NATIONAL LUNG HOSPITAL In the world amp Vietnam Prevalence 1 st in male 2 nd in female Mortality 1 st in both genders LUNG CANCER Common malignant disease INTRODUCTION Bronchogenic Carcinoma ID: 780506
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Slide1
STUDY OF APPLICATION OF FLUORESCENCE BRONCHOSCOPY TO BRONCHOGENIC CARCINOMA DIAGNOSIS
NATIONAL LUNG HOSPITAL
Slide2In the world & Vietnam: Prevalence: 1st in male, 2nd in female Mortality: 1st in both genders.
LUNG CANCER
Common malignant disease
INTRODUCTION
Slide3Bronchogenic Carcinoma: cancer of trachea, bronchi (main, lobar, segmental and subsegmental)Lung Cancer or
Bronchogenic Carcinoma(S.Ikeda 1974)
INTRODUCTION
Slide4Diagnosis of Lung CancerChest X-ray, CT, MRI, PET…
Lung needle biopsy
Exploratory surgery
Bronchoscopy
INTRODUCTION
Slide51
Assessing the lesions of bronchogenic
carcinoma in
fluorescene
bronchoscopy
2
Describe some clinical,
paraclinical
features of bronchogenic carcinoma
Objectives
Slide6Literature Review Causes and risk factors of lung cancer:Cigarette smokingSubstances not related to cigarette: Arsenic, Asbestos, Nickel…
Risk factors: + Age: peak in 55 – 65 + Gender: World: male/female: 6/1
Vietnam: male/female: 4/1
+ Other factors: family history, diet, chronic pulmonary diseases,
socioeconomic status.
Slide7Literature ReviewClinical signs & symptoms:A. Local: Cough, chest pain, dyspneaB. Compression:Hoarseness, hiccup, dysphagia, superior vena cava syndrome…Pleural, pericardial effusionC. Paraneoplastic syndromes
D. General signs: Fever, loss of appetite, weight lossE. Symptoms of metastasis: headache (brain met), bone pain (bone met), abdominal pain (liver met)…
Slide8Literature Review Paraclinial features:Diagnostic Imaging: Chest X-ray, CT Scanner, MRI…Tumor markers: CEA,
Cyfra 21-1, Pro-GRPBronchoscopyPathology: cytology, histopathology
EGFR mutation testing
Slide9Lung cancer stages: AJCC 2010Stage group
T
N
M
0
T0
N0
M0
IA
IB
T1a
-b
T2a
N0
N0
M0
M0
IIA
IIB
T1a-b, T2a
T2b
T2b
T3
N1
N0
N1
N0
M0
M0
M0
M0
IIIA
IIIB
T3
T1-3
T4
T1-3
T4
N1
N2
N0-1
N3
N2-3
M0M0M0M0M0IVAny TAny NM1a-b
Literature Review
Slide10Literature ReviewMain histopathologic types of lung cancer (WHO 2015): Adenocarcinoma Squamous Cell Carcinoma Carcinoid Tumor
Mixed Lung Cancer
Slide11Fluorescence Bronchoscopy DevicesLiterature Review
Tumor with decrease in fluorescence
Slide12Subjects
Patients were diagnosed primary lung cancer by histopathological evidence from bronchial biopsy specimens obtained at fluorescene
bronchoscopy in National Lung Hospital from December 2014 to August 2015
Slide13Study design: Cross-sectional
Sampling technique: Convenient
Data
collection tool
:
Data collection form
Methods
Slide14DATA ANALYSIS & MANAGEMENT Study variables Cilinical features: age, gender, history, time of detecting tumorClinical signs & symptoms: general, objective, subjective, performance status
Primary tumor location, metastatic sitesParaclinical
features:
- Imaging, laboratory tests
-
Fluorescene
bronchoscopy
- Histopathology
Methods
Slide15Data was entered and analyzed using SPSS 16.0.Statistical issues:Descriptive: mean, standard deviation, max, min. Statistical tests: chi-square test was used. Statistically significant results (p < 0.05) were included. Fisher’s exact test was used when sample sizes are smaller than 5.DATA ANALYSIS & MANAGEMENT
Methods
Slide16Bronchogenic Carcinoma
White light bronchoscopy
Fluorescence bronchoscopy
Images of lesions
Histopathology
T Classification
TNM Staging
Conclusion
Research Process Flowchart
Slide17Chart 3.2: Gender distribution
1Clinical & paraclinical features
Study
Male/female
Hoàng
Đình
Chân (2004)
5.76
Lê
Thu
Hà
(2009)
4
RESULTS & DISCUSSION
Male
Female
Slide18RESULTS & DISCUSSION1
Clinical &
paraclinical
features
< 40 40 – 49 50 – 59 60 – 69 > 70
Slide19RESULTS & DISCUSSIONStudy
Smoking historyPha
n
Lê
Thắng
(2000)78.4%
Lê Thu Hà (2009)71
.
