细胞病理学在经支气管镜超声引导针吸活检术中的作用  

Value of cytopathology in endobronchial ultrasound-guided transbronchial needle aspiration

作　　者：陈颖[1] 平波[1] 王龙富[1] 冯丽青[1] 徐维萍[1] 吴佳文[1] 杨文韬[1] 周晓燕[1] 蔡旭[1] 胡鸿[2] 陈海泉[2] 沈磊[1] 

机构地区：[1]复旦大学附属肿瘤医院病理科复旦大学上海医学院肿瘤学系,200032 [2]复旦大学附属肿瘤医院病理科复旦大学上海医学院胸外科,200032

出　　处：《中华病理学杂志》2012年第1期44-47,共4页Chinese Journal of Pathology

摘　　要：目的探讨细胞病理学检查在经支气管镜超声引导针吸活检术（EBUS—TBNA）诊断中的作用及用于表皮生长因子受体（EGFR）基因突变分析的可行性。方法回顾性分析复旦大学附属肿瘤医院2009年4月至2010年9月行EBUS—TBNA的连续病例200例，可取得细胞块的部分标本进行免疫组织化学染色（EnVision法），22例阳性病例还用细胞学标本进行EGFR基因突变分析。结果200例中140例有组织学对照。细胞学诊断标本不充足24例（12．0％，24／200）。良性病变42例（23．9％，42／176），可疑12例（6．8％，12／176），恶性肿瘤122例（69．3％，122／176）。与组织学及临床共同诊断对照，细胞学的敏感度94．4％，特异度100％。细胞块及免疫酶标对准确分型及胸腔外转移性肿瘤的诊断有帮助。细胞学标本检测EGFR突变率36．4％（8／22）。结论EBUS-TBNA细胞学是一种诊断肺癌及其纵隔淋巴结转移的准确、敏感和特异的方法。EBUS-TBNA细胞学标本是进行分子病理学检测的重要材料。Objective To evaluate the role of cytopathology in endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） for lung tumor diagnosis and staging. Methods Twohundred consecutive cases of lung tumor with EBUS-TBNA performed during the period from April, 2009 to September, 2010 in Shanghai Cancer Hospital were retrospectively reviewed. The cytologic diagnoses were categorized as non-diagnostic, negative, suspicious and malignant. When available, cell block preparation and immunohistochemistry were performed. On the 22 positive cases diagnosed hy on-site evaluation, epidermal growth factor receptor （EGFR） mutation study was carried out. Results In the 200 cases of cytology specimens, 122 cases （69. 3% ） were diagnosed as malignant, 42 cases （23.9%） as benign and 12 cases （6. 8% ） as suspicious for malignancy. The non-diagnostic rate was 12.0% （24/200）. Amongst the 200 cases studied, 140 cases （70.0%） had histologic correlation available （via core biopsy, mediastinoscopic biopsy or surgical excision）. The sensitivity and specificity of EBUS-TBNA cytologic diagnoses were 94. 4% and 100%, when using histopathologic findings and clinical follow-up data as gold standard. The cell block preparation and immunohistochemistry were useful in subtyping and diagnosis of extrathoracic malignancy. EGFR mutations were detected in 8 cytology samples （36. 4% ）. Conclusions EBUS-TBNA is a sensitive and specific tool for diagnosis and staging of lung cancer. The cytology samples can be used for further ancillary investigations including cell block preparation, immunohistochemistry and molecular studies.

关 键 词：肺肿瘤 纵隔肿瘤 基因 erbB-1 突变 细胞学技术 

分 类 号：R734.2[医药卫生—肿瘤]