EBUS-TBNA联合免疫组化在肺癌诊断中的作用

The application of EBUS-TBNA combined immunohistochemical technique in the diagnosis of lung cancer

目的分析超声支气管镜引导针吸活检术(EBUS-TBNA)联合免疫组化技术在肺癌诊断中的作用。方法选取2017年2至12月间在河南省人民医院就诊的经胸部CT疑似肺癌伴纵隔、肺门淋巴结肿大(短径≥1cm)的患者328例为研究对象。所有患者行EBUS-TBNA检查,对获取的标本进行病理学检查,EBUS-TBNA检查需经颈部淋巴结活检、手术、经皮肺穿、胸腔镜、纵隔镜或临床随访(至少半年以上)等其他检查方法验证。计算EBUS-TBNA检查的准确性、灵敏度、特异度、阳性预测值、阴性预测值,EBUS-TBNA获取的小标本病理学与免疫组化在肺癌及其亚型诊断率方面的差异。结果 1.所有病例EBUS-TBNA均穿刺取材成功。328例患者中经EBUS-TBNA确诊292例:其中恶性肿瘤218例,良性疾病74例。EBUS-TBNA未确诊36例。2. EBUS-TBNA在肺癌诊断的准确性、敏感度、特异性、阳性预测值、阴性预测值分别为96. 6%、95%、100%、100%、90. 8%。3.组织病理+免疫组化对肺癌诊断率高于灌洗、刷检,对肺癌亚型诊断率高于常规细胞+TCT+组织病理、灌洗和刷检,P值均<0. 05。4.最终诊断为肺癌的患者共220例,其中209例经EBUS-TBNA确诊。小细胞肺癌免疫组化标志物主要表达为CD56 95. 9%、SYN 91. 7%,且Ki67呈高表达;腺癌免疫组化主要为CK7 93. 0%、TTF-1 86. 3%、Napsin A 77. 4%;鳞癌免疫组化表型主要为P40 96. 1%、P63 94. 1%、CK5/6 92. 0%。结论 EBUS-TBNA在肺癌伴淋巴结转移的诊断方面具有较高的准确性、灵敏度、特异度、阳性预测值,但存在一定的假阴性; EBUS-TBNA获取的标本行病理联合免疫组化检查可明显提高肺癌及其亚型的诊断率。

Objective To analyze the role of EBUS-TBNA combined immunohistochemical technique in the diagnosis of lung cancer. Methods 328 lung cancer patients with mediastinal and pulmonary lymphadenopathy（ short diameter≥1 cm） were examined by chest CT examination from February to December 2017 at the People’s Hospital of Henan Province. All patients were examined by EBUS-TBNA for pathological examination of the obtained specimens. The EBUS-TBNA examination was subject to other examination methods such as neck lymph node biopsy,surgery,percutaneous lung puncture,thoracoscope,mediastinal lens or clinical follow-up（ at least six months）. The accuracy,sensitivity,specificity,positive prediction,and negative prediction of EBUS-TBNA WERE calculated,and the difference between the pathology of small specimens obtained by EBUS-TBNA and immunohistochemistry in the diagnosis rate of lung cancer and its subtypes were compared. Results（ 1） All cases of EBUS-TBNA were successfully punctured. Of the 328 patients diagnosed with EBUS-TBNA,292 were diagnosed： 218 were malignant tumors; 74 cases of benign diseases. EBUS-TBNA was not diagnosed in 36 cases.（ 2） The accuracy,sensitivity,specificity,positive prediction values,and negative prediction values of EBUS-TBNA in the diagnosis of lung cancer were 96. 6%,95%,100%,100%,and 90. 8%.（ 3） Histopathology plus immunohistochemistry diagnosis rate of lung cancer is higher than irrigation,brush examination,and diagnosis rate of lung cancer subtypes is higher than conventional cell ＋ TCT ＋ Histopathology,irrigation,brush examination,P values were all 〈 0. 05.（ 4） A total of 220 patients with lung cancer were finally diagnosed,of which 209 were diagnosed by EBUS-TBNA. The immunohistochemical markers of small cell lung cancer were mainly expressed as CD56 95. 9% and SYN 91. 7%,and Ki67 was highly expressed; The immunohistochemistry of adenocarcinoma was mainly CK7 93. 0%,TTF-1 86. 3%,Napsin A 77. 4%,and the immunohistochemical phenotypes of squamous carcinoma were mainly P40 96. 1%,P63 94. 1%,and CK5/6 92. 0%. Conclusion EBUS-TBNA has high accuracy,sensitivity,specificity,and positive prediction in the diagnosis of lung cancer with lymph node metastasis,but there are certain false negative values. The diagnostic rate of lung cancer and its subtypes could be significantly improved by the combined pathologic immunohistochemical examination obtained by EBUS-TBNA.