肺纤维支气管镜细胞病理学检查对肺癌诊断与分型的临床价值
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摘要
目的:探讨肺纤维支气管镜细胞病理学检查对肺癌的临床诊断与组织学分型的应用价值。方法:总结我院2000年7月~2009年7月十年间通过肺纤维支气管镜细胞刷取材、传统的细胞病理学三级诊断报告的1538份标本,应用2001年美国《解剖病理程序手册》中对细胞病理学五级诊断和描述性说明的报告模式,对传统的细胞病理学三级诊断报告的标本进行复检比对和质量分析评价。结果:经肺纤维支气管镜细胞刷取材的1538份标本,肺癌细胞病理学三级诊断报告模式诊断的阳性率为49.9 %(767/1538),可疑恶性细胞占9.6%(147/1538),恶性细胞阴性占40.6%(624/1538),五级诊断报告模式诊断的阳性率为53.1 %(816/1538),可疑恶性细胞占3.6%(55/1538),恶性细胞不确定即不典型细胞占2.8%(43/1538),恶性细胞阴性占40.6%(624/1538);细胞病理学诊断为肺癌的816例中肺癌组织学分型分别为鳞状细胞癌36.4%(297/816),小细胞未分化癌33.5%(273/816),腺癌17.2%(140/816),三种分型差异有显著性意义(χ2=371.76,P<0.01);不同年龄组细胞病理学诊断的阳性率不同即:60岁以上的占42.2%(344/816),50～59岁的占35.8%(292/816),40～49岁的占17.3%(141/816),40岁以下的占4.8%(39/816),不同年龄组间肺癌的阳性率差异有显著意义(χ2=285.93,P<0.01);不同性别肺癌细胞病理学诊断的阳性率不同即男性67.2 %(548/816)>女性32.8 %(268/816),男女比为2.04︰1,两者之间差异有显著性意义(χ2=96.08,P<0.01);采用五级诊断报告模式复检后发现三级诊断报告为可疑恶性细胞9.6%(147/1538)中包含恶性细胞阳性33.3 %(49/147)、可疑恶性细胞37.4%(55/147)、恶性细胞不确定29.3%(43/147)。结论:1.本研究通过肺纤维支气管镜细胞病理学检查对53.1%的肺癌可明确临床诊断;随着纤维支气管镜的临床普及,肺纤维支气管镜细胞病理学检查可作为肺癌诊断的常规检查之一。2.肺纤维支气管镜细胞病理学检查可进行肺癌的鳞状细胞癌、腺癌、小细胞未分化癌等组织学分型,在不进行病理检查的情况下,亦能够明确组织学分型,对确定治疗方案具有临床意义。3.三级诊断报告中的可疑恶性细胞采用五级诊断报告模式复检,结果说明复检在细胞病理学质量控制中的重要性,同时是细胞病理学诊断准确性的质量保证。4.与我国细胞病理学沿用至今的传统三级诊断报告模式相比,美国所用的五级诊断报告模式中除明确恶性细胞阳性外,还能将细胞非典型性改变与可疑恶性细胞相区别,五级报告模式值得在我国临床推广应用。
Objetive:To discuss the value of fiberbronchoscopic brushing cytology in the diagnosis and classification of lung cancer. Methods: Analysis of 1538 cases who were suspected to have lung cancer were reviewed through fiberbronchoscopic brushing, smears, alcoholic fixation, Papanicolaou staining and microscopy histopathology diagnosis.Results:Among 1538 patients, 816 were diagnosed as lung cancer, the positive rate was 53.1% .Among the 816 patients, 548 were male and 268 were female with the positive rate of 67.2 % and 32.8% , respectively(χ2=96.08,P<0.01). The positive rate of cytological differentiating various histologic type were 36.4% in patients with lung squamous cell carcinoma, 33.5% in patients with small cell undifferentiated lung carcinoma, 17.2% in patients with lung adenocarcinoma (χ2=371.76 ,P<0.01 ) .There was statistical significance between different age group(χ2=285.93,P<0.01).In the conventional 3 categories reporting mode of China,suspicious for malignant cells is 9.6%(147/1538).Using the 5 categories reporting mode of the USA, suspicious for malignant cells of 3 categories reporting include suspicious for positive for malignant cells33.3%(49/147),malignant cells34.7%(55/147)and inconclusive for malignant cells29.3%(43/147).Conclusion:The fiberbronchoscopic brushing cytology is an important and effective method for lung cancer diagnosis, it can diagnose lung cancer for more than 50%.With the development of the fiberbronchoscopic, the fiberbronchoscopic brushing cytology act as one of the measure for diagnosing lung cancer. Without of biopsy, fiberbronchoscopic brushing cytology can define histological type.This aplys to the patients who have lost the opportunity of an operation, especially .According to the histological type, the program of therapy ,such as radiotherapy and chemotherapy can be chosen .It is of greate value to the early treatment of lung cancer.Reviewing the specimens is one important part of quality control in cytopathology.This can assure the accuracy of the diagnosis in cytopathology.Compare with the conventional 3 categories reporting mode of China,the diagnostic category and descriptive text for reporting non-gynecologic cases follows 5 categories in the USA,including negative for malignant cells,inconclusive for malignant cells,suspicious for malignant cells,positive for malignant cells,unsatisfactory specimen.The 5 categories reporting mode of the USA descripte and clarify suspicious for malignant cells,and make sure it is real suspicious for malignant or atypical cells.It is worth to spread the 5 categories reporting mode of the USA in China.
