痰脱落细胞涂片结合TCT及痰沉渣琼脂石蜡双包埋切片在肺癌高危人群筛查中的应用

The application of sputum exfoliated cell smears combined with thin-prep cytology test and sputum sediment AGAR paraffin double embedding method in the screening of high-risk lung cancer group

目的观察痰脱落细胞涂片结合液基薄层细胞学（TCT）、痰沉渣琼脂石蜡双包埋切片（APSM）和肺癌高危人群筛查中的临床效果。方法选择2014年8月至2016年6月期间在医院及社区搜集符合本研究高危人群定义的287名南海经济开发区居民实施肺癌筛查。肺癌高危人群定义为年龄〉40岁，并且均符合下列任何一项者：每年〉20包香烟的吸烟史；具有肺癌家族史；肺部既往病史包括慢性阻塞性肺病（COPD）、肺结核（Tuberculosis）；职业接触史。结果在287名疑似肺癌患者痰液标本中，自荧光支气管镜（Fluorescent bronchoscipy，FB）技术和手术切除标本病理组织学检查临床医师确诊为肺癌273例（95．12％）。痰脱落细胞涂片、TCT及APSM法检测肺癌细胞结果之间比较差异无统计学意义（χ^2=2．3995、8．1349、1．7340，P〉0．05）；TCT＋APSM细胞学联合检测肺癌细胞检出阳性率为97．80％，显著高于痰脱落细胞涂片检测的74．36％（χ^2=62，6096，P〈0．05）。结论TCT＋APSM细胞学联合两种制片的应用在肺癌高危人群筛查中支气管刷检制片、染色等方面，是便于实施质量控制的一项新技术，有效地减少假阴性，并且减少可疑癌报告例数，显著地提高痰恶性肿瘤细胞的检出率。

Objective To observe the clinical effect of sputum exfoliated cell smears combined with thin-prep cytology test （TCT） and sputum sediment AGAR paraffin double embedding method （APSM） in the screening of high-risk lung cancer group. Methods From August 2014 to June 2016, 287 residents from Nanhai Economic Development Zone were screened for lung cancer screening in hospitals and communities, who were consistent with the definition of high risk population in this study. High-risk lung cancer population defined as 〉 40 years old of age, and in line with any of the following： 〉 20 packets of cigarettes a year smoking history; family history of lung cancer; lung history including chronic obstructive pulmonary disease （COPD）, tuberculosis; occupational exposure history. Results Among the 287 patients with suspected lung cancer, 273 cases （95.12%） were diagnosed as lung cancer by pathologic examination of the technique of fluorescent bronchoscopy （FB） and surgical resection, there were no statistically significant differences in the testing result among sputum exfoliated cell smears, TCT, APSM （χ^2=2.399 5, 8.134 9, 1.734 0, P〉0.05）. The positive rate of TCT ＋ APSM cytology combined detection for lung cancer cells was 97.80%, significantly higher than 74.36% of sputum exfoliated cell smears （χ^2=62.609 6, P〈0.05）. Conclusions The combination of TCT ＋ APSM cytology is a new technique for the quality control of bronchial brush examination and staining in the screening of high risk lung cancer population, which can effectively reduce false negative, and reduce the number of suspicious cancer cases, significantly improve the detection rate of sputum malignant tumor cells.