纤维支气管镜下刷取标本液基细胞学检查在肺癌临床诊断中的价值  

Value of liquid-based cytology of brushing specimens obtained via fiberoptic bronchoscopy for the diagnosis of lung cancer

作　　者：赵焕[1] 郭会芹[1] 张传欣[2] 赵琳琳[1] 曹箭[1] 潘秦镜[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院病理科细胞学室,100021 [2]福建省三明市第二医院病理科

出　　处：《中华肿瘤杂志》2015年第6期431-435,共5页Chinese Journal of Oncology

摘　　要：目的：探讨纤维支气管镜（ FOB）下刷取标本液基细胞学检查对临床诊断肺癌的价值。方法回顾性分析2011年1月至2012年5月中国医学科学院肿瘤医院收治的FOB下刷取标本液基细胞学病例资料，评价其在肺癌诊断中的意义。结果共收集4380例，其中3763例有组织病理学及临床随访结果（肺癌3306例，良性病变457例）。刷取标本液基细胞学诊断肺癌的敏感性、特异性和准确性分别为72．4％（2392／3306）、99．3％（454／457）和75．6％（2846／3763）。在液基细胞学诊断为癌的1992例病例中，528例（26．5％）未取到活检，113例（5．7％）活检阴性。液基细胞学对非小细胞癌和小细胞癌分型诊断的准确性为99．0％（1487／1502，P＜0．001）。以术后组织病理为金标准，液基细胞学对鳞癌、腺癌和小细胞癌的分型准确性分别为95．6％（351／367）、95．6％（351／367）和100％（367／367，P＜0．001），钳取活检组织病理的分型准确性分别为97．0％（293／302）、97．4％（294／302）和99．7％（301／302），二者分型准确性的差异均无统计学意义（均P＞0．05）。结论 FOB下刷取标本液基细胞学能明显提高肺癌的检出率，并且有较高的特异性和分型准确性，是肺癌诊断和分型诊断的有效工具。Objective To investigate the value of the liquid-based cytology （ LBC ） of brushing specimens obtained via fiberoptic bronchoscopy for clinical diagnosis of lung cancer. Methods We retrospectively analyzed the LBC cases in our hospital from January 2011 to May 2012, and evaluate its role in the diagnosis of lung cancer. Results The clinical data of a total of 4 380 cases were reviewed and 3 763 of them had histopathological or clinical follow-up results （ including 3 306 lung cancer cases and 457 benign lesion cases） . The sensitivity, specificity, and accuracy of LBC diagnosis for lung cancer were 72. 4%（2 392/3 306）, 99.3%（454/457） and 75.6%（2 846/3 763）, respectively. Of the 1 992 lung cancer cases diagnosed by brushing LBC, 528 cases（26.5%） were failed to take forceps biopsy and 113 cases（5.7%） showed negative forceps biopsy results. The accurate rate of subtyping of LBC for non-small cell carcinoma and small cell carcinoma was 99.0% （1 487/1 502） （P〈0.001）.Take the resection histopathology as gold standard, the accurate rates of subtyping squamous cell carcinoma, adenocarcinoma and small cell carcinoma by LBC were 95.6%（351/367）, 95.6%（351/367） and 100%（367/367）, respectively, （P〈0.001）. The accurate rates of subtyping of squamous cell carcinoma, adenocarcinoma and small cell carcinoma by forceps biopsy were 97.0%（293/302）,97.4% （294/302） and 99.7% （301/302）, respectively, （Kappa=0.895, P〈0.001） . There was no significant difference in subtyping respectively between forceps biopsy and brushing LBC（P〉0.05）. Conclusions Fiberoptic bronchoscopic brushing liquid-based cytology can significantly improve the detection rate of lung cancer, and have a high specificity and accurate rate of subtyping. It is an effective tool for the diagnosis and subtyping of lung cancer.

关 键 词：肺肿瘤 诊断 液基细胞学 刷取细胞学 纤维支气管镜 

分 类 号：R734.2[医药卫生—肿瘤]