超声支气管镜引导下的经支气管针吸活检术在肺和纵隔占位性病变诊断中的应用  

Application Value of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Diagnosis of Space-occupying Lesions of Lung and Mediastinum

作　　者：姚璐 谭慧[3] 阮永华[1] 钱忠义[1] 杨志鸿[1] 阮锐[4] 张琦颖 周明婷 方星尹 YAO Lu;TAN Hui;RUAN Yong-hua;QIAN Zhong-yi;YANG Zhi-hong;RUAN Rui;ZHANG Qi-ying;ZHOU Ming-ting;FANG Xing-yin(Dept.of Pathology,Kunming Medical University,Kunming Yunnan 650500;Clinical Skills Center,Kunming Medical University,Kunming Yunnan 650500;First Department of Thoracic Surgery,The Third Affiliated Hospital of Kunming Medical University&Yunnan Cancer Hospital,Kunming Yunnan 650118;Dept.of Orthopedics,The First Affiliated Hospital,Kunming Medical University,Kunming Yunnan 650032;Grade 2015 Clinical Medicine Major,Kunming Medical University,Kunming Yunnan 650500,China)

机构地区：[1]昆明医科大学病理学系,云南昆明650500 [2]昆明医科大学临床技能中心,云南昆明650500 [3]昆明医科大学第三附属医院云南省肿瘤医院胸外一科,云南昆明650118 [4]昆明医科大学第一附属医院骨科,云南昆明650032 [5]昆明医科大学,云南昆明650500

出　　处：《昆明医科大学学报》2021年第3期41-48,共8页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目[2015FB021,2017FE468(-012)];昆明医科大学大学生创新基金(No.2018-26)。

摘　　要：目的探讨超声支气管镜引导下的经支气管针吸活检术(EBUS-TBNA)在肺和纵隔占位性病变诊断及肺癌分期中的应用价值。方法90例肺和纵隔占位病变施行超声支气管镜引导下的经支气管针吸活检术,穿刺的151份标本经石蜡包埋,HE染色,细胞病理学诊断,免疫细胞化学Ki67检测,对肺癌进行淋巴结分期,以组织病理学诊断结合临床共同诊断为标准,分析细胞学诊断的符合率及敏感性。结果EBUS-TBNA穿刺成功率100%(151/151),诊断率91.1%(82/90),肺和纵隔占位性病变在EBUS-TBNA术后诊断率显著提高(P<0.01)。90例中恶性肿瘤占72.22%(65/90),良性病变占18.89%(17/90),8.89%未明确诊断(8/90)。细胞学查见恶性细胞57例,诊断敏感度为87.69%,80%的肺癌获TNM分期(44/55)。肺结核及肉芽肿性炎Ki67阳性指数0~3%,肺恶性结节ki67阳性指数20%~80%,肺良性病变与恶性肿瘤Ki67表达差异有显著统计学意义(P<0.01)。结论EBUS-TBNA是一种安全、灵敏、准确的诊断方法,可显著提高肺和纵隔占位性病变的诊断成功率,对肺癌的分类、分期、治疗和预后判断均有重要的指导意义及临床应用价值,Ki67阳性指数是判断EBUS-TBNA穿刺细胞良恶性质的重要参考指标。Objective To investigate the value of transbronchial needle aspiration biopsy(EBUS-TBNA) guided by ultrasound bronchoscope in the diagnosis of lung and mediastinal space-occupying lesions and staging of lung cancer.Methods Ninety patients with space-occupying lesions of lung and mediastinum underwent transbronchial needle aspiration biopsy guided by ultrasound bronchoscope.151 specimens were embedded in paraffin,stained with HE,and diagnosed by cytopathology.Ki67 was detected by immunocytochemistry.Lymph node staging was performed for lung cancer.The coincidence rate and sensitivity of cytological diagnosis were analyzed according to the criteria of histopathological diagnosis combined with clinical diagnosis.Results The success rate of EBUS-TBNA puncture was 100%(151/151),and the success rate of diagnosis was 91.1%(82/90).The diagnostic rate of lung and mediastinal space-occupying lesions after EBUS-TBNA was significantly increased(P<0.01).Among 90 cases,malignant tumors accounted for 72.22%(65/90),benign lesions accounted for18.89%(17/90),and 8.89%had no definite diagnosis(8/90).57 cases of malignant cells were found by cytology.The sensitivity of cytopathological diagnosis was 87.69%.TNM staging was achieved in 80%of lung cancers(44/55).Ki67 positive index of pulmonary tuberculosis and granulomatous inflammation was 0-3%.The positive index of Ki67 in malignant pulmonary nodules ranged from 20%to 80%.There was significant difference in Ki67 expression between benign and malignant lung lesions(P<0.01).Conclusions EBUS-TBNA is a safe,sensitive and accurate diagnostic method,which can significantly improve the diagnostic success rate of lung and mediastinal space-occupying lesions.It has important guiding significance and clinical application value for the classification,staging,treatment and prognosis of lung cancer.Ki67 positive index is an important reference index for judging the benign and malignant of EBUS-TBNA puncture cells.

关 键 词：经支气管针吸活检 肺癌 肺结节 结节病 结核病 细胞学 KI-67 

分 类 号：R734.2[医药卫生—肿瘤] R734.5[医药卫生—临床医学]