Objetive:To discuss the value of fiberbronchoscopic brushing cytology in the diagnosis and classification of lung cancer. Methods: Analysis of 1538 cases who were suspected to have lung cancer were reviewed through fiberbronchoscopic brushing, smears, alcoholic fixation, Papanicolaou staining and microscopy histopathology diagnosis.Results:Among 1538 patients, 816 were diagnosed as lung cancer, the positive rate was 53.1% .Among the 816 patients, 548 were male and 268 were female with the positive rate of 67.2 % and 32.8% , respectively(χ2=96.08,P<0.01). The positive rate of cytological differentiating various histologic type were 36.4% in patients with lung squamous cell carcinoma, 33.5% in patients with small cell undifferentiated lung carcinoma, 17.2% in patients with lung adenocarcinoma (χ2=371.76 ,P<0.01 ) .There was statistical significance between different age group(χ2=285.93,P<0.01).In the conventional 3 categories reporting mode of China,suspicious for malignant cells is 9.6%(147/1538).Using the 5 categories reporting mode of the USA, suspicious for malignant cells of 3 categories reporting include suspicious for positive for malignant cells33.3%(49/147),malignant cells34.7%(55/147)and inconclusive for malignant cells29.3%(43/147).Conclusion:The fiberbronchoscopic brushing cytology is an important and effective method for lung cancer diagnosis, it can diagnose lung cancer for more than 50%.With the development of the fiberbronchoscopic, the fiberbronchoscopic brushing cytology act as one of the measure for diagnosing lung cancer. Without of biopsy, fiberbronchoscopic brushing cytology can define histological type.This aplys to the patients who have lost the opportunity of an operation, especially .According to the histological type, the program of therapy ,such as radiotherapy and chemotherapy can be chosen .It is of greate value to the early treatment of lung cancer.Reviewing the specimens is one important part of quality control in cytopathology.This can assure the accuracy of the diagnosis in cytopathology.Compare with the conventional 3 categories reporting mode of China,the diagnostic category and descriptive text for reporting non-gynecologic cases follows 5 categories in the USA,including negative for malignant cells,inconclusive for malignant cells,suspicious for malignant cells,positive for malignant cells,unsatisfactory specimen.The 5 categories reporting mode of the USA descripte and clarify suspicious for malignant cells,and make sure it is real suspicious for malignant or atypical cells.It is worth to spread the 5 categories reporting mode of the USA in China.
引文
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[35]唐京京.经纤维支气管镜确诊的110例青年人肺癌的临床分析[J].重庆医学, 2009(10):2496-2497.
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[2]Jamal A, Siegel R, Ward E, et al. Cancer statistics[J]. CA: A Cancer Journal for Clinicians, 2006(56): 106-130.
[3]Jamal A, Murray E, Ward E, et al. Cancer statistics[J]. CA: A Cancer Journal for Clinicians. 2005(55):10-30.
[4]Johan Vansteenkiste. The Future in Diagnosis and Staging of Lung Cancer. Introduction[J]. Respiration, 2006(73): 3-4.
[5]周有尚.肺癌[M].北京:人民卫生出版社, 1980: 148-174.
[6]李连弟,鲁凤珠,张思维等.中国恶性肿瘤死亡率20年变化趋势近期预测分析[J].中华肿瘤杂志, 1997, 19(l): 3-9.
[7]陈万青,张思维,李连弟等.中国部分市县1998～2002年肺癌的发病与死亡[J].中国肿瘤, 2006, 15(9):570-574.
[8]李龙芸.继续深入开展肺癌的基础与临床研究[J].中华内科杂志, 2000, 39(11): 725-727.
[9]Maintain CF. Revisions in the international system for staging lung cancer[J]. Chest, 1997, 111(3): 232-237.
[10]高树庚,张德超.肺癌筛查和早期诊断研究进展[J].癌症进展杂志, 2004, 2(3): 198-202.
[11]Linda L, Humphrey. Lung Cancer. Screening with Sputum Cytological Examination, Chest Radiography and Computed Tomography:An Update for the U.S.Preventive Services Task Force[J]. Ann Intern Med, 2004(140): 740-753.
