检验细胞可以侦测肺癌


  Nov. 1, 2005(蒙特娄讯)-根据发表于胸腔医学期刊第71届美国胸腔医学会(ACCP)科学座谈的试验结果显示,一项口腔黏膜刮除检验可以作为筛检早期肺癌的工具。
  
  研究者从150位确定为肺癌病患、以及990位高危险但筛检呈阴性的病患采取面颊黏膜细胞,结果发现这项检验方法的敏感度为66%、专一性为70%;筛检出第一期肺癌的敏感度为61%,代表150位病患中筛检出47位。
  
  研究者使用一种系统,称为自动定量流式细胞仪(AQC),有数千个细胞核来自一个特定DNA染色检体,被评估用来侦测这些细胞核;这种检验会产生一个单一数据,代表恶性肿瘤潜在存在与否;AQC检验并不能作为病理检验的根据。
  
  这项试验中受试者的吸烟习惯是差不多的,都是老菸枪,每年平均吸菸52-54包,而且每年吸菸的中位数从42到45包。
  
  Bojana Turic医师在记者会中表示,这项试验可能是作为病患进行计算机断层筛检癌症之前的起始诊断工具;Turic医师是试验主持人,同时也是加拿大英属哥伦比亚Perceptronix医学公司临床与管理事务主任,该公司为这项检验的研发厂商,且赞助这项试验。
  
  Turic医师向Medscape表示,我们需要与胸腔医学专家合作研究这项检验是否有效;该项试验与计算机断层可以同时进行,以决定病患是否需要后续追踪;此外,也可以作为断层扫描前的检验,因为这项检验是便宜且方便的。
  
  Turic医师表示,当问到一般的医师可以在诊间使用这样的检验吗?他认为,一开始的重点将放在由专科医师来使用这样的诊断工具。
  
  Turic医师指出,在不远的未来,我们将会把重点放在胸腔科医师来使用这样的检验,看是否可以像人类乳突状病毒检验一样广泛应用。
  
  ACCP总裁Michael Alberts医师向Medscape表示,尽管目前的实验数据不足,不能决定这项检验在临床上对于不同的病患是否适用,不过这是诱人的第一步。
  
  Alberts医师向Medscape表示,许多人渴望一种简单、快速、且便宜的肺癌筛检,我们想要的是一种可以使用于大众便宜且快速的检验。
  
  在接下来的科学座谈中,Roger Kemp博士,Perceptronix公司的产品经理向听众表示,除了肺癌之外,口腔颊黏膜的变化与其它癌症,包括口腔癌与咽喉癌有关。
  
  他表示,这可能会影响到我们临床前试验与临床试验的结果。
  
  Perceptronix,英属哥伦比亚癌症署的相关企业,最近将临床试验结果呈送加拿大卫生署,申请新医疗检验上市案,来取得作为诊断工具的执照。

Cheek Cells May Detect Lung Ca

By
Medscape Medical News

Nov. 1, 2005 (Montreal) — An analysis of buccal mucosal scrapings may be useful as a screening method for early-stage lung cancer, according to a study presented here at CHEST 2005, the 71st annual scientific meeting of the American College of Chest Physicians (ACCP).

Researchers examined cheek cells scraped from 150 confirmed lung cancer cases and 990 high-risk negative cases and found that the method yielded 66% sensitivity and 70% specificity. The sensitivity for stage 1 lung cancer reached 61%, representing 47 of the 150 cases.

The investigators used a system called automated quantitative cytometry (AQC), where thousands of cell nuclei from one specimen are prepared with a specific DNA stain, and evaluated to detect subtle changes in those nuclei. The analysis yields a single score, indicating the potential presence of a malignancy. The AQC analysis does not warrant manual pathological review.

The subjects in the study were matched for their smoking behavior, with all subjects being heavy smokers, mean pack-years ranging from 52 to 54, and median pack-years ranging from 42 to 45.

The test may hold promise as an initial diagnostic tool before a patient undergoes computed tomography to test for malignancy, said Bojana Turic, MD, the study's lead investigator and director of clinical and regulatory affairs for Perceptronix Medical Inc., in Vancouver, British Columbia, Canada, at a news conference. Perceptronix Medical Inc., the developer of the diagnostic test, funded the study.

"We need to work with chest specialists to determine where this will be most useful," Dr. Turic told Medscape. "It could be that this test and CT are done at the same time, to see which patients will be followed. It could be this test is done before CT because the test is cheap and easy to deliver."

When asked if general practitioners would eventually be able to use the test in their offices, Dr. Turic said that the initial focus is on specialists using the diagnostic tool.

"For the immediate future, we would like to focus on pulmonologists being able to use this test," said Dr. Turic. "It remains to be seen if it will function like a Pap test does for cervical cancer."

W. Michael Alberts, MD, president of the ACCP, told Medscape that despite the data being too preliminary to determine if the test will have any applicability in the clinic for the individual patient, he called it "a very intriguing first step.

"It's a line of inquiry that may produce an easy, quick, and cheap screening test for lung cancer," Dr. Alberts told Medscape. "We would like to have a cheap, fast, and quick test that would apply to all populations."

In a subsequent scientific session at the meeting where the data were presented, Roger Kemp, PhD, a product director at Perceptronix, told attendees that the changes in buccal mucosa might be associated with other cancers apart from lung cancer, such as oral or laryngeal cancers.

"This may confound the results of our preclinical data and data from clinical trials," he said.

Perceptronix, a spin-off company of the British Columbia Cancer Agency, recently submitted clinical trial data to Health Canada, the Canadian federal body that approves new drug products, to obtain a diagnostic device license application.

CHEST 2005: Abstract 2738. Presented Oct. 31, 2005.

Reviewed by Gary D. Vogin, MD

    
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