CT引导经皮肺穿刺组织学联合细胞学检查的应用

The application of CT-guided percutaneous lung biopsy combined with cytological examination

目的对比分析CT引导下经皮肺穿刺活检组织学、细胞学与两者同时送检的诊断敏感性,旨在进一步提高CT引导肺穿刺的诊断敏感性和准确性。方法对113例肺部病变采用巴德全自动活检枪在CT引导下经皮进行肺穿刺活检,所取活检组织在固定前,进行活组织印片及组织液涂片操作,然后分别将组织学、细胞学与两者结合的敏感性进行统计学分析。结果 113例患者穿刺成功109例,穿刺成功率为96.5%,94例穿刺诊断为恶性肿瘤,另外有2例组织学及细胞学未发现恶性肿瘤的病例经随访证实为恶性肿瘤;其中组织学及细胞学均为阳性66例,组织学阳性细胞学阴性15例,组织学阴性而细胞学阳性11例,组织学敏感性为84.4%,细胞学敏感性为80.2%,两者之间比较,差异无统计学意义(P>0.05),组织学与细胞学联合敏感性为95.8%,组织学、细胞学与两者结合的诊断敏感性差异有统计学意义(P<0.05)。结论 CT引导经皮肺穿刺切割活组织检查的敏感性优于印片细胞学检查,而为防止假阴性的出现,同时进行印片及涂片细胞学检查可作为一种有效的补充,能够进一步提高CT引导下肺穿刺检查的诊断敏感性和准确性。

Objective In order to improve the sensitivity and accuracy of CT guided lung biopsy further, the diagnostic sensitivity of CT guided percutaneous lung biopsy, histology, cytology and the simultaneous detection of them were compared and analyzed. Methods Budds automatic biopsy gun was used in CT guided percutaneous lung biopsy in 113 patients with lung lesions. The biopsy tissue and tissue liquid smear were performed before the fixation of the biopsy takentissues, and then the sensitivity of histology, cytology and combination were analyzed respectively. Results One hunderd and thiteen cases of patients with successful puncture were 109 cases, the success puncture rate was 96.5%, 94 cases were diagnosed as malignant tumor, another 2 cases which histology and cytology revealed no malignant tumor cases were confirmed as malignant tumor by the follow-up; the results of histology and cytology were both positive in 66 cases, 15 cases with positive histologically and negative cytology. Histology and cytology were both negative in 11 cases, the sensitivity ofhistological cytology was 84.4%, the sensitivity of cytology was 80.2%, there was no statistically significant difference （P〉0.05） between the tow methods, histology and cytology combined with a sensitivity of 95.8%,compared with histology, cell respectively, diagnosis sensitivity differenceof the combina- tion of histology and cell was statistically significant （P〈0.05）. Conclusion The sensitivity of CT-guided percutaneous lung puncture biopsy is better than that of imprinted cytology, in order to prevent the emergence of false negative, and at the same time imprint and smear cytology can be used as an effective supplement, which can further improve the diagnostic sensitivity and accuracy of CT-guided lung puncture biopsy examination.