/Copy
' 1. Most patients with early-stage lung cancer have no obvious relevant positive signs.
2. The patient has extrapulmonary signs of unknown origin that cannot be cured after long-term treatment, such as clubbing of the fingers (toes), non-migratory joint pain, male breast hyperplasia, dark skin or dermatomyositis, ataxia and phlebitis, etc. .
3. In patients with clinical manifestations highly suspicious of lung cancer, physical examination reveals vocal cord paralysis, superior vena cava obstruction syndrome, syndrome, etc., indicating the possibility of local invasion and metastasis.
4. In patients with clinical manifestations highly suspicious of lung cancer, physical examination reveals hepatomegaly accompanied by nodules, subcutaneous nodules, supraclavicular fossa lymph node enlargement, etc., suggesting the possibility of distant metastasis.
Imaging examination
The imaging examination methods for lung cancer mainly include chest X-ray, magnetic resonance imaging (,), ultrasound, radionuclide imaging, positron emission computed tomography (positron emission tomography) and other methods.
Imaging examinations are mainly used for lung cancer diagnosis, staging, restaging, efficacy monitoring and prognosis assessment. During the diagnosis and treatment of lung cancer, one or more imaging examination methods should be selected reasonably and effectively based on different examination purposes.
1. Chest line examination
Chest X-ray is the basic imaging examination method before and after treatment for lung cancer, usually including frontal and lateral chest X-rays. When you have questions about the basic images of the chest X-ray, or need to understand the details of the images displayed by the chest X-ray, or look for other information that is helpful for imaging diagnosis, further imaging examination methods should be selected in a targeted manner.
2. Chest examination
The chest can display a lot of image information that is difficult to find on online chest X-rays. It can effectively detect early peripheral lung cancer, further verify the location and extent of the disease, and also identify benign lesions. , malignant, it is currently the most important and commonly used imaging method in the diagnosis, staging, efficacy evaluation and post-treatment follow-up of lung cancer.
For patients newly diagnosed with lung cancer, the chest scan range should include both adrenal glands. For chest lesions that are difficult to diagnose qualitatively, guided percutaneous lung biopsy can be used to obtain a cytological or histological diagnosis. For lung cancer screening in high-risk groups, chest scans are recommended.
Thin-layer reconstruction is the most important examination and diagnosis method for pulmonary nodules. For solitary nodules in the lungs, thin-layer reconstruction and multi-planar reconstruction should be performed routinely. For nodules that cannot be clearly diagnosed at the initial diagnosis, depending on the size and density of the nodules, follow-up intervals should be followed to pay attention to changes in nodule size and density. In particular, the solid component increases in some solid nodules and the solid component appears in non-solid nodules.
3. Examination
Examination in the chest can be selectively used in the following situations to determine whether the chest wall or mediastinum is invaded, to show the relationship between superior sulcus tumors and the brachial plexus and blood vessels, to differentiate between hilar masses and atelectasis , the limit of obstructive pneumonia. For patients who are contraindicated in injecting iodinated contrast agents, it is the first choice examination method to observe the invasion of the mediastinum and hilar large vessels and lymph node enlargement. It also has certain value in identifying fibrosis and tumor recurrence after radiotherapy.
It is especially suitable for determining whether there is metastasis to the brain and spinal cord. Brain enhancement should be used as a routine preoperative staging examination for lung cancer. It has high sensitivity and specificity for bone marrow cavity metastasis and can be selected according to clinical needs.
4. Ultrasound examination
It is mainly used to detect the metastasis of solid important organs in the abdomen and abdominal and retroperitoneal lymph nodes. It is also used to examine bilateral supraclavicular fossa lymph nodes for intrapulmonary lesions adjacent to the chest wall or Chest wall lesions can be distinguished between cystic and solid, and ultrasound-guided puncture biopsy can be performed. Ultrasound is also commonly used to extract and locate pleural effusion and pericardial effusion.
5. Bone scan examination
A routine examination used to determine bone metastasis of lung cancer. When the bone scan shows suspicious bone metastasis, the suspicious parts should be examined and verified.
6. Inspection
Recommended for those with conditions. It is the best method for lung cancer diagnosis, staging and restaging, efficacy evaluation and prognosis assessment.
Endoscopy
1. Bronchoscopy
Bronchoscopy is the most commonly used method to diagnose lung cancer, including brushing under direct bronchoscopy, biopsy, needle aspiration and bronchial lavage Obtain cytology and histology diagnosis. The combined application of the above methods can improve the detection rate.
