给编辑:
In a recent article printed in the欧洲呼吸杂志,Infanteet al.1验证了一种逐步方法,包括口服抗生素,后续计算机断层扫描和计算机断层扫描引导的活检,用于局灶性肺玻璃玻璃渗透不相差(GGOS)的鉴别诊断和管理。尽管一项回顾性研究,但他们的工作提供了有关焦点GGO的歧视和管理的关键信息。但是,本文中的某些结果并未完全支持其结论。
One of the major conclusions in the study by Infanteet al.1was that the stepwise approach increased the diagnostic specificity and reduced time to definitive diagnosis. They recommended response to antibiotic trial as the first management step. After a course of oral antibiotics, five (12.5%) patients with inflammatory lesions were ruled out. However, six patients in their study were evaluated with lesions retrospectively visible in earlier computed tomography scans and oral antibiotics were not given. Since the patients with regression were outnumbered by those without treatment, the possibility that all five patients with regression did not receive antibiotic treatment could not be excluded. If all the patients with regression lesions did receive oral antibiotics treatment, the response rate could be elevated to 14.7% (five out of 34 patients). Because this is a central part of their conclusion, clarification of the question may be helpful. Infanteet al.1假设抗生素治疗后具有回归的病变是良性GGO。然而,据报道,在支气管肺泡癌(BAC)和腺癌中,随访过程中固体成分的外观减小,并具有混合亚型2。因此,必须分析回归模式和可疑外观患者的进一步随访。抗生素治疗,回归模式和GGO的组织学之间的相关性需要更大的研究进行验证。已知BAC具有相对缓慢的生长模式和懒惰的临床过程。多年来,一些BAC甚至可能在尺寸和外观上稳定。10例未确定病变的患者也可能有恶性肿瘤的风险。
文献中已经报道了BAC的放射图表现。婴儿et al.1presented that nonpolygonal shape, apparent radial growth and clear-cut margins were associated with malignant histology. The association between a solid component and lung cancer was nonsignificant in their study. However, correlation of a solid component with increased suspicion for invasive adenocarcinoma has been reported2,3。GGO的大小增加,GGO内的固体成分的发展以及串行计算机断层扫描上混合衰变病变的固体成分的增加,这表明恶性肿瘤2,3。由于抗生素治疗后40-60天进行了随访计算机断层扫描,因此对射线照相表现的比较可能会提供更强大的功能,以改善其研究中的恶性肿瘤预测。
The other conclusion of their study is that segmentectomy might be the ideal resection volume for focal GGOs. Although BAC has a low invasive potential and excellent prognosis after surgical excision, the indications of sublobar resections including wedge resection and segmentectomy remain controversial4–8。Aerogenous spread, a BAC hallmark, is related to the predominantly local recurrences after sublobar resection. The lack of large, randomised series with long-term follow-up makes the precise role of sublobar resections unclear. Infanteet al.1主张进行局灶性GGO的分段切除术,主要基于回顾性和非随机研究,报告报告了小型早期肿瘤的等效治愈速率进行解剖分割和标准叶切除术6。但是,在研究中,七名BAC患者中有6例接受了叶切除术,而不是分割切除术。在所有40名患者中,只有四个接受了分割切除术。此外,他们研究中的两名患者在同侧肺中出现了复发性肺癌。其中一个在右下叶切除术后6个月复发。我们想知道,原因是什么原因导致他们的倡导者与真实实践之间的差距。他们的实践经验和结果都没有为他们的结论提供足够的支持来推荐分割切除术。直到持续的随机临床试验确认了司伐骨切除术和标准叶切除术的等效治疗速率之前,叶切除术和纵隔淋巴结采样或解剖是治愈方法的治疗方法,包括T1 BAC4,5。
The data presented by Infanteet al.1in figure 1 and the text are not consistent. For example, the number of patients with no regression, with lung cancer and the number of patients with resection are inconsistent. Figure 1 is also difficult to interpret because the number of patients is confusing and its structure is not well arranged. Publication of a paper with such defects is discouraging.
Statement of interest
None declared.
- ©ERS Journals Ltd