Thin-section spiral volumetric CT for the assessment of lobar and segmental bronchial stenoses. Clinical Radiology 1998;53:110-115
63． Padhani AR, Fishman EK, Heitmiller RF, et al. Multiplanar dispay of spi ral CT data of the pulmonary hi la in patients with lung cancer. Clinical Imaging 1995;19:252-257
64． Summers RM, Feng DH, Holland SM, et al. Virtual bronchoscopy: segmentation method for real-time display. Radiology 1996;200:857-862
65． Naidich DP, Harkin TJ. Airways and lung: correlation of CT with fiberoptic bronchoscopy. Radiology 1995;197:1-12
66． Mayr BM, Ingrisch H, Haussinger K, et al. Tumors of the bronchi:
role of evaluation with CT. Radiology 1989;172:647-652
67． Set PAK, Flower CDR, Smith IE, et al. Hemoptysis: comparative study of the role of CT and fiberoptic bronchoscopy. Radiology 1993; 189:677-680
68． Marshall TJ, Flower CDR, Jackson JE. The role of radiology in the investigation and management of patients with haemoptysis. Clinical Radiology 1996;51:391-400
69． SaidaY, KujiraokaY, Akaogi E, et al. Early squamous cell carcinma of the lung: CT and pathologic correlation. Radiology 1996;201:61-65
70． White CS, Romney BM, Mason AC, et al. Primary carcinoma of the lung overlooked at CT: analysis of finding in 14 patients. Radiology 1996;199:109-115
71． Gurney JW. Missed lung cancer at CT: imaging finding in nine patients. Radiology 1996;199:117-122
72． 周清华主编.肿癌基础研究与临床治疗进展.北京:科学出版社. 1999, 1-33
73． 徐昌文,吴善芳,孙燕主编.肺癌.第二版.上海:上海科学技术出版社, 1993, 43-45
74． Roth JA, Cox JD, Hong WK. Lung cancer, 2~(nd). Maiden: Black well science. 1-161
75． Naidich DP, Webb WR, Muller NL, et al. Computed tomography and magnetic resonance of the thorax, 3~(rd). Philadelphia: Lippincott-Raven,161-251．