膜式液基细胞学检测在肺癌诊断中的应用

Application of ThinPrep cytology test in the diagnosis of lung cancer

目的 探讨纤维支气管镜刷片（BWC）和支气管肺泡灌洗液（BALF）膜式液基细胞学检测（TCT）在肺癌诊断中的价值.方法 收集同时进行BWC和BALF TCT检查的肺癌病例385例,比较传统涂片和TCT两种方法的敏感度;分析BWC和BALF TCT对肺癌诊断的敏感度和分型的准确性.结果 TCT检测的敏感度为76.1％（293/385）,传统涂片检测的敏感度为54.8％（211/385）,TCT检测肺癌的敏感度高于传统涂片,差异有统计学意义（P＜0.05）.在中央型肺癌诊断中,BWCTCT的敏感度为74.4％（131/176）,BALF TCT的敏感度为70.5％（124/176）,两者比较差异无统计学意义（P＞0.05）.在周围型肺癌的诊断中,BALF TCT的敏感度为83.3％（174/209）,BWC TCT的敏感度为44.0％（92/209）,两者比较差异有统计学意义（P＜0.05）.TCT与组织学的符合率,在BWC中,鳞癌为92.7％（127/137）,腺癌为92.6％（151/163）,小细胞癌为96.8％（61/63）,总符合率为91.9％（354/385）.在BALF中,鳞癌为92.0％（126/137）,腺癌为94.5％（154/163）,小细胞癌为98.4％（62/63）,总符合率为92.7％（357/385）.结论 TCT检测能提高肺癌的诊断率;由于肺癌的解剖部位的不同,在肺癌诊断中BALF和BWC TCT的敏感度不同.如果两者结合,则可能提高肺癌的诊断率.

Objective To explore the diagnostic value of bronchofiberscopic washing cytology （BWC） and bronchoalveolar lavage fluid （BALF） ThinPrep cytology test （TCT） in the diagnosis of lung cancer. Methods Three hundred and eighty-five lung cancer patients who completed the BWC and BALF TCT were selected. The sensitivity was compared between the conventional smear and the two TCT methods. The sensitivity and accuracy of BWC and BALF TCT in the diagnosis of lung cancer were analyzed. Results The sensitivity of TCT was 76.1% （293/385） in the diagnosis of lung cancer,and conventional smear was 54.8%（211/385）. The sensitivity of TCT was significantly higher than that of conventional smear （P〈 0.05）.In the diagnosis of central lung cancer, the sensitivity of BWC TCT and BALF TCT was 74.4% （ 131/176） and 70.5% （124/176）,and there was no statistical difference （P 〉 0.05）. In the diagnosis of peripheral lung cancer,the sensitivity of BALF TCT and BWC TCT was 83.3% （174/209） and 44.0% （92/209）,and there was statistical difference （P 〈 0.05）. In BWC TCT, the accuracy of TCT and histology in squamous cancer was 92.7% （127/137） ,in adenocarcinoma was 92.6% （ 151/163 ）, in small cell cancer was 96.8% （61/63）, and total accuracy was 91.9% （354/385）. In BALF TCT,the accuracy of TCT and histology in squamous cancer was 92.0% （126/137）,in adenocarcinoma was 94.5% （154/163）,and in small cancer was 98.4% （62/63）,and total accuracy was 92.7%（357/385）. Conclusions TCT has more diagnostic value in lung cancer. BWC and BALF TCT show different sensitivity in the diagnosis of lung cancer of different kinds. BWC TCT combination with BALF TCT is helpful to improve the diagnosis of lung cancer.