| Background and purposeThe incidence rate and mortality of lung cancer are the first place in malignant tumors,which seriously threaten human health.More than 85%of lung cancer pathological types are non-small cell lung cancer(NSCLC)and lung squamous cell carcinoma is one of the common types of NSCLC.At present,surgery,radiotherapy and chemotherapy,molecular targeted therapy and immunotherapy are the main methods for the treatment of lung squamous cell carcinoma.Despite the progress and development of the treatment,the 5-year survival rate of the disease is still low,only 8%～15%.Compared with the treatment of lung adenocarcinoma,the treatment of the means and the treatment effect of lung squamous cell carcinoma are far from each other.In addition,the clinical symptoms and signs of squamous cell carcinoma of the lung are not typical and easy to be ignored.Therefore,nearly 2/3 of the patients have been in the middle and late stage when they came to the hospital for initial diagnosis,lost the best chance of operation,and seriously affected the survival time.The final diagnosis of lung space occupying lesions depends on the pathological basis.At the same time,the follow-up treatment also depends on pathological diagnosis and stage,so early and accurate pathological diagnosis can effectively treat malignant lesions and avoid the transformation of benign and malignant lesions.At present,the biopsy technology of lung space occupying lesions can be divided into:percutaneous lung biopsy(guided by ultrasound,MRI or CT),transbronchoscopic lung biopsy(including radial ultrasound-guided lung biopsy,transbronchoscopic sampling of pulmonary parenchymal nodules based on virtual bronchoscope navigation system),transesophageal ultrasound-guided fine needle aspiration biopsy,etc.CT-GPLB has become an indispensable and important method in the clinical diagnosis and treatment of lung cancer.Although its clinical diagnosis and treatment value,safety and practicability have been proved by some researchers,but the research applicable to China,especially Henan and other Central Plains has not been carried out.There are few comparative studies on the advantages,disadvantages and feasibility of CT-GPLB and US-GPLB.This study will discuss the two kinds of puncture methods,and provide a theoretical basis for the selection of guiding methods in the initial stage of lung puncture biopsy in Central Plains,especially in primary hospitals.Although CT-GPLB has been used in clinic for many years,its clinical application status and prevention and treatment of complications in the process of puncture are lack of big data statistical analysis.Aiming at this defect,this study makes theoretical basis for necessary items of pre puncture examination,precautions in the process of puncture and relevant treatment after puncture;previous studies lack of CT guided percutaneous lung puncture This study compares the two pathological results to find the theoretical basis for the difference of pathological results.Compared with the gene targeted therapy of lung adenocarcinoma,there is a great controversy on the mutation rate of EGFR gene and the efficacy of Gefitinib in patients with advanced lung squamous cell carcinoma.There is a big gap between the detection of EGFR gene and lung adenocarcinoma after the diagnosis of lung squamous cell carcinoma,and there is less research on the targeted therapy of advanced lung squamous cell carcinoma.There are few clinical studies on EGFR wild-type advanced lung squamous cell carcinoma patients who have just been put on the market.This study confirmed the efficacy of enrotinib hydrochloride in the treatment of advanced lung squamous cell carcinoma,and provided a new treatment for the patients with EGFR gene mutation wild type,failure of multi-line chemotherapy and refractory advanced lung squamous cell carcinoma after Gefitinib resistance.This research is mainly from three aspects:1.Analysis of clinical data and prevention and treatment of complications of 1268 cases of CT-GPLB in our hospital in 2018.2.The analysis of pathological results after percutaneous lung biopsy guided by CT,the guiding significance of CT and enhanced CT images to the puncture,and the comparative analysis between CT-GPLB and US-GPLB.3.The status of EGFR gene mutation and the therapeutic effect of Gefitinib were analyzed.The clinical study of enrotinib in the treatment of EGFR wild-type advanced squamous cell carcinoma was carried out.The main innovations of this study are as follows:1.The clinical data and pathological samples of 1268 cases of CT-GPLB were analyzed.Which reflected the current situation of diagnosis and treatment of lung space occupying diseases in Henan Province and the most advanced level of lung biopsy in China.2.Compare CT-GPLB with US-GPLB,so as to provide basis for clinical selection of other