CT引导下经皮肺穿刺细胞学和组织学联合检查的诊断价值

Diagnostic value of cytopathological diagnosis in combination with histopathological diagnosis for lung biopsy specimens under CT guidance

目的探讨CT引导下经皮肺穿刺细胞学和组织病理学联合检查在肺部周围性和弥漫性病变诊断中的价值。方法回顾性分析370例CT引导下经皮肺穿刺标本,分析细胞学与组织病理学诊断方法的相关性,比较细胞学、组织病理学以及两者结合诊断的敏感性、假阴性率,分析细胞学分型的准确率。结果 370例肺穿刺标本中,组织病理学诊断为癌、恶性肿瘤、疑癌、异型和阴性的例数分别为177(47.84%)、22(5.95%)、16(4.32%)、12(3.24%)和143(38.65%),细胞学诊断相应的例数为166(44.87%)、10(2.70%)、16(4.32%)、49(13.24%)和129(34.87%),两种检测方法结果相关(P<0.001)。细胞学诊断敏感性为80.00%(192/240),组织病理学诊断敏感性为89.58%(215/240),两者结合诊断敏感性为98.33%(236/240),细胞学诊断与组织病理学诊断的敏感性差异有显著性(P<0.05),组织病理学与两者结合诊断敏感性差异有显著性(P<0.05)。细胞学阳性病例分型准确率为66.15%(127/192)。术中及术后并发症为14.59%,其中气胸31例,针道出血或痰中带血23例,均经相应处理后好转。结论 CT引导下经皮肺穿刺对于肺部病变是安全的、高敏感性和高准确性的定性诊断方法,同时行细胞学和组织病理学检查可显著提高诊断率,临床应用价值高。

Purpose To investigate the value of cytopathological diagnosis in combination with histopathological diagnosis for peripherial and diffuse lung diseases by biopsy specimens under CT guidance. Methods A total of 370 cases of lung biopsy specimens under CT guidance were reviewed. The correlation between cytopathological diagnosis and histopathological diagnosis was analyzed. The sensitivity and false negative rate of cytopathological diagnosis, histopathological diagnosis and the combinational diagnosis method were calculated, and the accordance rate of cytopathological diagnosis with histopathological diagnosis was analyzed. Results Among the 370 cases, histopathological diagnosis revealed 177 （47.84%） cancers, 22 （5.95%）malignant tumors, 16 （4. 32% ）suspicious malignancy, 12 （3.24%） atypical cells and 143 （38.65%）negative findings, whereas the corresponding number for cytopathological diagnosis were 166（44. 87% ）, 10（2. 70% ）, 16（4. 32% ）, 49（13.24% ）and 129（34. 87% ）. The two diagnosis methods were correlated （P 〈 0. 001 ）. The sensitivity of cytopathological diagnosis, histopathological diagnosis and the combinational method were 80.00% （192/240）, 89. 58% （215/240） and 98. 33% （236/240）, respectively. The cytopathological diagnosis and the histopathological diagnosis had a statistically significant difference in the sensitivity （P 〈 0. 05 ）. The difference in sensitivity between the combinational method and the histopathological diagnosis was statistically significant（P 〈 0. 05 ）. Overall, 66. 15% （127/192） of the cytopathogically positive cases were precisely typed by cytopathological diagnosis. Complications during or after the operation were found in 14. 59% of cases, among which 31 had pneumothorax and 23 had bleeding in the needle passage or bloody sputum, all improving after appropriate treatment. Conclusion Percutaneous lung biopsy under CT guidance is a safe, sensitive and accurate method for diagnosis of lung diseases, and the combinational use of cytopathological diagnosis and histopathological diagnosis significantly increases the rate of diagnosis and has a favorable clinical application value.