液基细胞病理检测结合经支气管针吸活检在非小细胞肺癌分期中的临床应用

Application value of liquid-based cytologic test and transbronchial needle aspiration in the mediastinal staging of non-small cell lung cancer

目的探讨液基细胞病理检测(LCT)结合经支气管针吸活检(TBNA)在非小细胞肺癌(NSCLC)纵隔淋巴结分期中的应用价值。方法回顾性分析2011年8月至2013年12月在宝鸡市中心医院经常规电子支气管镜检查组织学确诊并最终行手术切除的NSCLC患者96例。术前均行TBNA纵隔淋巴结分期,穿刺物分别行常规涂片(CS)法与LCT法处理;全组患者均行肺癌根治切除术及淋巴结清扫术,分析LCT法检测结合TBNA对NSCLC术前纵隔淋巴结分期的准确率。结果 96例患者经TBNA检查7个部位共258组淋巴结,TBNA穿刺成功519针。LCT法检测219组淋巴结阳性,阳性率为84.88%(219/258),高于CS法检测的54.65%(141/258),差异有统计学意义(P<0.05)。LCT法纵隔淋巴结分期的准确率为93.75%(90/96),高于CS法的62.5%(60/96),差异有统计学意义(P<0.05)。96例患者均能耐受并成功完成TBNA,未出现大出血、纵隔感染等并发症。结论 LCT法结合TBNA能有效提高NSCLC纵隔淋巴结分期的准确率,值得临床推广应用。

Objective To investigate the clinical value of liquid-based cytologic test（ LCT） and transbronchial needle aspiration（ TBNA） in the mediastinal staging of non-small cell lung cancer（ NSCLC）. Methods The clinical data of 96 patients with NSCLC diagnosed by conventional electronic bronchoscopy from August 2011 to December 2013 in our hospital were retrospectively analyzed. Mediastinal staging by TBNA were performed before operation. TBNA specimens were prepared by conventional smears（ CS）and LCT,respectively. All patients subsequently underwent pulmonary resection with mediastinal lymph node dissection. The differences in the cytopathological diagnosis between the two preparation methods in TBNA specimens were compared. The accuracy rate of mediasinal staging of NSCLC by LCT and TBNA was analyzed. Results 96 patients with 258 lymph nodes were punctured. TBNA procedures were successfully carried out in 519 /539（ 96. 29%）. The positive rate of TBNA specimens by LCT was 84. 88%（ 219 /258）,while the positive rate of TBNA specimens by CS was 54. 65%（ 141 /258）. The difference was statistically significant（ P〈0. 05）. The accuracy rate of mediasinal staging of NSCLC by TBNA of LCT smears was 93. 75%（ 90 /96）,which was higher than that of CS（ 62. 5%,60 /96）. The difference was statistically significant（ P〈0. 01）. Sixty-nine patients had no serious complications including massive haemorrhage or mediasinal infection by TBNA examination. Conclusion The combined method of LCT and TBNA can improve the accuracy of mediasinal staging of NSCLC,which has certain clincical application value.