81例CT引导下经皮肺穿刺活检标本临床病理结果

Clinicopathological results of 81 specimens of CT guided percutaneous lung biopsy

目的:分析CT引导下经皮肺穿刺活检标本的临床病理学及免疫组织化学诊断,结合血清肿瘤标志物检测探讨其对肺部占位性病变的诊断价值。方法:回顾性分析81例肺部占位性病变患者CT引导下肺穿刺活检标本病理学、25例免疫组织化学诊断及73例血清肿瘤标志物癌胚抗原(carcinoembr yonic antigen,CEA),细胞角蛋白19片段(cytokeratin-19-fragment,CYFR A21-1),神经元特异性烯醇化酶(neuron-specific enolase,NSE)检测结果。结果:81例CT引导下肺穿刺活检标本组织病理学诊断率为96.3%,其中恶性病变53例(腺癌29例,鳞癌20例,小细胞癌1例,未明确类型的非小细胞肺癌1例,其他类型肺癌1例,胸腺恶性肿瘤1例);良性病变25例(炎性包块7例,结核5例,肺炎7例,硅沉着病3例,炎性假瘤2例,神经鞘瘤1例);25例行免疫组织化学检查的病例中诊断恶性肿瘤24例(腺癌13例,鳞癌8例,小细胞癌1例,未确定分型2例),其中P63及CK5/6在鳞癌阳性率为87.5%,TTF-1及CK-7在腺癌阳性率为69.2%和76.9%,差异有统计学意义(P<0.05);CEA,CYFR A21-1,NSE及3项联合对肺癌诊断的灵敏度分别为54.9%,68.6%,37.3%,80.4%。结论:CT引导下经皮肺穿刺活检标本病理诊断阳性率高,结合免疫组织化学及血清肿瘤标志物联合检测可为肺癌的诊断及病理分型提供辅助性参考依据。

Objective： To analyze the clinicopathological and immunohistochemical results of CT guided percutaneous lung biopsy specimens, and to investigate the diagnostic value of serum tumor markers in the diagnosis of pulmonary space occupying lesions. Methods： The pathological diagnosis of 81 specimens of CT guided lung biopsy, of which 25 cases of immunohistochemical results and 73 cases of the concentrations of serum tumor markers [carcino-embryonic antigen （CEA）, cytokeratin-19-fragment （CYFRA21-1）, neuron-specific enolase （NSE）] were analyzed retrospectively. Results： The diagnosis rate of 81 specimens of CT guided percutaneous lung biopsy was 96.3%, there were 53 cases of malignant lesions included 29 adenocarcinoma, 20 squamous carcinoma,1 small cell carcinoma, 1 uncertain type of non-small cell lung cancer, 1 other types of lung cancer and 1 thymic carcinoma. Twenty-two cases of benign lesions included 7 inflammatory mass, 5 tuberculosis, 7 pneumonia, 3 pneumoconiosis, 2 inflammatory pseudotumor and 1 neurilemmoma. Immunohistochemical staining was used in 25 cases, 24 cases were diagnosed as malignant lesions included 13 adenocarcinoma, 8 sqnamous carcinoma, 1 small cell carcinoma and 2 uncertain type of lung cancer. The positive rate of P63 and CK5/6 in squamous cell carcinoma were 87.5%, TTF-1 and CK-7 were 69.2% and 76.9% in adenocarcinoma, there were significant differences between them （P〈0.05）; the sensibility of CEA, CYFRA21-1, and NSE of diagnosis the lung cancer were 54.9%, 68.6%, and 37.3% respectively. In combined detection for three targets, the sensibility rate was 80.4%. Conclusion： Combination of pathological and immunohistochemical detection of CT-guided percutaneous lung biopsy specimen with lung tumor makers can improve the sensitivity and accuracy rate of diagnosis of early stage lung cancer. Immunohistochemical results are useful to identify the pathologic category of lung tumor.