现场快速评估在纤维支气管镜活检中的应用研究  

Application research of rapid on-site evaluation in transbronchial lung biopsy

作　　者：黄秋博 Giuseppe Marciano 胡早秀[2] 谭慧[1] 晋萍 张磊[1] 黄云超[1] 赵光强[1] HUANG Qiu-bo;HU Zao-xiu(The First Department of Thoracic Surgery,The Third Affliated hospital of Kunming Medical University&Yunnan Cancer Hospital,Yunnan Province,The laboratory of Yunnan Lung Cancer research Kunming 650118,China;De-partment of Pathology,Yunnan Cancer Hospital,Third Affliated hospital of Kunming Medical University&Yunnan Province,Kunming 650118,China;Lung disease diagnosis and treatment cencer of Siena university in Italy,Siena Italy)

机构地区：[1]昆明医科大学第三附属医院云南省肿瘤医院胸外一科,高原区域性高发肿瘤国际合作联合实验室,云南省肺癌研究重点实验室 [2]昆明医科大学第三附属医院云南省肿瘤医院病理科 [3]意大利锡耶纳大学医院肺部疾病诊疗中心,锡耶纳意大利 [4]昆明医科大学第三附属医院云南省肿瘤医院,云南昆明650118

出　　处：《云南医药》2018年第2期97-100,共4页Medicine and Pharmacy of Yunnan

基　　金：国家自然科学基金重点项目(U1202224)

摘　　要：目的探讨纤维支气管镜活检结合细胞学现场快速评估(ROSE)对肺部中央型肿块诊治的临床价值。方法选取2016年6月-2017年12月昆明医科大学第三附属医院云南省肿瘤医院胸外一科收治的110例胸部CT或PET-CT检查提示中央型肺部肿块的患者分为2组,行纤维支气管镜活检,其中现场细胞学组58例,常规细胞学组52例。术后对2组患者所取的组织或体液均行常规细胞学及组织学病检,必要时行免疫组化协助诊断。将确诊为肺恶性肿瘤病例,行术后基因检测。结果现场细胞学组与非现场细胞学组的确诊率分别为82.76%、82.70%,一致性kappa大于0.8,现场细胞学与常规细胞学诊断符合率高度一致;首次活检时间分别为(18.92±1.63)min、(11.48±0.886)min,差异有统计学意义(P<0.001)。二次检查率分别为3.44%,17.30%(P<0.05),差异有统计学意义。活检出血发生率分别为2.13%、4.85%,差异无统计学意义(P>0.05)。现场细胞学组肺恶性肿瘤标本行术后基因检测EGFR基因突变8例,ALK基因突变1例。常规细胞学组因组织有限,仅有1例肺恶性肿瘤标本行基因检测,未发现基因突变。结论纤维支气管镜活检结合快速现场评估(ROSE)在肺部中央型肿块诊疗中,缩短了诊治时间,是有效且可靠的技术;针对术中ROSE技术提示病变组织部位,可获取更多组织用于术后免疫组化及基因检测,值得临床推广应用。Objective To investigate the clinical value of transbronchial lung biopsy combined with rapid on-site evaluation(ROSE)for enlarged Lung cancer diagnosis.Methods 110 patients with central Lung tumor by chest CT or PET-CT revealed who treated in The First Department of Thoracic Surgery of Third Affliated hospital of Kunming Medical University&Yunnan Cancer Hospital during June in 2016 to December in 2017.They were randomly divided into the two groups,and both of them were given transbronchial lung biopsy.There were 58 cases in on-site cytology group,while there were 52 cases in routine cytology group.The tissue or bodily fluids from both groups were tested for regular cytology,histology,Immunohistochemistry and Genetic testing after operation.Results The diagnose rate in on-site cytology group and routine cytology group was 82.76%and 82.70%,Consistent kappa was greater than 0.8,so the on-site cytology was highly consistent with conventional cytological diagnosis.respectively,the time of inspection was(18.92±1.63)and(11.48±0.886)min,respectively,the secondary inspection rate was 3.44%and 17.30%,and there was statistical difference of above-mentioned data between the two groups(P<0.05).The incidence rate of inspection bleeding was 2.13%,4.85%,and there was no statistical difference of above-mentioned data between the two groups(P>0.05).The sample of Lung cancer in on-site cytology group were did genetic test,there were 8 cases of EGFR gene mutation and 1 case of ALK gene mutation.In routine cytology group,there was only one sample did genetic test,but no mutation was found.Conclusion transbronchial lung biopsy combined with ROSE in the diagnosis of enlarged Lung cancer is effectively and reliable.Fiberoptic bronchoscope combine with ROSE can reduce the incidence rate of complication such as inspect bleeding and secondary inspection rate,its safety is higher and better than only fiberoptic bronchoscope.

关 键 词：纤维支气管镜活检 快速现场评估(ROSE) 中央型肺部肿块 肺癌 免疫组化 基因检测 

分 类 号：R734.2[医药卫生—肿瘤]