液基细胞学检测结合经支气管针吸活检在肺癌纵隔淋巴结转移诊断中的临床应用  

Application of liquid-based cytologic test and transbronchiai needle aspiration in diagnosis of mediastinal lymph node metastasis in lung cancer

作　　者：陈凯[1] 张春峰[1] 王宝锋[1] 吴正霞[1] 张和平[1] 蔡宇星 杨拴盈[2] 

机构地区：[1]宝鸡市中心医院呼吸内科,721008 [2]西安交通大学第二附属医院呼吸内科,710004

出　　处：《国际呼吸杂志》2015年第6期417-422,共6页International Journal of Respiration

摘　　要：目的探讨液基细胞学检测（LCT）结合经支气管针吸活检（TBNA）对肺癌纵隔淋巴结转移诊断的应用价值。方法回顾性分析2011年6月至2014年2月间在宝鸡市中心医院呼吸内科138例行常规电子支气管镜检查经组织学确诊的肺癌病例，均行TBNA纵隔淋巴结分期，穿刺物分别行常规细胞学涂片（CS）法与LCT法处理，ⅢA期以内的非小细胞肺癌患者行肺癌根治切除术及淋巴结清扫术，总结穿刺结果，评价LCT法检测结合TBNA的诊断价值和安全性。结果138例患者经TBNA检查8个部位共352组淋巴结，TBNA穿刺成功704针（95．65％，704／736）。LCT法阳性的329组（93．47％），CS法阳性的243组（69．03％），差异有统计学意义（χ^2=68．96，P〈0．01）。48例手术的ⅢA期以内的非小细胞肺癌患者术前行TBNA检查7个部位共118组淋巴结，以术后淋巴结病理结果为参考，LCT法与CS法的敏感性、特异性、准确性、阳性预测值和阴性预测值分别是87．96％、100．00％、88．98%、100．00％、43．48%和53．70％、100．00％、49．15％、100．00%、16．67％。LCT法在肺癌纵隔淋巴结分期的敏感性、阴性预测值、准确性等方面均明显高于CS法（χ^2值分别为33．52、20．17、43．81，P值均〈O．01）。结论LCT联合TBNA能提高肺癌纵隔淋巴结转移诊断的阳性率、敏感性、准确性，且安全易行，值得临床推广应用。Objective To investigate the clinical value of liquid-based cytologic test （LCT） and transbronchial needle aspiration （TBNA） in the diagnosis of mediastinal lymph node metastasis in lung cancer. Methods The clinical data of 138 patients with lung cancer diagnosed by conventional electronic bronchoscopy from June 2011 to February 2014 in our hospital were retrospectively analyzed. Mediastinal staging by TBNA were performed. TBNA specimens were prepared by conventional smears （CS） and LCT smears respectively. The patients who were diagnosed as non-small cell lung cancer within IlIA period subsequently underwent pulmonary resection with mediastinal lymph node dissection, The diagnostic sensitivity, accuracy, specificity, positive predictive value, and negative predictive value were evaluated. Results 352 lymph nodes in 138 patients were punctured. TBNA procedures were successfully carried out in 704/736（95.65 % ）. The positive rate of TBNA specimens by LCT was 93.47 % （329/352）, while the positive rate of TBNA specimens by CS was 69.03 % （243/352） ,the difference was statistically significant （ χ^2= 68.96, P 〈0.01）. 118 lymph nodes in 48 patients who were diagnosed as non-small cell lung cancer within nl A period were punctured. Overall diagnostic sensitivity, specificity,accuracy,positive predictive value, and negative predictive value of cytopathology for mediastinal staging in TBNA specimens by LCT were 87.96%, 100.00%, 88. 980%, 100.00%, and 43.48%, while those by CS were 53. 70%,100. 00%, 49.15%, 100.00%, and 16.67%. The sensitivity, negative predictive value and accuracy of LCT were higher than those of CS, the difference was statistically significant （ χ^2 = 33.52, 20.17,43.81, respectively, all P 〈0.01 ）. Conclusions The combined method of LCT and TBNA can improve the positive rate, sensitivity, and accuracy in the diagnosis of mediastinal lymph node metastasis in lung cancer. It is worth to clinical application for its safety and effectivity.

关 键 词：经支气管针吸活检 纵隔淋巴结转移 液基细胞学检测 肺肿瘤 

分 类 号：R734.2[医药卫生—肿瘤]