经支气管镜针吸活检联合现场细胞学对肺癌诊断的临床价值

The Value of Transbronchial Needle Aspiration Combined with Rapid On-site Evaluation of Cytology in the Diagnosis of Lung Cancer

背景与目的国内外目前已有多篇现场细胞学应用于经支气管镜针吸活检(transbronchial needle aspiration,TBNA)的报道,但专门针对肺癌患者的研究很少。本研究的目的是探讨TBNA联合现场细胞学在肺癌诊断中的作用。方法回顾性分析2012年12月-2013年12月在滨州市人民医院行TBNA并最终确诊为肺癌的69例患者,其中行现场细胞学者37例,未行现场细胞学者32例。比较现场细胞学结果与最终HE染色结果的一致性,同时比较两组患者的诊断率、每个淋巴结穿刺针数、并发症发生率及细胞学诊断费用。结果现场细胞学与HE染色一致性为94.1%(32/34)。现场细胞学组诊断率与非现场细胞学组相比无统计学差异(91.9%vs 78.1%,P=0.20);但平均穿刺针数及并发症发生率,现场细胞学组少于非现场细胞学组(t=29.5,P<0.05;χ2=4.4,P<0.05),现场细胞学组患者细胞学诊断费用低于非现场细胞学组(t=10.9,P<0.05)。结论 TBNA联合现场细胞学诊断肺癌,与HE染色一致性好,且能减少穿刺针数及并发症,节省细胞学诊断费用,值得推广。

Background and objective There have been several studys about transbronchial needle aspiration （TBNA） combined with rapid on-site evaluation （ROSE） so far at home and abroad, yet few studys were especially for patients with lung cancer. The aim of our study is to investigate the effect of TBNA combined with ROSE in the diagnosis of lung cancer. Methods The data of the patients from December 2012 to December 2013, who were performed with TBNA and ultimately diagnosed with lung cancer in the People＇s Hospital of Binzhou City, were retrospectively analyzed, qhe patients were divided into two groups, ROSE group （rapid on-site evaluation group） and no-ROSE group （the group without rapid on-site evaluation）. Among these patients, 37 patients were in the ROSE group and 32 patients were in the no-ROSE group. The result of ROSE and HE stain, the diagnostic yields and needle passes of each lymph node, the complication and cytology diagnostic cost of TBNA with ROSE and without ROSE were compared. Results The coherence of ROSE and HE stain was 94.1% （32/34）. The diagnostic yields of TBNA were 91.9% （34/37） and 78.1% （25/32） in ROSE group and no-ROSE group respectively, no significant differences were found. But the median number of needle passes of each lymph node and the percentage of the complication in ROSE group and no-ROSE group was significantly lower （t=29.5, P〈0.05 and X^2=4.4, P〈0.05, respectively）. The cytopathological diagnostic cost of ROSE group was significantly lower compared with no-Rose group （t= 10.9, P〈0.05）. Condusion TBNA combined with ROSE has good concordance with HE stain in the diagnosis of lung cancer, and could reduce the needle passes, cytopathological diagnostic cost and complication, worthy of popularized.