Læknablaðið - 15.07.1999, Blaðsíða 22

610
LÆKNABLAÐIÐ 1999; 85
Greining illkynja æxla í lungum
með berkjuspeglun
Sigurður Magnason1, Helgi J. ísaksson2, Sigurður Björnsson3, Steinn Jónsson3
Magnason S, ísaksson HJ, Björnsson S, Jónsson S
Bronchoscopic diagnosis of lung malignancies
Læknablaðið 1999; 85: 610-5
Objective: To assess the diagnostic yield of ftberop-
tic bronchoscopy in patients with a variety of radio-
graphic findings suspected of malignancy.
Material and methods: The study group was com-
posed of all patients who underwent bronchoscopy in
our hospital over a seven year period (1986-1993)
where cytologic samples were obtained. Schematic
drawings of endobronchial and radiographic ftndings
done at the time of bronchoscopy were reviewed and
the results of cytologic and histologic samples were
compared for sensitivity and diagnostic accuracy.
Results: Bronchoscopy and cytologic sampling was
performed on 189 patients. Tissue samples were ob-
tained in 109 patients from visible endobronchial ab-
normalities or peripheral lesions using the transbron-
chial approach with fluoroscopic guidance. A total of
64 malignancies were diagnosed, 43 by broncho-
scopy (67%). Among 58 patients who had primary
malignancy of the lung, adenocarcinoma was the
most frequent histologic type (50%) followed by
squamous cell carcinoma (22%) and small cell carci-
noma (17%). The diagnostic sensitivity of cytology
was 30% whereas that of tissue biopsy was 70%
among those patients where both tests were obtained.
The two methods complemented each other to give a
joint sensitivity of 76%. Among 13 patients with
Frá ’læknadeild Háskóla íslands, 2Rannsóknastofu Há-
skóla Islands í meinafræði, 3lyflækningadeild Sjúkrahúss
Reykjavíkur. Fyrirspurnir, bréfaskipti: Steinn Jónsson lyf-
lækningadeild Sjúkrahúss Reykjavíkur.
Lykilorð: lungnakrabbamein, berkjuspeglun, Irumurann-
sókn.
malignancy and normal endobronchial appearance,
transbronchial biopsy was performed in 10 of which
seven were diagnostic. Patients with primary malig-
nancy who underwent surgery had a five year survi-
val of 37% while the overall ftve year survival was
15.5%.
Conclusions: In this study histology was much more
sensitive than cytology as a sampling technique
during bronchoscopy (p< 0.01). Adenocarcinoma has
become the most frequent histologic type of primary
lung malignancy in Iceland and overall survival
among patients with primary tumors compares with
recent international trends.
Keywords: lung cancer, bronchoscopy, cytology.
Ágrip
Markmið: Að meta greiningarárangur af
berkjuspeglun hjá sjúklingum sem grunaðir
voru um illkynja sjúkdóm í lungum.
Efniviður og aðferðir: Þeir sjúklingar sem
rannsakaðir voru með berkjuspeglun og töku
sýna til frumurannsóknar á sjö ára tímabili
(1986-1993) á Landakotsspítala mynduðu rann-
sóknarhópinn. Upplýsingar um útlit berkja og
röntgenmynda skráðar við speglun voru flokk-
aðar og greiningarárangur af frumu- og vefja-
rannsókn borinn saman.
Niðurstöður: Berkjuspeglun og taka frumu-
sýnis með burstatækni voru framkvæmdar hjá
189 sjúklingum. Vefjasýni voru einnig tekin frá
109 þessara sjúklinga úr sjáanlegu æxli eða
með sýnistöku í gegnum berkju í skyggningu.
Alls fundust illkynja æxli hjá 64 sjúklingum
þar af voru 43 greindir við berkjuspeglun
(67%). Meðal 58 sjúklinga með frumæxli í
lungum voru kirtilmyndandi krabbamein al-
gengasta vefjagerðin (50%), en næst komu
flöguþekjukrabbamein (22%) og smáfrumu-
krabbamein (17%). Næmi frumurannsóknar