超声内镜引导下经支气管针吸活检术对肺小细胞癌的诊断价值及病理特征

The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of small cell lung cancer and the pathological characteristics

目的：探讨超声内镜引导下经支气管针吸活检术（EBUS-TBNA）细胞学检查和组织学检查诊断肺小细胞癌的价值。方法：回顾性分析2013年1月~2014年11月间确诊的肺小细胞癌患者的EBUS-TBNA检查结果,分析EBUS-TBNA细胞学和组织学检查的病理特征,比较两种检查的诊断符合率。结果：28例患者行EBUS-TBNA细胞学检查,诊断符合率78.6%;25例行组织学检查,诊断符合率96.0%。应用EBUS-TBNA细胞学及组织学检查的25例患者,符合率100.0%。病理特征：细胞小,胞质稀少,核圆形、卵圆形或梭形,染色质深染,细颗粒状,通常不见核仁,核分裂像常见,易挤压、拉丝,细胞间互相镶嵌。免疫组化结果：CK阳性率100%,CD56阳性率90%,Syn阳性率55%,TTF1阳性率89.47%,Cg A阳性率60%。结论 ：对于肺门/纵隔淋巴结肿大的肺小细胞癌患者,联合应用EBUS-TBNA细胞学及组织学检查,可提高诊断率,微创高效。

Objective ：To explore the value of endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA）in diagnosis of small cell lung cancer.Methods： From January 2013 to November 2014, the pa- tients who underwent EBUS-TBNA,finally diagnosed as small cell lung cancer in the hospital,were retrospec- tively enrolled in our study.To analyze the pathological characteristics by using EBUS-TBNA cytology and his- tology and compare the diagnosis rate between the two methods.Results：Twenty-two cases were diagnosed as small cell lung cancer in 28 patients who underwent EBUS-TBNA cytology.The diagnostic rate was 78.6%. Twenty-five cases in 28 patients underwent EBUS-TBNA histology,and 24 cases（96.0%）were disgnosed.While all the 25 cases were diagnosed as small cell lung caner by using EBUS-TBNA cytology and histology.The diagnostic rate was 100.0%.The pathological characteristics：tumour cells were small,round,ovoid and had scant cytoplasm,round,ovoid or spindled nuclei.Nuclear chromatin was finely granular and nucleoli were absent or inconspicuous.Cell borders were rarely seen and mitoses were frequent.Cells were always inlaiding with each other.Immunohistochemical features ： the positive rates were CK （ 100% ）, CD56 （90%）, Syn （55 % ）, TrF 1 （ 89.47% ）, CgA（60%）.Conclusion：EBUS-TBNA is high value as a minimally invasive,convenient procedure for the diag- nosis of small cell lung cancer with hilar and/or mediastinal lymphadenopathy,it could make up each other and improve the diagnosis rate by using EBUS-TBNA cytology and histology.