液基细胞学与经支气管针吸活检在肺癌诊断中应用

Application of liquid-based cytology and transbronchial needle aspiration in diagnosing lung cancer

目的探讨液基细胞学(liquid-based cytology,LBC)与经支气管针吸活检(transbronchial needle aspiration,TBNA)在肺癌诊断中的应用价值。方法 TBNA取材共833例,其中674例常规制备传统涂片(conventional smears,CS)后制备LBC涂片,余159例仅制作CS,比较两种制片方法在TBNA细胞病理学诊断中的差异和优、缺点,并将细胞病理学诊断与组织病理学相比较。结果 CS标本不满意率为16.4%,高于LBC涂片的标本不满意率(10.2%)。TBNA标本中LBC诊断肺癌的敏感性和准确性分别为93.5%和95.3%,CS敏感性和准确性分别为93.8%、95.3%,统计学显示两种方法的敏感性及准确性均无差异。18.5%(5/27)可疑癌病例应用LBC可得以确诊。两种制片方法得出阳性病例的分型准确率无差异。鳞癌、腺癌和小细胞癌与组织病理诊断的符合率分别为93.5%、98.3%和100%。结论在TBNA标本中应用LBC诊断肺癌的敏感性和准确性高、分型准确,与组织病理诊断符合率高,且与CS合用有互补作用。此外,LBC标本不满意率低,细胞结构清楚、背景干净、涂片数量少、阅片时间明显缩短。

Purpose To evaluate the role of liquid-based cytology （LBC） and transbronchial needle aspiration （TBNA） in diagnosing lung carcinomas. Methods 833 cytopathological specimens were collected by TBNA with a 21-gauge needle. LBC smears were pre- pared from needle rinsing obtained following preparation of conventional smears （CS） in 674 cases, and in the other 159 cases only CS were prepared. The differences in the cytopathological diagnosis between the two preparation methods in TBNA specimens were com- pared. The cytopathologieal diagnosis and histopathological diagnosis were also compared. Results The inadequate rate of CS （ 16. 4% ） was higher than that of LBC smears （ 10. 2% ）. The sensitivity and accuracy of cytopatbology for diagnosing lung carcinomas in TBNA specimens by LBC were 93.6% and 93.5% respectively, while those by CS were 93.8% and 93.5%. There was no statisti- cal difference in the sensitivity and accuracy by the two preparation methods. 18.5 % （5/27） of the suspicious cases were confirmed as cancer by LBC. There was no statistical difference in the cytotying accuracy of cytopathology in diagnosing lung carcinoma between by LBC and by CS. The coincidence rate of eytopathology with histopathology in diagnosing squamous cell carcinoma, adenoncarcinoma and small cell carcinoma were 93.5% , 98. 3% ～ 100%, respectively. Conclusions Cytopathology by LBC is sensitive and accurate in diagnosing lung cancer in the TBNA specimens and the cytotying is accurate in most cases. LBC has a complementary role when eombinded with CS. Besides, LBC has a well application prospect in TBNA specimens with lower inadequate rate, clearer cell struc- ture, cleaner background, less smears, less time spent.