2. Transbronchial needle aspiration (,) and ultrasonic bronchoscopy-guided transbronchial needle biopsy (,)
Can puncture lymph nodes and masses in the trachea or parabronchus, which is helpful in the diagnosis of lung cancer and lymph node staging. The traditional operation based on chest positioning has high requirements on the surgeon and is not a routine recommended examination method. Hospitals with qualified conditions should actively carry out it. By performing puncture of intrathoracic lesions in real time, accurate pathological and cytological diagnosis of lung cancer lesions and lymph node metastasis can be obtained, and it is safer and more reliable.
3. Transbronchial lung biopsy (,)
It can be performed under the guidance of online, airway ultrasound probe, virtual bronchoscope, electromagnetic navigation bronchoscope and bronchoscope, and is suitable for diagnosing peripheral lung lesions at home and abroad. (,), which examines the intraluminal conditions at the same time as diagnosis, is an important means for non-surgical diagnosis of pulmonary nodules.
4. Mediastinoscopy
As an effective method to diagnose lung cancer and evaluate lymph node staging, it is the current gold standard for clinical evaluation of the status of mediastinal lymph nodes in lung cancer.
5. Thoracoscopy
It can accurately diagnose and stage lung cancer, especially for early-stage lung cancer where pathological specimens cannot be obtained by examination methods such as transthoracic needle biopsy (,). For micronodular lung lesions, wedge resection of the lesions under thoracoscopic surgery can achieve the purpose of clear diagnosis and treatment.
For intermediate and advanced lung cancer, thoracoscopy can be used to perform biopsy of lymph nodes, pleura and pericardium, and tissue and cytological examination of pleural effusion and pericardial effusion, which can provide reliable basis for formulating comprehensive treatment plans and individualized treatment plans.
Other examination techniques
1. Sputum cytology examination
It is currently one of the simple and convenient non-invasive diagnostic methods for diagnosing lung cancer.
2.
Puncture of intrathoracic masses or lymph nodes can be performed under the guidance of ultrasound or ultrasound.
3. Thoracentesis
Thoracentesis can obtain pleural effusion and conduct cytological examination.
4. Pleural biopsy
For pleural effusion with unknown diagnosis, pleural biopsy can increase the positive detection rate.
5. Biopsy of superficial lymph nodes and subcutaneous metastatic nodules
For patients with superficial lymph node enlargement and subcutaneous metastatic nodules, needle aspiration or biopsy should be performed routinely to obtain pathological diagnosis.
Laboratory examination
1. General laboratory testing
Before treatment, patients need to undergo routine laboratory testing to understand the patient's general condition and whether they are suitable for taking corresponding treatment measures.
Routine blood tests
Liver and kidney function tests and other necessary biochemical tests
Patients who require invasive examinations or surgical treatments also need to undergo necessary coagulation function tests.
2. Serological tumor marker detection
Currently, the commonly used primary lung cancer markers recommended by the American Committee on Clinical Biochemistry and the European Tumor Marker Expert Group include carcinoembryonic antigen (,), neuron-specific antigen Alcoholase (,), cytokeratin fragment (,) and gastrin-releasing peptide precursor (,), as well as squamous cell carcinoma antigen (,), etc. The combined use of the above tumor markers can improve their sensitivity and specificity in clinical application.
Auxiliary diagnosis
During clinical diagnosis, tumor markers related to lung cancer can be detected as needed, auxiliary diagnosis and differential diagnosis can be performed, and the possible pathological types of lung cancer can be understood. ①Small cell lung cancer (,) and are ideal indicators for diagnosis. ②In patients with non-small cell lung cancer (non-small cell lung cancer), the elevated levels of , , and in the patient's serum are helpful for the diagnosis. And it is generally believed to have high specificity for lung squamous cell carcinoma. If indicators such as , , , and are jointly detected, the accuracy of identifying and can be improved.
Efficacy Monitoring
Before treatment (including before surgery, chemotherapy, radiotherapy and molecular targeted therapy), the first test needs to be carried out, and tumor markers that are sensitive to the patient should be selected as indicators for observing the efficacy after treatment. . After the patient receives the first treatment, the tumor marker can be tested again based on the half-life of the tumor marker. If the patient receives chemotherapy and is higher than before, it indicates that the prognosis may be poor, or if the survival time is shorter and the patient's serum level decreases significantly after treatment, the prognosis may be better. When there is only an increase in serum markers without evidence of imaging progression, do not change the original treatment strategy for lung cancer.
News