2%
1
Clinical &
paraclinical
features
Smoking
Non-smoking
%
< 20 20 – 30 > 30
5% 30% 45%
Slide201
RESULTS & DISCUSSION
Table 3.1.
Tumor location on chest
x-ray
Study
Tumor location
Nguyễn
Việt
Cồ
( 1994)
Right lung (64.2%), left
lung
(35.3%), upper lobe (52.4%), lower
lobe (
29.14%).
Tumor Location
Bronchogenic Carcinoma
n
%
Lung
Right
22
55
Left
14
35
Both
4
10
Total
40
100
Lobe
Upper
21
52,5
Middle
6
15
Lower
13
32,5
Total
40
100
Clinical &
paraclinical
features
Slide21Chart 3.10. Histopathologic types
1RESULTS & DISCUSSION
Study
Histopathologic
types
Houwen
L (1994)
Central lung cancer: squamous cell
60%
Peripheral lung cancer:
adenocarcinoma 70%
Phan
Lê
Thắng
(2000)
Central lung cancer: squamous cell
38.5%
Peripheral lung cancer:
adenocarcinoma 74.5%
Clinical &
paraclinical
features
Small cell
Adenocarcinoma
Squamous cell
Large cell
Slide222Assessing the lesions of
bronchogenic carcinoma in white light bronchoscopy:
RESULTS & DISCUSSION
Study
Lesions
Ngô
Quý
Châu
(2002)
Papillary tumor
17%, infiltration 39%, compression 30%
Nguyễn
Đại
Bình
(1999)
Papillary tumor 29.2
%, infiltration 47.9%, compression 12.3%
Lesion
Number
Percentage
Papillary tumor
10
25
Infiltration
24
60
Compression
6
15
Total
40
100
Table 3.3. Lesions of
bronchogenic carcinoma in white light bronchoscopy
Slide23RESULTS & DISCUSSIONTable 3.4. Lesions of bronchogenic carcinoma in fluorescence bronchoscopy Bronchoscopy
LesionWhite light
(
n = 40
)
Decrease in fluorescence
(n =
40)
Papillary
tumor
10
10
Infiltration
24
24
Compression
6
6
Decrease in fluorescence
significantly different from
papillary tumor
,
infiltration,
compression
0
40
Assessing the lesions of
bronchogenic carcinoma
in
fluorescene
bronchoscopy
:
2
Slide24RESULTS & DISCUSSIONHistopathologic typeNumber
PercentageHyperplasia
4
10
Dysplasia
3
7.5
Metaplasia
3
7.5
Cis
0
0
Cancer
20
50
Chronic inflammation
10
25
Total
40
100
Table 3.5. Histopathologic types of 40 decrease in
fluorescene
lesions of
bronchogenic carcinoma
2
Assessing the lesions of
bronchogenic carcinoma
in
fluorescene
bronchoscopy
:
Slide25RESULTS & DISCUSSIONTable 3.6. Comparison of T classification of bronchogenic carcinoma between white light bronchoscopy and fluorescene bronchoscopyT classification
White light bronchoscopy
Fluorescene
bronchoscopy
Number
Number
T1
0
0
T2
7
2
T3
4
3
T4
9
15
Total
20
20
Assessing the lesions of
bronchogenic carcinoma
in
fluorescene
bronchoscopy
:
2
Slide26RESULTS & DISCUSSIONTable 3.7. Comparison of stage of bronchogenic carcinoma between white light bronchoscopy and fluorescene bronchoscopyStage group
White light bronchoscopyFluorescene
bronchoscopy
Number
Number
IIa
1
0
IIb
0
1
IIIa
5
1
IIIb
2
6
IV
1
1
Total
9
9
2
Assessing the lesions of
bronchogenic carcinoma
in
fluorescene
bronchoscopy
:
Slide27CONCLUSION Clinical & paraclinical features
1
- Bronchogenic carcinoma has some features: male more common than female, common in smokers, squamous cell carcinoma has high percentage.
Assessing the lesions of bronchogenic
carcinoma in
fluorescene
bronchoscopy
-
Fluorescene
bronchoscopy helps to identify accurately the margin of primary tumor of bronchogenic carcinoma (50%).
-
Fluorescene
bronchoscopy helps to stage more accurately than white light bronchoscopy (9 in total of 40 patients changed stage).
2
Slide28Lung cancer patients who are operable should be ordered a fluorescence bronchoscopy to operate scientifically and rationally.Recommendation
Slide29Thanks for listening