Correct diagnosis and classification of lung adenocarcinoma are extremely important! Complete analysis of pulmonologists

Reporter: Zeng Zhenghao reports

Malignant tumors have been the top ten causes of death in China for many years, and lung cancer is the malignant tumor with the highest mortality rate. In recent years, many celebrities have contracted lung cancer even if they do not smoke. Therefore, people have an inexplicable fear of lung cancer, and lung cancer prevention and treatment has therefore become an important issue.

Lung cancer is a malignant tumor with a high mortality rate. However, different lung cancer cell types, treatment methods and drugs are very different. Only early-stage lung cancer has a chance to be cured by surgery! Director of the Department of Thoracic Medicine at New Taipei City Tucheng Hospital (Chang Gung Memorial System) Zhong Fucai said that correct diagnosis and staging of lung cancer are the most fundamental and important basis for correct treatment of lung cancer. Come and take a look at the doctor's analysis.

A non-smoking woman with lung adenocarcinoma was followed up for more than 5 years after correct diagnosis and treatment

46-year-old Ms. T came to the clinic because of chronic cough for more than a month, which showed that the left lung lobe There are abnormal shadows combined with enlarged mediastinal lymph nodes. The most likely diagnosis is lung adenoma combined with lymphatic metastasis. The picture below shows the chest X-ray of the case and found a mass in the left upper lung lobe (shown by the red arrow in Figure D), which was confirmed by chest computed tomography imaging. After the location of the mass in the left lung lobe (shown as the red arrow in Figure A), slices were performed under bronchoscopy ultrasound guidance (shown as the red arrow in Figure C). At the same time, chest computed tomography (shown as the blue arrow in Figure A) and whole-body PET Photography (as shown by the blue arrow in Figure B) showed suspected metastasis of paratracheal lymph nodes. Through bronchoscopy, mediastinal ultrasound and fine needle aspiration? (as shown by the blue arrow in Figure E) enough specimens were obtained, and the final pathology report was obtained. Confirmed to be lymphatic metastasis of lung adenocarcinoma, complete correct diagnosis and staging, and use this to correctly choose treatment!

▲Bronchoscopic surgery - lung cancer diagnosis and staging tool chart

How to correctly diagnose and stage lung cancer?

Malignant tumors have been among the top ten causes of death in China for many years, and lung cancer is the malignant tumor with the highest mortality rate. In recent years, many celebrities have contracted lung cancer even if they do not smoke. Therefore, people have an inexplicable fear of lung cancer, and the prevention and treatment of lung cancer has therefore become an important issue.

The correct diagnosis and staging of lung cancer is the most fundamental and important basis for the correct treatment of lung cancer. In addition to tumor size and organ invasion, the most important clinical staging of lung cancer is mediastinal lymph node staging. Usually, patients will first complete clinical imaging diagnosis and staging, that is, chest computed tomography and whole-body PET imaging. However, clinical images alone cannot correctly distinguish certain inflammatory lesions from lymphatic metastasis caused by tumors. Obtain accurate tumor diagnosis and lymph node staging by cytology or pathology through bronchoscopic ultrasound sampling. Bronchoscopic mediastinal ultrasound and fine-needle aspiration provide a less invasive and damaging option to normal tissue, but a highly accurate option for staging mediastinal lymph nodes. It only requires fasting for 6-8 hours, and then undergoes local anesthesia and mild to moderate depth. The combination of sedation and sedation can be completed in about 1 hour.

1. Diagnosis and staging of lung cancer

The first step is imaging diagnosis, usually "chest X-ray". Abnormal shadows have been found on chest X-rays, and general "thoracic computed tomography" is used to further confirm the nature and location of the chest X-ray shadows. After confirming the location and size of the lung tumor on chest computed tomography imaging, the next step is pathological diagnosis, which is the so-called "biological biopsy".

Many patients will be afraid or even reject when they hear that their lungs need biopsy. However, biopsy is the only way to obtain pathological diagnosis. Today, low-invasive and mild to moderate deep sedation has greatly improved the discomfort of examinations. Depending on the size and location of the tumor, you may choose (1) bronchoscopy slices, (2) imaging slices such as "chest ultrasound" or "computed tomography-guided slices", (3) surgical slices, etc. Each has advantages and disadvantages, but these should be discussed with your physician.

2. Bronchoscopy Ultrasound

The bronchi have many branches in the lungs. Computerized tomography images can only show the approximate location of the tumor. When performing bronchial sectioning, bronchoscopy ultrasound Locate lung tumors and can perform correct and effective sectioning to correctly diagnose lung tumors (as shown by the red arrow in Figure C) Pathological diagnosis.

3. Transbronchial endobronchial ultrasound and fine needle aspiration (EBUS-TBNA: endobronchial ultrasound tran *** ronchial needle aspiration)

Past clinical images of the mediastinum The accuracy of staging of lymph nodes in the lungs and lungs is poor. The more accurate ones are "surgical thoracoscopy" or "mediastinal endoscopic surgery". Although the accuracy is higher, it requires general anesthesia and tracheal intubation, which is highly invasive. Therefore, "bronchoscopy with mediastinal ultrasound and fine-needle aspiration" provides a less invasive method and is an option for correct staging of mediastinal lymph nodes. The front-end ultrasound probe of the bronchoscope is used to confirm the parabronchial lymph nodes. The lesion is located and enough specimens are obtained through bronchoscopy, mediastinal ultrasound and fine needle aspiration (as shown by the blue arrow in Figure E), and the cytological or pathological staging is obtained by sampling. This is for the correct staging of mediastinal lymph nodes. For lung cancer that has the opportunity for surgical resection, the best preoperative staging assessment and postoperative follow-up are required.

For the recurrence of mediastinal lymph nodes after surgical treatment, it also provides high diagnostic yield and low-invasive examination. It only needs to be fasted for 6-8 hours, and can be completed in about 1 hour through local anesthesia and sedation. 1 hour after surgery Ready to eat.

4. Drug treatment of lung adenocarcinoma

How to treat lung adenocarcinoma? The treatment method is decided based on the pathological tissue and staging results. Patients with early-stage lung cancer can be cured by surgery, but some patients require preoperative treatment or postoperative adjuvant treatment: such as chemotherapy, immunotherapy, radiotherapy, etc.

If locally advanced lung cancer is inoperable but has not metastasized, patients can also receive consolidation therapy including chemoradiotherapy and immunotherapy. It can also be based on pathological cell types, analysis of tumor gene mutations, and patient physical status, etc., to select targeted therapy, chemotherapy or radiation therapy. However, most patients with advanced lung adenocarcinoma have special gene mutations (EGFR, ALK, ROS1, etc.), of which about 55% are epidermal growth factor (EGFR) mutations. EGFR-targeted drugs have also developed into the third generation, and health insurance has also Open benefits. The progression-free survival time for first-line EGFR-targeted drugs is about 9-19 months, and the overall survival time is about 21-38 months. Physicians can choose appropriate drug treatment according to the patient's genetic mutation type.

The public should pay attention to their own health and try to avoid risk factors. For people in high-risk groups such as those with a family history of lung cancer and smokers, "low-dose chest computed tomography" (LDCT) screening can also be considered. The test is especially aimed at detecting lung nodules smaller than one centimeter to increase the detection rate of early lung cancer. If you have any abnormalities, you should seek medical treatment as soon as possible for early detection and early treatment.

Original source: Health Medical Network