快速现场评价技术在肺占位病变良恶性判断中的作用  

The role of rapid on-site evaluation in the diagnosis of lung space-occupying lesions

作　　者：李燕[1] 蔡后荣[1] 演欣 高玉娟[1] 柏涛[2] 郑金榆[2] 代静泓[1] LI Yan;CAI Hourong;YAN Xin;GAO Yujuan;BAI Tao;ZHENG Jinyu;DAI Jinghong(Department of Respiratory Medicine,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China;Department of Pathology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院呼吸与危重症医学科,江苏南京210008 [2]南京大学医学院附属鼓楼医院病理科,江苏南京210008

出　　处：《中国呼吸与危重监护杂志》2018年第5期484-487,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家自然科学基金青年基金(81501972);南京市医学科技发展课题(YKK15063);"十三五"南京市卫生青年人才培养工程第三层次人才(QRX17115)

摘　　要：目的评估快速现场评价(ROSE)技术对肺占位病变良恶性的判断价值,以及对支气管镜活检取材质量的影响。方法 2017年6月1日至2017年12月30日,在胸部CT表现为肺占位性病变的患者中行支气管镜下活检,并留取活检组织开展ROSE技术,由经过3个月细胞病理学培训的呼吸科专科医师进行ROSE判读,判读结果与后续的常规病理检查结果进行比对。回顾性分析同时期CT表现为肺占位行支气管镜活检、但未行ROSE的病例,比较两组病例常规病理报告提示取材质量的差别。结果共纳入101例患者行支气管镜下活检并行ROSE,呼吸科专科医师的判读结果与后续常规病理结果相比,恶性病变的一致率为84.1%,良性病变的一致率为93.8%,一致性检验提示两者具有较好的一致性(κ值为0.66,P<0.01)。开展ROSE的病例组与未行ROSE的病例组相比,最终常规病理报告显示取材满意的比例无显著性差异(98.0%比94.5%,P=0.14)。结论 ROSE技术应用在支气管镜活检中能够较好地判断肺占位病变的良恶性。经过短期细胞病理学培训的呼吸科专科医师有能力进行快速现场细胞学评价,从而避免了需要细胞病理医师现场参与诊断的困难。Objective To evaluate the role of rapid on-site evaluation （ROSE） in the diagnosis of lung spaceoccupying lesions. Methods From June 1, 2017 to December 30, 2017, transbronchial biopsies were performed in patients with lung space-occupying lesions on chest CT, and biopsies were taken for ROSE and subsequent routine pathological examination. ROSE interpretation was performed by a pulmonologist who had been trained in cytopathology for 3 months. The interpretation was correlated with the follow-up routine pathological examination. The contemporary cases with lung space-occupying lesions who underwent transbronchial biopsies without ROSE were retrospectively reviewed. The quality assessment of biopsy specimens recorded in pathological reports were compared between cases with and without ROSE. Results A total of 101 patients underwent transbronchial biopsies in parallel with ROSE. The interpretation results of the pulmonologist were compared with the follow-up routine pathology, which showed that the consistency rate of malignant lesions was 84.1% and the consistency rate of benign lesions was 93.8%. Consistency test showed good agreement between the ROSE conducted by the pulmonologist and the routine pathological examination by pathologists （κ=0.66, P〈0.01）. The quality assessment of biopsy specimens showed that there was no significant difference on rate of satisfied biopsy specimens between cases with and without ROSE （98.0% vs 94.5%, P=0. 14）. Conclusions The use of ROSE combining with bronchoscopy allows good preliminary assessment of lung space-occupying lesions.Pulmonologists trained in short-term formal cytopathology are fully capable of performing ROSE, thereby obviating the need for cytopathologists to participate in on-site evaluation.

关 键 词：快速现场评价技术 肺占位 支气管镜检查 呼吸科医师 

分 类 号：R734.2[医药卫生—肿瘤]