液基细胞学检测在早期非小细胞肺癌诊断中的临床价值  

Clinical value of liquid based cytology in the diagnosis of early non-small cell lung cancer

作　　者：薛立芝 谭焕腾 张思泉 Xue Lizhi;Tan Huanteng;Zhang Siquan(Department of Clinical Laboratory,Xixi Hospital of Hangzhou,Hangzhou,Zhejiang 310023,China;Department of Clinical Laboratory,Tongde Hospital of Zhejiang Province,Hangzhou,Zhejiang 310012,China;Intensive Care Unit,Xixi Hospital of Hangzhou,Hangzhou,Zhejiang 310023,China)

机构地区：[1]杭州市西溪医院检验科,310023 [2]浙江省立同德医院检验科,杭州310012 [3]杭州市西溪医院重症医学科,310023

出　　处：《中国基层医药》2020年第18期2220-2223,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨液基细胞学检查在早期非小细胞肺癌诊断中的临床价值。方法选取杭州市西溪医院和浙江省立同德医院2018年10月至2019年10月收治的经组织病理学确诊的早期非小细胞肺癌患者120例,均行纤维支气管镜检查。标本均行液基细胞蜡块制作及苏木精-伊红(HE)染色,组织学标本由2名及以上经验丰富的组织病理学医生阅片后给出病理报告;细胞学样本首先由初级细胞学诊断医生阅片进行初筛,再由副主任医师或主任医师阅片,结合临床症状给予细胞学病理报告。结果液基细胞学HE染色鳞癌多大小形状不等,单个散在,可呈多边形、圆形,染色质均匀分布,核仁不明显;液基细胞学HE染色腺癌常聚集成实性团,胞质丰富,细胞大小规律,细胞核多呈圆形,染色质较细,并且核仁较明显;液基细胞学HE染色小细胞癌多松散聚集成堆,胞质稀少如裸核状,核深染,部分带棱角或呈短梭形。液基细胞学制片对非小细胞肺癌诊断灵敏度和特异度均高于传统涂片(χ2=4.874、4.512,均P<0.05)。液基细胞学制片鳞癌阳性率(72.88%)和腺癌阳性率(85.29%)高于传统制片(54.24%和61.76%),差异有统计学意义(χ2=4.427、6.031,P<0.05);而两组小细胞癌阳性率差异无统计学意义(χ2=1.333,P>0.05)。液基细胞学制片Ⅰa期阳性率(86.48%)高于传统制片(64.86%),差异有统计学意义(χ2=4.698,P<0.05);而两组Ⅰb期阳性率和Ⅱa期阳性率差异均无统计学意义(均P>0.05)。结论液基细胞学检查在早期非小细胞肺癌诊断中具有重要价值,可提高诊断灵敏度和特异度。Objective To investigate the clinical value of liquid based cytology in the diagnosis of early non-small cell lung cancer(NSCLC).Methods From October 2018 to October 2019,120 patients with early NSCLC who were confirmed diagnossis by histopathology were selected from Xixi Hospital of Hangzhou and Tongde Hospital of Zhejiang Province.All patients underwent fiberbronchoscopy.All the specimens were performed liquid-based cell wax block and HE staining.Two or more experienced histopathological doctors read the histological samples and then gave pathological reports.The cytological samples were first screened by the primary cytological diagnosis doctors,and then read by the deputy director or chief physician.The cytological pathological reports were given in combination with the clinical practice.Results HE staining in liquid-based cytology showed that squamous cell carcinoma had many different sizes and shapes,single scattered,polygonal and round,even distribution of chromatin,and no obvious nucleolus.HE staining of adenocarcinoma in liquid-based cytology often gathered solid mass,rich cytoplasm,regular cell size,round nucleus,fine chromatin,and obvious nucleolus.HE staining of small cell cancer in liquid-based cytology mostly scattered,the cytoplasm was rare as naked nucleus,the nucleus was deeply stained,some were angular or short shuttle shaped.The sensitivity and specificity of liquid based cytology in the diagnosis of NSCLC were higher than those of traditional smear(χ2=4.874,4.512,all P<0.05).The positive rates of squamous cell carcinoma(72.88%)and adenocarcinoma(85.29%)in liquid based cytology were significantly higher than those in traditional cytology(54.24%and 61.76%)(χ2=4.427,6.031,all P<0.05),but there was no statistically significant difference in positive rate of small cell cancer between the two groups(χ2=1.333,P>0.05).The positive rate of stageⅠa in liquid based cytology(86.48%)was higher than that in traditional cytology(64.86%),there was statistically significant difference(χ2=4.698,P<0.05),bu

关 键 词：癌 非小细胞肺 癌症早期检测 支气管镜检查 细胞学技术 敏感性与特异性 诊断 鉴别 

分 类 号：R734.2[医药卫生—肿瘤] R730.43[医药卫生—临床医学]