纤维支气管镜活检对肺癌早期诊断的作用及影响因素的探讨

Role and Impact Factors of Bronchoscope Biopsy in the Early Diagnosis of Lung Cancer

目的评价支气管纤维镜活检在肺癌诊断中的作用,探讨病理制片技术对活检组织病理诊断的影响。方法患者采用纤维支气管镜镜下直接钳取或透壁活检,组织经系列石蜡制片程序,制备微小组织病理切片。对病理诊断资料进行分析。结果 520例微小组织病理切片质量均符合诊断要求。其中41例为血块和(或)坏死组织;2例组织挤压变形;2例进行了2次活检,其中1例证实为小细胞肺癌。临床诊断肺癌病例中74.4%确诊为肺癌。组织病理活检肺癌诊断率为42.5%,男性肺癌诊断率高于女性(χ2=7.093,P=0.008),诊断肺癌的平均年龄女性显著小于男性(P<0.001)。结论纤维支气管镜活检是早期诊断肺癌的重要途径,足量、准确地取材、石蜡包埋技巧和连续切片可增加肺癌病理诊断的准确性;女性确诊肺癌的年龄小,应予以重视。

Objective To evaluate diagnostic value of bronchoscope biopsy in lung cancer, and explore the effect of pathological sectioning technique in histologic diagnosis. Methods Patients underwent bronchoscope biopsy to take the lesions ofmucosa and lung tissue directly. Tiny tissue samples were processed pathologic sections by a series of procedures. Pathological findings were analyzed. Results The quality of paraffin sections from tiny samples was accorded with histologic diagnosis requirement in 520 cases. 41 cases were blood clots and （or） necrotic tissue. Two samples were pressed artificially. Two patients underwent bronchoscope biopsy twice, which confirmed one case of small cell lung cancer. 74.4% of clinical diagnosis as lung cancer was confirmed through lesions biopsy. Histologic diagnosis rate of lung cancer was 42.5%. Diagnostic yield of male was higher than that of females （χ2 = 7.093, P= 0.008）. The mean age diagnosed lung cancer in women was significantly younger than in men （P〈0.001）. Conclusions Bronchoscope biopsy is an important approach for early diagnosis of lung cancer. Adequate and accurate forceps biopsy for sampling, paraffin embedding technique and serial sections may increase the accuracy ofhistologic diagnosis. Women diagnosed with lung cancer are younger, and more attention should be paid to.