纤维支气管镜刷检液基薄片细胞学联合免疫细胞化学在肺癌病理分型诊断中的临床价值  

Clinical study of brush liquid-based cytology combined with automatic immunohistochemistry in the classification and diagnosis of lung cancer

作　　者：赵琳琳 孙悦 王聪 曹箭 郭会芹 赵焕 张智慧 Zhao Linlin;Sun Yue;Wang Cong;Cao Jian;Guo Huiqin;Zhao Huan;Zhang Zhihui(Cytopathology Section,Department of Pathology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院病理科,100021

出　　处：《中华肿瘤杂志》2019年第5期326-330,共5页Chinese Journal of Oncology

基　　金：中国医学科学院医学与健康科技创新工程(2017-12M-1-006);国家重点研发计划(2016YFC1302100).

摘　　要：目的探讨纤维支气管镜刷检液基薄片细胞学联合免疫细胞化学(ICC)检测进行肺癌病理分型的可行性。方法将171例肺部病变患者的纤维支气管镜刷检标本制成液基薄片,在细胞形态学诊断的同时使用全自动免疫组化仪进行ICC检测,其结果与组织病理学诊断结果进行比较。结果 171例患者中,单独细胞形态学诊断可分型130例(76.0%),其中诊断鳞癌31例,腺癌44例,小细胞癌55例;细胞形态学联合ICC诊断可分型162例(94.7%),其中诊断鳞癌38例,腺癌61例,小细胞癌63例,差异有统计学意义(P<0.001)。以组织病理学诊断结果为金标准,细胞形态学联合ICC的诊断分型符合率高于单独细胞形态学诊断分型的符合率,其中鳞癌由85.2%提高至97.1%(P=0.093),腺癌由92.5%提高至98.0%(P<0.001),小细胞癌由96.1%提高至98.3%(P=0.465)。结论液基薄片细胞学与全自动免疫组化仪检测相结合,能够有效提高纤维支气管镜刷检标本诊断病理分型的准确性,为临床治疗提供更加客观的诊断结果。Objective To explore the feasibility of bronchoscopic brushing liquid-based slide cytology combined with automatic immunocytochemistry (ICC) for pathological typing of lung cancer. Methods A liquid-based thin-prep was prepared from 171 bronchoscopic brushing specimens of patients with pulmonary lesions. ICC was detected by automatic immunohistochemistry instrument while cytomorphological diagnosis was made. The results were compared with those of histopathological diagnosis. Results Among 171 patients, 130 (76.0%) could be classified by cell morphology alone, including 31 squamous cell carcinomas, 44 adenocarcinomas and 55 small cell carcinomas;162 (94.7%) could be classified by cell morphology combined with ICC, including 38 squamous cell carcinomas, 61 adenocarcinomas and 63 small cell carcinomas (P<0.001). According to the gold standard of histopathological diagnosis, the coincidence rate of cytomorphology combined with ICC was higher than that of cell morphology alone. The coincidence rate of squamous cell carcinoma was increased from 85.2% to 97.1%(P=0.093), adenocarcinoma from 92.5% to 98.0%(P<0.001), and small cell carcinoma from 96.1% to 98.3%(P=0.465). Conclusion The combination of liquid-based thin-prep cytology and automatic immunohistochemistry can effectively improve the accuracy of pathological typing of brushing specimens under fiberoptic bronchoscopy, and provide more objective diagnostic results for clinical treatment.

关 键 词：肺肿瘤 纤维支气管镜 液基细胞学 免疫细胞化学 病理分型 

分 类 号：R734.2[医药卫生—肿瘤]