两种方法获得的非小细胞肺癌标本病理结果的差异

Value of CT-guided percutaneous lung biopsy in diagnosing non-small cell lung cancer compared with biopsy from surgical approach

目的探讨CT引导下经皮肺穿刺活检标本病理结果的可靠性,及其对非小细胞肺癌的诊断价值。方法选择非小细胞肺癌患者91例,影像学检查发现肺部肿物,经痰液细胞学、支气管镜的涂片细胞学或活检组织学等检查,均未能明确诊断的肺部病变患者,后经CT引导下经皮肺内病灶穿刺术,获得涂片细胞学和(或)活检组织学证据,明确诊断为非小细胞肺癌,再行外科手术切除获得完整的病理结果。比较CT引导下经皮肺穿刺活检不同病理类型及不同途径的病理结果与外科手术切除标本的病理结果的差异。结果 CT引导下经皮肺穿刺活检的病理结果与手术结果的符合率为86.81%(79/91)。与手术病理结果比较,经皮肺穿刺活检不同病理类型的符合率差异无统计学意义[鳞癌vs腺癌vs腺鳞癌:88.57%(31/35)vs 86.27%(44/51)vs 80.00%(4/5),χ2=0.310,P>0.05];经皮肺穿刺标本采用不同方法的病理类型结果与手术结果的比较差异有统计学意义(χ2=9.698,P<0.05),经涂片细胞学+活检组织学获得病理结果的符合率[94.4%(51/54)]高于单独涂片细胞学[60.0%(6/10)]和单独活检组织学[81.4%(22/27)]。结论CT引导下经皮肺穿刺活检对非小细胞肺癌的定性诊断是可靠的,但其病理类型结果可能与手术结果不一致。

Objective To investigate the reliability of CT-guided percutaneous lung biopsy pathological results in diag-nosing Non-small cell lung cancer （NSCLC）. Methods Patients （n=91） were selected whose radiology examination re-vealed pulmonary masses but were failed to be confirmed with pulmonary lesion through sputum or bronchoscopy. Then, they were diagnosed as non-small cell lung cancer by CT-guided percutaneous lung biopsy. After that, they received surgical op-eration and biopsies were taken during operations for pathological analysis. Pathological results between from percutaneous lung biopsy （pathological types and using different analysis tools） and from surgical operation were compared. Results The coincidence rate of pathological type is 86.81%（79/91） using pathological results through percutaneous lung biopsy or oper-ation. Compared with the pathological results of operation, the coincidence rate of pathological type using percutaneous lung biopsy show no statistical significance [Squamous cell carcinoma 88.57%（31/35） vs Grandular cell carcinoma 86.27%（44/51） vs adeno-squamous carcinoma 80.00%（4/5）,χ2=0.310,P〉0.05];the coincidence rate of percutaneous lung biopsy pathologi-cal results using different approaches demonstrate statistical significance compared with surgical biopsy pathological results （χ2=9.698, P〈0.05）. The coincidence rate of pathological results obtained by Smear and biopsy [94.4%（51/54）] is higher than that of surgical biopsy pathological results using smear alone [60.0%（6/10）] and by biopsy alone [81.4%（22/27）]. Con-clusion Using CT-guided percutaneous lung biopsy, it can produce reliable results on pathological type of non-small cell lung cancer. But the reliability can be affected by different analysis approaches that were hired to exam samples from CT-guided percutaneous lung biopsy.