Clarify the pathological diagnosis method of lung tumor

Lung cancer is the leading cause of cancer death worldwide. In the increasingly industrialized 21st century, the incidence rate is still rising. It is unscientific and unreasonable to rush into treatment without accurate clinical staging. The diagnosis of lung cancer cannot rely on chest X-ray, CT, MRI and other imaging examinations. Even PET/CT cannot replace the pathological diagnosis of lung cancer. Only pathological diagnosis is the final diagnosis and the fundamental basis for treatment decisions.

There are many methods for pathological diagnosis of lung tumors, but each has its own advantages and disadvantages. One or more methods can be selected according to different conditions.

1. Sputum exfoliative cytology examination: The positive rate of sputum exfoliative cytology examination is 20%~50%, and about half of them can distinguish the type. The advantages are convenient sampling, simple method, no pain, and repeated sampling and testing. After the patient gargles in the morning, he coughs actively, and sputum is coughed up from deep inside and left in the specimen cup. The positive rate of sputum with blood in the sputum is higher. Generally, sputum is sent for testing 3~6 times. The disadvantages are that the lesions are small, the sputum volume of early patients is small or no sputum, and it is not easy to diagnose.

2. Fiberoptic bronchoscopy: Bronchoscopy is an effective means of pathological diagnosis of lung tumors. Through bronchoscopy, the location and range of the tumor can be observed, and tissues and cells of the lesion can be taken by forceps or brushes for pathological examination. The advantage is that most patients can be diagnosed based on this, but the disadvantage is that the patient will feel some pain during the examination, and there is also the possibility of bleeding and infection.

3. Lung puncture biopsy: There are two types: fine needle puncture and special biopsy gun puncture. The former obtains less specimens and is mainly used for cytopathological diagnosis, while the latter can obtain tissue specimens and can be used for histopathological diagnosis with higher accuracy; however, the former has less trauma and almost no serious complications, while the latter has a higher incidence of pneumothorax and bleeding. Guidance methods include X-ray fluoroscopy, CT or B-ultrasound.

4. Thoracoscopic biopsy: It is a minimally invasive surgery that can perform pathological diagnosis and treatment at the same time. The advantage is that it is easy to diagnose early lesions, but the disadvantage is that it requires surgery and general anesthesia, which is expensive.

5. Mediastinoscopy: Mediastinoscopy is an effective means of diagnosing mediastinal lymph node metastasis of lung cancer.

6. Thoracotomy: If the above examinations are still undiagnosed and the cancer is highly suspected to be malignant, thoracotomy should be considered. However, the decision must be made after carefully weighing the pros and cons based on the patient's age, lung function, and surgical complications.

Clinically, some patients are diagnosed with clear pathology by puncturing metastatic lymph nodes on the surface of the body, such as supraclavicular lymph nodes, or by puncturing and aspirating pleural effusion exfoliated cells for examination. However, these patients are in a more advanced stage of the disease and have limited treatment options, with chemotherapy, traditional Chinese medicine, and supportive care being the main treatments.

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