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Sputumscreening auf Lungenkrebs ehemals asbestexponierter Arbeitnehmer

Korrelation von Sputumzytometrie und Zytologie mit der Enddiagnose

Sputum screening for lung cancer following earlier occupational exposure to asbestos

Comparison of sputum cytometry and cytology with diagnosis of cancer

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die Korrelation zwischen semiautomatisierter Sputumzytometrie (ASC), konventioneller Zytologie (CY) und Lungenkrebs wurde an 640 ehemals asbestexponierten Arbeitnehmern als Vorbereitung für ein Lungenkrebsscreeningprogramm untersucht (867 Untersuchungen). Nach konventioneller Röntgenuntersuchung des Thorax in 2 Ebenen wurde Sputum gesammelt. Es wurden jeweils 2 Objektträger für die ASC (saure Hydrolyse, Thionin) und die CY (Papanicolaou) gefärbt. ASC-suspekte Proben wurden mittels CY überprüft. 791 Proben waren ASC-benigne, 7 inadäquat und 69 (7,8%) ASC-suspekt. Davon wurden 4 durch CY als tumorverdächtig klassifiziert, 16 als CIS/schwere Dysplasie. 14 Proben zeigten mittelgradige/leichte dysplastische Veränderungen, 34 waren normal, inflammatorisch oder wiesen Plattenepithelmetaplasien auf, 1 war inadäquat. In einer Untergruppe von 143 Patienten mit „tumorsuspekten“ anamnestischen Angaben bei ASC-unauffälligen Proben ergab eine CY-Überprüfung 1 schwere und 13 leichte oder mittelgradige Dysplasien, 124 normale oder inflammatorische Befunde und 4 inadäquate Proben. Vorläufig konnten 7 Patienten mit Lungenkrebs identifiziert werden (Prävalenz 0,81%), 4 Plattenepithelkarzinome (CY: „high grade lesions“), 3 Pleuramesotheliome, 6 Proben waren ASC-positiv. Bei 1 Pleuramesotheliompatienten war das Sputum schwergradig dysplastisch verändert. Der Einsatz von ASC und CY sollte in einer kontrollierten prospektiven randomisierten Studie mit gemeinsam radiologischen und molekularbiologischen Verfahren überprüft werden.

Abstract

In this case-finding study the results of automated sputum cytometry (ASC) and conventional cytology (CY) were examined to see whether a correlation of either with lung cancer could be found in subjects whose work had earlier involved asbestos exposure. Following a conventional chest X-ray in two planes, sputum was collected. From each specimen, two slides were prepared for ASC (acid hydrolysis, thionin) and two were stained for CY (Papnicolaou). Specimens in which the results of ASC were suggestive were studied by CY in addition. After ASC, 69 out of 867 sputum specimens were suspicious. CY gave rise to suspicions of tumour disease in 4 of the specimens in this subgroup, and of CIS/severe dysplasia in 16. Another 14 showed signs of moderate or mild dysplasia, 34 were normal or inflammatory, with or without cellular metaplasia, and only 1 was inadequate. In a subgroup of 143 patients who had observations suggestive of tumour disease in their history while ASC showed no signs of malignant disease an additional CY revealed 1 case of severe and 13 of mild or moderate dysplasia, and 124 with normal or inflammatory findings; only 4 of these specimens were inadequate. So far, 7 patients with lung cancer have been identified (prevalence 0.81%): 4 with squamous epithelial cancers (CY; high-grade lesions) and 3 with mesotheliomas. Six were positive on ASC. In 1 patient with pleural mesothelioma the sputum was severely dysplastic. The diagnostic power of ASC and CY in detection of lung cancer should be tested in a controlled prospective randomized study with radiological and molecular biological methods.

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Marek, W., Nensa, F., Richartz, G. et al. Sputumscreening auf Lungenkrebs ehemals asbestexponierter Arbeitnehmer. Trauma Berufskrankh 8, 96–102 (2006). https://doi.org/10.1007/s10039-006-1129-8

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