支气管内超声引导针吸活检术在肺癌诊断中的临床研究

Clinical research of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer

目的本研究旨在探讨支气管内超声引导针吸活检术(EBUS-TBNA)在肺癌诊断及分子病理检查中的临床意义。方法本研究共入组104例临床可疑肺癌患者,均进行了支气管内超声检查或超声引导针吸活检术,并对所收集的标本进行了病理学检测。采用扩增受阻突变体系检测EGFR基因突变,免疫组织化学法进行肺癌标志物检测。采用SPSS 19.0进行统计学分析。结果 104例患者均成功进行了支气管内超声检查,成功率为100%。行穿刺患者87例,穿刺率为83.7%,均完成针吸活检术,穿刺成功率为100%。行针吸活检术的患者均无出血、气胸或感染等并发症发生。选取5例标本进行EGFR基因突变检测,DNA质量合格,2例患者为EGFR敏感突变。4例标本行细胞免疫组化,成功率为100%。患者术中5min、15min及手术结束时HR、SBP及DBP值与基础值比较均无显著性差异(t=1.599,P>0.05)。结论行EBUS-TBNA的患者比率高,该方法创伤小,安全性高,可重复性强,其标本质量与数量可进行后续分子病理及细胞病理学检查,为肺癌准确分期及肺癌精准化个体化治疗提供了可靠的技术支持。

Objective To explore the clinical value of endobronchial ultrasound-guided transbronchial nee-dle aspiration （ EBUS-TBNA） in the diagnosis and molecular pathological examination of lung neoplasm. Methods 104 patients with lung lesions were enrolled in the study. The patients firstly received EBUS-TBNA and all specimens were examined by conventional pathological methods. Genetic mutations of epidermal growth factor receptor （ EGFR） were detected by amplification refractory mutation system （ ARMS） and tumor bio-markers were identified by immuno-histochemistry. SPSS 19. 0 was used to analyze the data. Results All the patients （n=104） were successfully car-ried out EBUS with the examination rate was 100%, among which 87 patients accepted TBNA with incidence of 83. 7% and examination of 100%. None patient received TBNA treatment occurred severe side effects including bleeding, pneumothorax or infection. 5 specimens were conducted EGFR gene mutation detection and 2 cases showed drug-sensitive mutation, indicating that the DNA of the cytological tissue by TBNA was qualified for genetic testing. Tumor-specific markers from four specimens were performed by immunohistochemistry and data showed the positive rate was 100%. HR, SBP and DBP values in 5min, 15min and at the end of surgery showed no significant difference （t=1. 599, P〉 0. 05）, while compared with base value. Conclusion EBUS-TBNA is feasible for patients with lung neoplasm with unique advantage including minimum invasion, promising safety and high reproduction. The spec-imens derived by TBNA are qualified for further diagnostic examination such as conventional pathological test, EGFR gene mutation test and immunohistochemistry. EBUS-TBNA provides a practical support for accurate disease staging and precise targeted therapy for patients with lung cancer.