Limited resection trial for pulmonary ground-glass opacity nodules: Fifty-case experience
Limited resection trial for pulmonary ground-glass opacity nodules: Fifty-case experience
复制标题
DOI：
10.1016/j.jtcvs.2004.07.038
复制
发表时间：
2005-05-01
影响因子：
6
通讯作者：
Nishiwaki, Y
中科院分区：
文献类型：
--
作者：
Yoshida, J;Nagai, K;Nishiwaki, Y
目的：探讨小肺癌有限切除后的复发率，评价术中冰冻切片检查对Noguchi分型的准确性。方法：入选标准：肺结节直径2 cm或以下，临床诊断或疑似肺外周T1 N0 M0癌，高分辨率CT上见毛玻璃样阴影，无明显胸膜凹陷或血管集束征。用定制的订书机墨盒取出楔形或节段性切除标本，立即再次充气，用苏木精-伊红和维多利亚蓝-范-吉森染色进行冷冻切片检查。如果肿瘤被证实为野口A型或B型，且切除边缘大于1厘米，患者将被关闭并在门诊基础上进行随访。终点为5年无瘤生存期和术中分类准确率。结果：从1998年8月至2002年10月，共纳入50例患者，男20例，女30例，年龄30~77岁。肿瘤大小2~21min，平均11 mm。Noguchi A型肿瘤2例，B型肿瘤23例，C型肿瘤15例，不典型腺瘤增生症5例，纤维瘤4例，肉芽肿1例。冰冻切片准确率约为98%(39/40)。1例术中B型诊断在术后病理检查后改为C型。中位随访50个月，无并发症、死亡或复发。结论：野口A型和B型肿瘤很可能是原位癌，冰冻切片检查具有很高的准确性。到目前为止，还没有发现局部复发或远处转移。有限切除的初步结果似乎很有希望。
Objective: This study was undertaken to determine the recurrence rate after limited resection of small lung carcinoma and to evaluate intraoperative frozen-section examination accuracy for Noguchi classification.Methods: Enrollment requirements were as follows: pulmonary nodule 2 cm or smaller, diagnosed or suspected clinical T1 N0 M0 carcinoma in the lung periphery, and ground-glass opacity findings and lack of evident pleural indentations or vascular convergence on high-resolution computed tomographic scan. A wedge or segmental resection specimen, removed with custom stapler cartridges, was immediately reinflated and examined by frozen-section with hematoxylin-eosin and Victoria blue-van Gieson stains. If the tumor was confirmed as Noguchi type A or B with resection margins greater than 1 cm, the patient was closed and followed up on an outpatient basis. End points were 5-year disease-free survival and intraoperative classification accuracy.Results: From August 1998 through October 2002, a total of 50 patients were enrolled (20 men and 30 women, ages 30-77 years). Tumor sizes ranged from 2 to 21 min (11 mm average). There were 2 Noguchi type A tumors, 23 Noguchi type B turnors, 15 Noguchi type C tumors, 5 atypical adenomatous hyperplasias, 4 fibroses, and 1 granuloma. Frozen-section accuracy was approximately 98% (39/ 40). One intraoperative type B diagnosis was revised to type C after postoperative pathologic study. No morbidity, mortality, or recurrence has been seen with a median follow-up of 50 months.Conclusion: Noguchi type A and B tumors may well be in situ carcinomas, and frozen-section examination was highly accurate. Neither local recurrence nor distant metastases have been found to date. Limited resection initial results appear promising.