EBUS-TBNA样本采用“涂片+液基+细胞块”细胞学检查的诊断效能分析  

Diagnostic efficiency of“smear+liquid-based+cell block”cytology examination methods in EBUS-TBNA samples

作　　者：虞红珍[1] 刘红艳[2] 秦蓉[1] 黄山[1] 吴继锋 YU Hong-zhen;LIU Hong-yan;QIN Rong;HUANG Shan;WU Ji-feng(Department of Pathology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Department of Respiratory Medicine,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院病理科,合肥230601 [2]安徽医科大学第二附属医院呼吸内科,合肥230601

出　　处：《临床与实验病理学杂志》2022年第6期696-701,共6页Chinese Journal of Clinical and Experimental Pathology

基　　金：安徽医科大学第二附属医院临床研究培育计划(2020LCYB14);安徽医科大学校科研基金(2021xkj174)。

摘　　要：目的评价经支气管内超声引导针吸活检(endo-bronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)病理样本采用“涂片+液基+细胞块”细胞学检查模式的诊断价值。方法收集2019年1月~2021年4月安徽医科大学第二附属医院病理科行EBUS-TBNA病理检查样本240例,其中分别送检涂片细胞学和组织病理检查21例,采用“涂片+液基+细胞块”细胞学检查219例,以细胞块结合免疫组化诊断及术后或其它活检组织病理为最终诊断。统计分析涂片细胞学、液基细胞学、细胞块诊断及组织病理诊断的标本满意率、阳性检出率/确定阳性诊断率、特异性及细胞块+免疫组化对肿瘤分型/来源诊断率;并对阴性病例进行随访和质控分析。结果240例样本中,最终诊断恶性肿瘤169例,肉芽肿性炎35例,其它良性病变36例。涂片细胞学的标本满意率、肿瘤阳性检出率/确定阳性诊断率、特异性分别为94.2%、76.9%/53.3%(提示肉芽肿5.7%)、100%,液基细胞学分别为99.5%、89.2%/66.2%(提示肉芽肿11.4%)、97.3%,细胞块诊断分别为98.2%、91.9%/81.1%(提示肉芽肿80%)、97.3%,组织病理诊断分别为38.1%、38.1%/4.8%、100%。细胞块+免疫组化的肿瘤分型/来源诊断率为99.2%(135/136)。结论EBUS-TBNA样本采用“涂片+液基+细胞块”细胞学检查可显著提高样本满意率、阳性检出率及确定阳性诊断率;细胞块结合免疫组化标记可辅助确诊肿瘤来源及类型,完全满足临床对病理的需求,值得推广。提高细胞学医师对少见肿瘤如淋巴瘤等形态学的认识及提高穿刺样本的质和量,将更进一步提高EBUS-TBNA的诊断效能。Purpose To evaluate the diagnostic value of“smear+liquid base+cell block”cytology for pathological samples of endo-bronchi ultrasound-guided transbronchial needle aspiration(EBUS-TBNA).Methods 240 cases of EBUS-TBNA were collected from January 2019 to April 2021 in the Department of Pathology,the Second Affiliated Hospital of Anhui Medical University,including 21 cases of smear cytology and histopathological examination respcetively,“smear+liquid base+Cell Block”cytology was used in 219 cases,and the final diagnosis was cell block combined with immunohistochemistry and post-operation or other biopsy histopathology.Statistical analysis of smear cytology,liquid-based cytology,cell block diagnosis and histopathologic diagnosis of the specimen satisfaction rate,positive detection rate/determine positive diagnosis rate,specificity and cell block+immunohistochemical diagnosis rate of tumor classification.The negative cases were followed up and quality control analysis was made.Results Among 240 cases of EBUS-TBNA,169 were malignant tumor,35 were granulomatous inflammation and 36 were other benign lesions.The specimen satisfaction rate,positive detection rate/determine positive diagnosis rate,specificity were 94.2%,76.9%,and 53.3%(granuloma 5.7%),100%of smear cytology.99.5%,89.2%,66.2%(granuloma 11.4%),97.4%of liquid-based cytology.98.2%,91.9%/81.1%(granuloma 80%),97.3%of cell block diagnosis.38.1%,38.1%/4.8%,100%of histopathologic diagnosis,respectively.The diagnostic rate of subtype of tumor/tissue origin in cell block+immunohistochemistry was 99.2%(135/136).Conclusion“Smear+liquid-based+cell block”cytology examination can significantly improve the rate of sample satisfaction,positive detection rate/determine positive diagnosis rate in EBUS-TBNA.Cell block combined with immunohistochemistry can help to diagnose the tissue origin and subtype of tumor.To improve the understanding of cytology of rare tumors such as lymphoma and to increase the quality and quantity of puncture samples will further improve the

关 键 词：肺肿瘤 肉芽肿 EBUS-TBNA “涂片+液基+细胞块” 阳性检出率 确定阳性诊断率 

分 类 号：R734.2[医药卫生—肿瘤]