经纤支镜小样本诊断肺癌组织类型准确性的影响因素分析

Analysis of factors influencing the diagnostic accuracy for pathologic type of lung cancer using bronchoscopy

目的探讨经纤支镜小样本诊断肺癌组织类型准确性的影响因素。方法收集经术前纤支镜活检、刷片或灌洗确诊或可疑为肺癌的患者114例,通过分析临床及病理特征,采用单因素及多因素分析,研究临床病理特征与纤支镜小样本活检组织类型诊断准确性的相关性。结果术前活检与术后病理组织类型诊断一致94例,病灶平均直径50mm,术后确诊60例鳞癌,32例腺癌,1例小细胞肺癌,1例囊性腺样癌;其中10例患者术前小样本组织行免疫组化染色确定病理类型。术前纤支镜病理活检与术后病理结果矛盾或不完全一致的非一致性病例患者20例,病灶平均直径为40mm,其中4例纤支镜标本及6例手术标本进行免疫组织化学染色方法进一步确定诊断。经单因素分析结果显示,纤支镜术前诊断与术后标本病理诊断的不一致性仅与肿瘤组织分化程度相关(P=0.006)。经多因素分析,将性别、年龄、肿瘤大小、原发灶部位、病理组织类型、分化程度、临床病理分期、淋巴结及血管浸润,纳入Logistic回归分析模型,结果显示,分化程度及血管浸润与术前纤支镜诊断及术后病理不一致性相关(P=0.005,OR,0.300,95%可信区间,0.129-0.696;P=0.026,OR,0.096,95%可信区间,0.012-0.757),而性别、年龄、肿瘤大小、原发灶部位、病理组织类型、临床病理分期、淋巴结浸润均与不一致性因素无关。结论肺癌分化程度及血管浸润与经纤支镜小样本活检诊断肺癌组织类型准确性密切相关。

Objective The pathologic type diagnosis is critical important in strategies-making for treatment options in lung cancer. Here, we identify the clinical and pathologic factors that influence the pathologic diagnostic accuracy using small biopsy via bronchoscope. Methods We collected 114 patients diagnosed by performing trasnbronchial lung biopsy or brushing using bronchoscope preoperatively. We assessed the factors influencing diagnostic accuracy of transbroncho scopic examination before surgery. Results The preoperative and postoperative diagnoses corresponded in 94 patients. The median tumor size was 50mm. 60 cases were squamous cell carcinoma. 32 cases were adenocarcinoma. 1 case was small cell lung cancer. 10 cases were performed immunohistochemical staining to diagnosis. The preoperative and postop- erative diagnoses conflicted in 20 cases. The median tumor size was 40mm, and 4 cases for bronchoscopy and 6 cases for surgery were performed immunohistochemical staining to diagnosis. Using univariate analysis, the tumors were often poorly differentiated in noncorresponding cases than in the corresponding cases （P=0. 006）. On multivariate analysis, the following variables were included in the Logistic model： sex, age, tumor size, tumor location, histologic type, differ- entiation grade, stage, lymphatic and vascular invasion. The results showed that tumor differentiation grade and vascular invasion were associated with the noncorresponding cases （P =0. 005, OR, 0. 300, 95% CI, 0. 129-0. 696; P = 0. 026, OR, 0. 096,95%CI,0. 012-0. 757）. Conclusion In our study, tumor differentiation grade and vascular invasion are fac- tors influencing the pathologic diagnostic accuracy for histologic type.