hospitals,especially basic hospitals.3.Analyze and discuss the effect of enrotinib hydrochloride in patients with advanced EGFR wild-type lung squamous cell carcinoma.Part I The clinical application of CT-GPLB in Pulmonary lesionsObjective1.Summarize the clinical data of 1268 cases of CT-GPLB,tmake a prediction on the diagnosis and treatment of lung space occupying diseases in Henan Province.2.Summarize and analyze the complications of CT-GPLB in 1268 cases.MethodsFrom January 1,2018 to December 31,2018,a total of 1268 patients underwent CT-GPLB in the imaging and nuclear medicine department of the First Affiliated Hospital of Zhengzhou University.The incidence of complications,clinical factors and imaging characteristics of the complications were analyzed and compared.Results1.General information 1268 patients cases,689 male and 579 female;467 with smoking history;338 with COPD or chronic bronchitis;57 with interstitial lung disease;age 10-87 years,average age 57.3 years;lesion size 0.7cm-11.9cm,average 2.19cm;peripheral lesions 875 cases and 393 cases had central focus,89 cases had tumor history.2.Success rate:1268 patients were all successful,the success rate was 100%,3.The incidence of complications:87 cases(6.9%)had pneumothorax,315 cases(24.8%)had bleeding,86 cases(6.8%)had hemoptysis,9 cases(0.7%)had pleural reaction.237 patients had two or more injections,35 patients(14.7%)had pneumothorax,113 patients(47.6%)had bleeding,3 patients had hemoptysis and 1 patient had hemothorax.There was no infiltration of blood or implantation of needle canal.4.In this study,it was found that the risk factors of pneumothorax were emphysema and interstitial lung disease,focus size and location,while focus size,focus location and CT enhanced intensity were the risk factors.5.Found that the CT-GPLB was poor in municipal hospitals,and most county-level hospitals did not carry out this operation.conclusions1.The success rate of CT-GPLB is high,and the complications are small.The number and depth of needle insertion,the degree of CT enhancement and whether COPD is combined,especially interstitial lung disease,are the main factors affecting the incidence of pneumothorax and hemothorax after CT-GPLB.2.CT-GPLB is easy to operate and safe.Some hospitals are not optimistic about its development,so it should be strengthened in the future clinical work.Part II Pathological results of CT-GPLB and its comparison with US-GPLBObjective1.Summarize the pathological data of 1268 cases of CT-GPLB,and to compare the CT focus morphology of NSCLC with the results of puncture.2.Compare the pathological results of the gross specimens obtained by CT-GPLB with those obtained by surgery.3.Compare the diagnostic success rate,puncture time,puncture times and complications between CT-GPLB and US-GPLB.MethodsFrom January 1,2018 to December 31,2018,a total of 1268 patients underwent CT-GPLB in the imaging and nuclear medicine department of the First Affiliated Hospital of Zhengzhou University.analyzed the pathological;compare the CT imaging and pathological results of 240 patients who were confirmed as NSCLC with surgical,compare the pathological types of puncture,compare of pathological types of surgical specimens with CT-GPLB.875 cases of periphTeral type were selected and compared with those of US-GPLB at the same time.Results1.General data 1268 cases with effective lung space occupying were collected,and 1251 cases with definite diagnosis rate of 98.6%.Among them,835 cases were malignant tumors and 416 cases were non malignant diseases.The results showed that 522 cases of adenocarcinoma accounted for 41.2%of lung occupying diseases and 62.5%of malignant tumors.The CT findings and pathological findings of 240 patients with non-small cell lung cancer(NSCLC)confirmed by lung puncture were analyzed.It was found that the proportion of mass shadow was 45.9%,that of nodular shadow was 27.5%,and that of cavity,diffuse lesion and GGO were 15.8%,6.0%and 5.0%,respectively.There was no statistical difference between the diameter of the lesion and the coincidence rate of the operation diagnosis.2.There was no significant difference between CT-GPLB and surgical operation in the pathological results of lung cancer samples(P>0.05).The coincidence rate of smear cytology and biopsy histology combined diagnosis pathological results with surgical pathological results was 96.7%,which was significantly higher than that of single application(P<0.05).3.There was no significant difference in the success rate and complications between the two groups(P>0.05).The average time of ultrasound-guided group(13.77 ±5.76 min)was significantly less than CT-guided group(27.2±10.6 min),but the latter is more widely used.Conclusions1.CT imaging morphology has statistical significance for the differential diagnosis of pathological types,mass shadow,nodule