痰液沉渣切片和痰涂片检查诊断肺癌的比较性研究

Comparative study of sputum sediment paraffin section and sputum smear examinations for diagnosis of lung can-cer

目的 寻找更快捷准确的痰液检查肺癌癌细胞的方法。方法 对经手术切除病理确诊的 12 0例肺癌患者 ,进行痰液涂片和痰液沉渣切片两种方法检查癌细胞的比较性研究。结果 ( 1) 12 0例肺癌患者痰涂片发现癌细胞 3 8例 ( 3 1.67%) ,而痰沉渣切片检出癌细胞 86例 ( 71.67%) (P <0 .0 0 1)。两种方法联合检出癌细胞 10 9例 ,检出率为 90 .83 %,显著优于单纯的痰沉渣切片法 (P <0 .0 0 1)。 ( 2 )痰沉渣切片HE染色能明确肺癌组织学类型的为 5 5 /86例 ( 63 .95 %) ,而痰涂片仅能分型 6/3 8例 ( 15 .79%) (P <0 .0 0 1)。 ( 3 )痰液沉渣切片可进一步作免疫组化染色 ,绝大部分HE染色不能分型的病例 ( 2 9/3 1)得以明确分型。结论 痰液沉渣切片方法简便、取材全面、癌细胞检出率高 ,并且能进行组织学分型 。

Objective To explore a rapid and accurate method for examining cancer cell from the sputum in patients with lung cancer. Methods One hundred and twenty patients with lung cancer diagnosed by operation and pathologically confirmed were enrolled in this study. Sputum sediment section and sputum smear examinations were performed and compared for diagnosis of lung cancer. Results (1) The positive rate of lung cancer cell was 71.67% (86/120) by sputum sediment section examination, however, only 31.67% (38/120) by sputum smear examination ( P <0.001). The diagnostic rate of combination of two methods for lung cancer was 90.83% (109/120), which was significantly higher than that of single sputum sediment section examination ( P <0.001). (2) With routine HE staining, 55 patients (55/86,63.95%) could be histologically identified by sputum sediment section examination, but only 6 patients (6/38,15.79%) by sputum smear examination ( P <0.001). (3) In 31 patients unidentified with routine HE staining, 29 were further histologically confirmed by sputum sediment section examination with immunohistochemistry. Conclusion Compared to sputum smear examination, sputum sediment section examination can make use of more sputum materials, show a higher sensitivity for cancer cell, and accurately identify the histological classification of tumor. It is supposed to be a good examination for lung cancer and deserved to be extended in clinical application.