纤维支气管镜刷检液基薄层细胞学检查在肺癌诊断中的应用价值

Application effect by fiber bronchoscopic brush inspection liquid thin-layer cytology in diagnosis of lung cancer

目的探讨纤维支气管镜刷检液基薄层细胞学检查在肺癌诊断中的应用价值。方法回顾性分析316例行纤维支气管镜刷检活检患者的临床资料,所有患者均经病理学明确诊断,以病理结果为金标准,分析纤维支气管镜刷检活检的敏感度、特异度、阳性预测值、阴性预测值,比较常规涂片与液基薄层细胞学对肺癌诊断的阳性率。结果纤维支气管镜刷检液基薄层细胞学肺癌检测:敏感度为94.6%,特异度为94.8%,阳性预测值为98.8%,阴性预测值为79.7%。液基薄层细胞学检查正确诊断鳞癌符合率为86.8%,腺癌符合率为85.3%,小细胞肺癌符合率为100.0%,未分化癌符合率为94.4%。258例肺癌患者中,液基薄层细胞学检查244例(94.6%)阳性,常规涂片检查164例(63.6%)阳性,液基薄层细胞学检查对肺癌诊断的阳性率显著高于常规涂片(P<0.01)。结论纤维支气管镜刷检液基薄层细胞学检查用于肺癌诊断具有较高的敏感度、特异度、阳性预测值及阴性预测值,与常规涂片比较,诊断阳性率显著提高。

Objective To investigate application value of fiber bronchoscopic brush inspection liquid thin-layer cytology in diagnosis of lung cancer. Methods Clinical data of 316 patients receiving fiber bronchoscopic brush inspection were retrospectively analyzed. All patients had confirmed diagnosis by pathology, which was taken as golden standard. Sensitivity, specificity, positive and negative predictive value of fiber bronchoscopic brush inspection were analyzed. Positive rates by conventional smear and liquid thin-layer cytology in diagnosis of lung cancer were compared. Results Fiber bronchoscopic brush inspection liquid thin-layer cytology had sensitivity as 94.6%, specificity as 94.8%, positive predictive value as 98.8%, and negative predictive value as 79.7%. Liquid thin-layer cytology had diagnosis coincidence rate for squamous carcinoma as 86.8%, 85.3% for adenocarcinoma, 100.0% for small cell lung cancer, and 94.4% for undifferentiated carcinoma. Among 258 lung cancer patients, 244 cases（94.6%） were shown positive by liquid thin-layer cytology and 164 cases（63.6%） by conventional smear. Liquid thin-layer cytology had obviously higher diagnosis positive rate of lung cancer than conventional smear（P〈0.01）. Conclusion Fiber bronchoscopic brush inspection liquid thin-layer cytology contains high sensitivity, specificity, positive and negative predictive value in diagnosis of lung cancer. Comparing with conventional smear, it shows much higher diagnosis positive rate.