活检在肺部占位性病变诊断中的意义

Significance of biopsy for pathological diagnosis of lung cancer in pulmonary lesions

目的研究肺部占位性病变活检对于肺癌病理诊断的意义、存在的问题和提高诊断符合率的方法。方法收集中日友好医院2008-01—2014-06间同时具有手术前后病理诊断的肺部占位性病变343例,进行手术前后病理诊断符合率的比较,分析造成手术前后病理诊断不符的原因。结果活检病理诊断总体符合率为65.3%,肺癌诊断符合率为60.6%,其中鳞状细胞癌最高。造成手术前后病理诊断不符的主要原因是假阴性,与患者年龄、性别、活检取材途径及肿瘤分期无关。使用IASLC/ATS/ERS活检及细胞学标本诊断分型,肺癌的诊断符合率从54.1%提高至67.3%。结论肺部占位活检可以提供准确的病理诊断。通过改进活检方法,规范肿瘤分类方法,合理使用辅助诊断方法可以进一步提高活检病理诊断的符合率。

Objective To study the significance of biopsy in the pathological diagnosis of lung cancer in the pulmonary lesions, the existing problems and how to improve the coincidence rate of pathological diagnosis. Methods We collected 343 cases of the pulmonary lesions with the pathological diagnosis before and after operation in China-Japan Friendship Hospital from January 2008 to June 2014. The coincidence rate of pathological diagnosis was analyzed between biopsy and post-operation. The cause of the difference was also studied, including false negative, the suspected diagnosis and mis- classification. Results The coincidence rate between biopsy and post-operation was 65.31% in total, and was 60. 64% in lung cancer. That of squamous cell carcinoma was highest. It had nothing to do with age, gender, tumor stage and biopsy approaches. The main reason causing the inconformity was false negative. We improved the diagnostic accordance rate from 54. 1% to 67.3% in lung cancer by using IASLC/ATS/ERS classification for small biopsy/cytology. Conclusion Pulmonary biopsy can provide accurate pathological diagnosis before operation. Through the improvement of biopsy apporach, the specification for tumor classification, the rational use of auxiliary diagnosis method can further improve the accuracy of pathological diagnosis in pulmonary mass biopsy.