207例肺癌纤维支气管镜细胞病理学方法的诊断价值探讨

Discussion on the diagnostic value of fiberbronchoscopic cytology in 207 cases of lung cancer

目的探讨纤维支气管镜细胞学方法诊断肺肿瘤的敏感性。方法对207例明确诊断的肺癌病例,从组织学类型上,分析刷片和灌洗液2种细胞学方法的诊断阳性率。结果 207例肺癌中,单独刷卡诊断阳性率68.1%(141/207),单独灌洗诊断阳性率37.2%(77/207),2种方法相结合的诊断阳性率为76.3%(158/207);较单独灌洗液诊断敏感性高(P<0.05);而与单独刷片敏感性差异无统计学意义(P>0.05)。同时,按组织学类型进行统计,腺癌和鳞癌中刷片比灌洗液具有更高的敏感性。结论纤维支气管镜刷片和灌洗液在不同的肺癌组织学类型中,诊断敏感性不同,2种细胞病理学方法结合能更好的提高肺癌的阳性诊断率;同时与组织学诊断联合应用,尤其是在支气管镜活检组织病理阴性情况下,对肿瘤最终诊断起互补作用。

Objective To evaluate the sensitivity of fiberbronchoscopic cytology in the diagnosis of lung cancer.Methods Through 207 confirmed cases of lung cancer,the diagnostic sensitivity was analyzed and evaluated from the point of histological structure by using bronchial brushing and alveolar lavage fluid.Results In the 207 cases of lung cancer,the positive diagnostic rate by bronchial brushing was 68.1%（141 /207）,while the positive diagnostic rate by alveolar lavage fluid was 37.2%（77 /207）,and the positive di-agnostic rate by the 2 combined detection methods was 76.3%（158 /207）,which was obviously higher than that of the alveolar lavage fluid（P 〉0.05）.However,no statistical significance could be seen in diagnostic sensitivity,as compared with that by bronchial brush-ing.From point of histological statistics,bronchial brushing was obviously more sensitive in the detection of adenocarcinoma and squa-mous carcinoma.Conclusion The diagnostic sensitivity of bronchial brushing and alveolar lavage fluid varied in different histological structures of lung cancer.The combination of 2 cytopathological methods could obviously increase the positive diagnostic rate of lung cancer.In the meantime,cytology combined with histology could supplement one another in the diagnosis of lung cancer,especially when the results of bronchoscopic biopsy displayed false negative.