and diffuse disease has better guiding significance than cavity and GGO,especially for the difference between benign and malignant diseases.2.There were significant statistical differences between the pathological results obtained by three ways of CT-GPLB(cytology smear,biopsy histology,cytology smear+biopsy histology)and the surgical pathological results.3.There was no significant difference in the success rate of pathological diagnosis,the number of punctures and complications between US-GPLB and CT-GPLB,the former took less time.The latter can find complications in the early stage,which has obvious advantages for GGO and small nodule space occupying puncture,and has more clinical application value.Part Ⅲ:Current status of EGFR gene mutation in lung squamous cell carcinoma diagnosed by CT-GPLB,efficacy analysis of Gefitinib and Anlotinib in extensive lung squamous cell carcinomaObjective1.Analyze the mutations of EGFR gene in patients with squamous cell carcinoma of the lung diagnosed by CT-GPLB in the imaging and nuclear medicine department of the First Affiliated Hospital of Zhengzhou University,find the differences in clinical data and CT imaging features between the two groups of EGFR gene sensitive mutations and wild-type patients.2.Analyze the clinical efficacy of gefitinib in patients with EGFR mutation sensitive advanced lung squamous cell carcinoma,and the clinical efficacy of enrotinib hydrochloride in patients with refractory advanced lung squamous cell carcinoma.MethodsCT of the imaging and nuclear medicine branch of the First Affiliated Hospital of Zhengzhou University from January 1,2018 to December 31,2018 The clinical data of patients with lung cancer diagnosed by percutaneous lung biopsy under guidance were analyzed.All patients were detected EGFR gene mutations in tumor tissues by the method of NGS,257 cases in total.The data of progression free survival,survival and drug toxicity of Gefitinib gefitinib in 25 patients with lung squamous cell carcinoma were collected.The clinical symptoms,imaging and drug toxicity of 11 patients with advanced stage of refractory squamous cell carcinoma of lung were collected and the treatment direction of these patients was discussed.Results1.The mutation rate of EGFR was 11.6%(30/257)in patients with lung squamous cell carcinoma.The mutation rate of EGFR was mainly in exon 19 deletion mutation(19de1)and exon 21(2573)nucleotide point mutation(L858R),which accounted for 43.3%(13/30)and 36.7%(11/30)of the total mutation respectively.2.The mutation rate was 19.0%(4/22)in female patients and 11.1%(26/235)in male patients,and 10.8%(22/204)in smoking patients had gene mutation,which was lower than 15.1%(8/53)in non-smoking patients,but there was no statistical difference between them.(P>0.05).3.By analyzing the imaging features of lung squamous cell carcinoma.,we can see that there is no significant difference between EGFR mutation sensitive type and wild type in its lobular sign,hairpin sign,tumor lung interface,solid component in tumor body,vacuole sign,bronchus inflation sign,pleura depression sign and blood vessel cluster sign.4.By the end of the follow-up date(December 31,2019),25 patients with advanced squamous cell carcinoma treated with gefitinib were followed up with complete follow-up data,including 0 CR patients,14 PR patients(56.0%),7 SD patients(28.0%),and 4 PD patients(16.0%).RR was 56.0%and DCR was 86.0%.The median PFS was 7.3(95%CI:5-10)months.The 2-year survival rate was 20%,and the median OS was 12.7 months.Most of the adverse reactions in this study were grade Ⅰ and Ⅱ,and most of them were rash,diarrhea,dry skin and pruritus.5.By the end of the follow-up date(December 31,2019),11 patients with advanced squamous cell carcinoma were followed up.The follow-up data were complete:Cr 0,PR 7(63.6%),SD 2(18.1%),PD 2(18.1%).RR was 63.6%and DCR was 81.7%.The median PFS was 3.3(95%CI:2.7-5.5)months.The adverse reactions in this study were mostly grade Ⅰ and Ⅱ,and hypertension,hand and foot skin reactions and bleeding were common.Conclusions1.CT-GPLB can meet the needs of gene sequencing.The mutation rate of EGFR gene in patients with lung squamous cell carcinoma is 11.6%,of which 19 deletions(19del)and 21 exons(L858R)are the main ones.2.There were no significant differences in sex,age,TNM stage and CT signs between EGFR mutation sensitive and wild type groups.3.Gefitinib has certain benefits for patients with EGFR sensitive mutation.It is suggested that EGFR gene detection should be performed routinely for patients with lung squamous cell carcinoma.For patients with wild-type EGFR gene mutation,failure of multi-line chemotherapy and patients with advanced refractory lung squamous cell carcinoma after Gefitinib resistance,enrotinib hydrochloride is a good choice. |
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