纤维支气管镜检查中刷检及灌洗液对肺癌诊断的价值

Evaluation of brushing and bronchial lavage examinations binding biopsy in diagnosis of lung cancer by bronchoscopy

[目的]探讨细胞学检查包括支气管刷片、灌洗液检查肺癌诊断中的诊断效价及应用价值。[方法]收集肺癌病例397例,纤支镜检查中分别采用活检、刷片及灌洗液取得组织和细胞学标本,制片作出病理诊断。[结果]诊断阳性率:组织学活检81.6%,纤支镜刷检66.8%,灌洗液29.2%。对比单独活检,活检结合刷检可以提高9.3%(P<0.001),活检结合灌洗液可提高6.5%(P<0.001),三者结合可将阳性率提高11.3%(P<0.001)。分型准确度:刷检和灌洗液显著低于组织活检(P<0.05),三者对小细胞癌的诊断准确度最高。[结论]纤支镜刷片、灌洗液与组织活检结合,可提高肺癌诊断阳性率,提高分型准确度,在肺癌诊断中具有极其重要的作用。

[Objective] The value of various diagnostic techniques including forcept biopsy,brushing and bronchial lavage follwing the fibreoptic bronchoscopy in the diagnosis of lung cancer were evaluated.[Methods] Flexible fibreoptic bronchoscopy was performed in 397 patients.Histological examination of specimens were obtained by forceps biopsy and cytological specimens were taken by brushing and bronchial lavage.[Results] Forceps biopsy specimens gave positive result in 81.6% of the cases,brushing in 66.8%,and the lavage in 29.2%.Addition to forcept biopay,brushing examination increased the sensitivity by 9.3%（P〈0.001）,and the bronchial lavage increased the sensitivity by 6.5%（P〈0.001）.The addition of both brushing and lavage increased the diagnostic yield of bronchoscopy by 11.3%（P〈0.001）.As to the pathological typing,the accuracy of brushing and lavage cytology is less than the biopsy（P〈0.05）.In all three methods,the diagnostic accuracy of small cell carcinoma was higher than other types of lung cancer.[Conclusion] These results indicate that cytological examinations including brushing and bronchial lavage can improve the efficiency of fibreoptic bronchoscopy in the diagnosis of lung cancer.