[12]Eddy DM. Screening for lung cancer[J]. Ann Intern Med, 1989, 111(3): 232-237.
[13]Petty TL. The early identification of lung carcinoma by sputum cytology.Cancer, 2000, 89(11 Suppl): 2461-2464.
[14]Erkilic S, Ozsarac C, Kullu S. Sputum cytology for the diagnosis of lung cancer.Comparison of smear and modified cell block methods[J]. Acta Cytol, 2003, 47(6): 1023-1027.
[15]邢学忠,高燕宁,张德超.肺癌的早期诊断[J].癌症, 2003, 22(2): 221-223.
[16]Cantaboni A, Pezzotta MG, Sironi M, et al. Quality assurance in pathology. cytologic and histologic correlation [J]. Acta Cytol, 1992, 36 (5): 717-721.
[17]Holiday DB, Mclarty JW, Farley ML, et al. Sputum cytology within and across laboratories.A reliability study[J]. Acta Cytol, 1995, 39(2): 195-206.
[18]Leung CS,Chiu B,Bell V. Comparison of ThinPrep and conventional preparation:nongynecologic cytology evaluation[J].Diagn Cytopathol,1997, 16(4): 368-371
[19]庄鹏晖,侯惠莲,张学斌等.液基细胞学和传统涂片法在痰液标本诊断肺癌中的价值比较[J].西安交通大学学报(医学版), 2007, 2: 2.
[20]Uyar DS, Eltabbakh GH, Mount SL. Positive predictive value of liquid-based and conventional cervical Papanicolaou semears reported as malignant[J]. Gynecol Oncol, 2003, 89(2): 227-232.
[21]Guo M, Hu L, Martin L, et al. Accuracy of liquid-based Pap tests: comparison of concurrent liquid-based tests and cervical biopsies on 782 women with previously abnormal Pap smears[J]. Acta Cytol, 2005, 49(2): 132-138.
[22]郭会芹,张智慧,曹箭等.痰和纤维支气管镜刷片细胞学检查在肺癌诊断中的意义[J].实用癌症杂志, 2009, 1(1): 57.
[23]徐慧琴,林利,杨桂芳.肺癌的纤维支气管镜刷细胞学诊断分析[J].肿瘤防治研究, 2003, 30(5): 398-399.
[24]马正中,阚秀,刘树范.诊断细胞病理学[M].郑州:河南科学技术出版社, 2000, 153. 472-479.
[25]王永才.最新脱落细胞病理诊断学多媒体图谱[M].北京:人民军医出版社, 2006: 78-80.
[26]孙开宇,王乐强,庄宏杰,滕琳,董亚伟,甄永强.纤维支气管镜下针吸活检对肺癌的诊断价值[J].临床误诊误治, 2008, 3(21): 18-19.
[27]Klein JS, Zarka MA. Transthoracic needle biopsy [J].Radiol Clin North Am, 2000, 38(2): 235-266.
[28]Wallace MJ, Krishnamurthy S, Broemeling LD, et al. CT-guided percutaneous fine-needle aspiration biopsy of small pulmonary lesions[J]. Radiology, 2002, 225: 823-828.
[29]Herth F, Beeker HD, Ernst A. Conventional vs endobronchial ultrasound-guided transbronchial needle aspiration: a randomized trial[J]. Chest, 2004, 125(l): 322-325.
[30]Holty JC, Kuschner WG, Gou MK. Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer:a meta- analysis[J]. Thorax, 2005, 60: 949-955.
[31]Laurent F, Latrabe V, Vergier B, et al. Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique [J]. Cardiovasc Intervent Radiol, 2000, 23: 266-272.
[32]Tomiyama N, Yasuhara Y, Nakajima Y, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in J apan[J]. Eur J Radiol, 2006, 59: 60-64.
[33]孟宇宏,李维华,虞积耀等.具有三向分化特征的大细胞癌[J].诊断病理学杂志, 1997, 4: 208.
[34]G. William, Moore MD, PhD Dong, et al. Oscar A. Iseri, MD.ANATOMIC PATHOLOGY PROCEDURE MANUAL. TABLE OF CONTENTS. DRAFT COPY ONLY. II. CYTOLOGY SERVICE. 113.quality improvement program in cytopathology. www.netautopsy. org/ axsop/ axsop113. htm.
[35]唐京京.经纤维支气管镜确诊的110例青年人肺癌的临床分析[J].重庆医学, 2009(10):2496-2497.
[36]王志瑾.肺癌流行病学[J].肿瘤防治杂志, 2002, 9(1):1-51
[37]周晋华,田秀梅.纤维支气管镜对182例肺癌检查结果分析[J].安徽医学. 2009(30):569-570.
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