应用EBUS-TBNA细胞块检查对肺癌的诊断价值及临床意义
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摘要
目的:探讨经支气管针吸活检(EBUS-TBNA)细胞块检测对于诊断肺癌的临床价值和意义。方法:回顾性分析2012年1月至2015年5月在我院行EBUS-TBNA检查的173例患者,收集标本,并应用液基细胞学(TCT)及细胞蜡块免疫组化法进行检测,分析在单独应用和联合应用时的敏感性、特异性以及准确性。结果:TCT检测结果阳性率是71.1%(123/173),细胞蜡块检测阳性率是87.28%(151/173),差异有统计学意义(P<0.05);而TCT联合细胞蜡块检测诊断的阳性率则是99.42%(172/173),高于单用细胞蜡块检测阳性率,差异有统计学意义(P<0.05);173例患者最终有172例经病理学确诊为肺癌,TCT敏感性为71.5%、准确性为71.1%,显著低于细胞蜡块免疫组化检测的敏感性87.79%、准确性87.28%,联合诊断敏感性、准确性均为100.0%。结论:通过对EBUS-TBNA取得的细胞块进行蜡块和细胞学的检测,可以有效提高对肺癌的诊断,为肺癌患者及早诊断、治疗赢得了时机。
Objective: To discuss the clinical value and significance of detection of EBUS-TBNA cells( EBUSTBNA) in the diagnosis of lung cancer. Methods: 173 cases of patients with EBUS-TBNA in our hospital from January 2012 to May 2015 were given retrospective analysis,specimen was collected,liquid basis cytology( TCT)and cell paraffin block immunohistochemical method were used to detect,the sensitivity,specificity and accuracy were analyzed when they were separate application and combined application. Results: The positive rate of TCT detection was 71. 1%( 123 /173),and the positive rate of cell wax detection was 87. 28%( 151 /173),the difference was significant( P < 0. 05),while the combined diagnosis positive rate was 99. 42%( 172 /173),with significant differences( P < 0. 05). 172 cases of patients were eventually diagnosed as lung cancer by pathological diagnosis among 173 cases of patients,the sensitivity of TCT was 71. 5%,the accuracy was 71. 5%,they were significantly lower than that of the cell wax block( 87. 79% and 87. 28%). Sensitivity,accuracy of combined diagnosis were both 100. 0%. Conclusion: The cells taken by EBUS-TBNA are given the detection of paraffin block and cytology,it can effectively improve the diagnosis of lung cancer,and win the opportunity for the early diagnosis and treatment of patients with lung cancer.
Objective: To discuss the clinical value and significance of detection of EBUS-TBNA cells( EBUSTBNA) in the diagnosis of lung cancer. Methods: 173 cases of patients with EBUS-TBNA in our hospital from January 2012 to May 2015 were given retrospective analysis,specimen was collected,liquid basis cytology( TCT)and cell paraffin block immunohistochemical method were used to detect,the sensitivity,specificity and accuracy were analyzed when they were separate application and combined application. Results: The positive rate of TCT detection was 71. 1%( 123 /173),and the positive rate of cell wax detection was 87. 28%( 151 /173),the difference was significant( P < 0. 05),while the combined diagnosis positive rate was 99. 42%( 172 /173),with significant differences( P < 0. 05). 172 cases of patients were eventually diagnosed as lung cancer by pathological diagnosis among 173 cases of patients,the sensitivity of TCT was 71. 5%,the accuracy was 71. 5%,they were significantly lower than that of the cell wax block( 87. 79% and 87. 28%). Sensitivity,accuracy of combined diagnosis were both 100. 0%. Conclusion: The cells taken by EBUS-TBNA are given the detection of paraffin block and cytology,it can effectively improve the diagnosis of lung cancer,and win the opportunity for the early diagnosis and treatment of patients with lung cancer.
引文
[1]韩非,张俭,孙加源,等.EBUS-TBNA细胞学检查对肺癌及结节病的诊断价值[J].上海交通大学学报:医学版,2011,31(12):1737-1740.
[2]冯晓云,葛琴,陆志斌.非小细胞肺癌患者血清miR-133b的表达水平及其临床意义探讨[J].东南大学学报:医学版,2015,34(6):934-937.
[3]康欢,胡蔚,康艳红,等.多种肿瘤标志物联合检测在肺癌诊断中的实用价值[J].现代医学,2012,40(6):706-708.
[4]肖奎,蒋洁菡,夏淑兰.超声支气管镜引导下的经支气管针吸活检对老年人肺癌的诊断价值[J].中华老年医学杂志,2014,33(9):958-960.
[5]康德勇,吴雪晶,冯昌银,等.EBUS-TBNA组织学与细胞学检查在肺门和纵隔占位病变诊断中的价值[J].临床与实验病理学杂志,2013,29(12):1353-1355.
[6]杨会珍,滕家俊,钟润波,等.气管内超声引导下经支气管针吸活检对肺内病变的诊断价值[J].中华结核和呼吸杂志,2013,36(1):17-21.
[7]陈克终,杨帆,赵辉,等.支气管内超声引导纵隔淋巴结穿刺活检术检测非小细胞肺癌表皮生长因子突变[J].中华实验外科杂志,2012,29(8):1469-1471.
[8]张嵩,马卫霞,姜淑娟,等.多种技术联合应用对肺癌诊断的临床价值[J].临床肺科杂志,2011,16(4):574-576.
[9]孙加源,韩宝惠,赵珩,等.超声支气管镜引导下经支气管针吸活检70例临床分析[J].中华结核和呼吸杂志,2010,33(10):738-741.
[10]刘尽国,张杰,张俭,等.液基薄层细胞学与免疫细胞化学联合在肺癌分型及鉴别诊断中的应用[J].临床与实验病理学杂志,2013,29(8):871-875.
[2]冯晓云,葛琴,陆志斌.非小细胞肺癌患者血清miR-133b的表达水平及其临床意义探讨[J].东南大学学报:医学版,2015,34(6):934-937.
[3]康欢,胡蔚,康艳红,等.多种肿瘤标志物联合检测在肺癌诊断中的实用价值[J].现代医学,2012,40(6):706-708.
[4]肖奎,蒋洁菡,夏淑兰.超声支气管镜引导下的经支气管针吸活检对老年人肺癌的诊断价值[J].中华老年医学杂志,2014,33(9):958-960.
[5]康德勇,吴雪晶,冯昌银,等.EBUS-TBNA组织学与细胞学检查在肺门和纵隔占位病变诊断中的价值[J].临床与实验病理学杂志,2013,29(12):1353-1355.
[6]杨会珍,滕家俊,钟润波,等.气管内超声引导下经支气管针吸活检对肺内病变的诊断价值[J].中华结核和呼吸杂志,2013,36(1):17-21.
[7]陈克终,杨帆,赵辉,等.支气管内超声引导纵隔淋巴结穿刺活检术检测非小细胞肺癌表皮生长因子突变[J].中华实验外科杂志,2012,29(8):1469-1471.
[8]张嵩,马卫霞,姜淑娟,等.多种技术联合应用对肺癌诊断的临床价值[J].临床肺科杂志,2011,16(4):574-576.
[9]孙加源,韩宝惠,赵珩,等.超声支气管镜引导下经支气管针吸活检70例临床分析[J].中华结核和呼吸杂志,2010,33(10):738-741.
[10]刘尽国,张杰,张俭,等.液基薄层细胞学与免疫细胞化学联合在肺癌分型及鉴别诊断中的应用[J].临床与实验病理学杂志,2013,29(8):871-875.