Detection of Preneoplastic Lesions
Detection of Preneoplastic Lesions
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癌前病变的检测
DOI：
10.1002/9780470696330.ch6
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
S. Lam
中科院分区：
文献类型：
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作者：
S. Lam
目前，肺癌患者的生存率很低，只有15%的患者在确诊后存活5年。虽然新的化疗药物和放射治疗改善了患者的生存和生活质量，但过去十年的总体影响主要是缓解而不是治愈（降低死亡率）。肺癌的生存与分期密切相关，5年生存率统计反映了分期分布。监测流行病学和最终结果（SEER）数据显示，只有16%的肺癌患者表现为局部疾病，其余患者表现为局部或远处转移[2]。提高治愈率需要在癌症还处于局部的早期阶段就对患者进行诊断。尽管来自三级医疗机构或学术中心的报告更为乐观，但来自SEER癌症登记处（1988-2002）的基于人群的统计数据表明，对于局部疾病，5年生存率仅为49.1%。因此，大约一半被诊断为局部疾病的个体将在5年内死亡，其中绝大多数死于疾病的复发和进展。显然，需要通过在侵袭前阶段检测和治疗疾病来改善结果的策略。在肺中定位肿瘤前病变有独特的挑战。与其他上皮器官相比，肺是一个内部器官，由一个复杂的分支系统组成，该系统引导气道通向周围的气体交换单元，其表面积与网球场大小相当。此外，肺癌不是单一的细胞类型，而是由几种细胞类型组成，它们优先位于气管支气管树的不同部位。没有单一的方法可以扫描整个支气管上皮的肿瘤前病变，并允许组织取样进行病理诊断和分子谱分析。几种生物光子成像方法已经发展起来，如自体荧光支气管镜检查和光学相干断层扫描（OCT），用于在光纤探针可到达的区域定位肿瘤前病变。多层螺旋CT是检测周围肺肿瘤前病变的灵敏工具。CT可以作为虚拟地图，利用导航系统对周围肺病变进行活检。在本章中，讨论了支持使用这些方法的现有证据和未来研究的方向。
Currently, lung cancer survival is poor with only 15% of patients surviving 5 years after diagnosis [1]. While new chemotherapy agents and radiotherapy have improved survival and quality of life of patients, the overall impact in the last decade has been mainly on palliation rather than cure (reduction in mortality). Lung cancer survival is strongly associated with stage, and the 5-year survival statistics reflect the stage distribution. The surveillance epidemiology and end results (SEER) data indicate that only 16% of lung cancer patients present with localized disease while the remaining presents with either regional or distant metastasis [2]. Improving cure rates involves diagnosing patients at an earlier stage, when the cancer is still localized. Despite more optimistic reports from tertiary care or academic centers, population-based statistics from the SEER cancer registry (1988–2002) indicate that for localized disease, 5-year survival is only 49.1%[2]. Thus, approximately half of the individuals diagnosed with localized disease will die within 5 years, with the vast majority of them dying from recurrence and progression of their disease. Clearly, strategies to improve outcome by detecting and treating the disease in the preinvasive stage is needed. There are unique challenges to localize preneoplastic lesions in the lung. In contrast to other epithelial organs, the lung is an internal organ consisting of a complex branching system of conducting airways leading to peripheral gas exchange units with a surface area of the size of a tennis court. In addition, instead of a single cell type, lung cancer consists of several cell types and they are preferentially located in different parts of the tracheobronchial tree. There is no single method that can scan the entire bronchial epithelium for preneoplastic lesions and allow tissue sampling for pathological diagnosis and molecular profiling. Several biophotonic imaging methods have been developed such as autofluorescence bronchoscopy and optical coherence tomography (OCT) for localization of preneoplastic lesions in areas accessible by fiberoptic probes. Multidetector spiral CT is a sensitive tool to detect preneoplastic lesions in the peripheral lung. CT can serve as a virtual map to enable biopsy of peripheral lung lesions using navigational systems. In this chapter, current evidence supporting the use of these methods and direction for future research is discussed.