快速现场评价在中央气道恶性病变中的临床应用初探

The clinical application of rapid on-site evaluation in lesions located on central airway and the effect of different biopsy methods

目的在中央气道恶性病变中,初步探讨活检钳钳取标本和二氧化碳冷冻冻取标本之间快速现场评价(ROSE)判读结果的一致性,以及其敏感度和特异度,并分析2组之间的细胞学差异。方法回顾性分析中央气道恶性病变患者共50例,所有患者均行全麻下支气管镜检查及治疗,使用活检钳钳取和二氧化碳冷冻冻取2种方法获取标本,进行常规病理学检查及ROSE分析。根据病理学结果,比较2种取材方法之间ROSE结果判读的一致性,以及诊断准确率,比较2种取材方法后细胞形态学改变。结果50例患者的钳取标本和冻取标本的病理学结果一致率可达100%;2种取材方法之间的ROSE结果判读一致性为96%(κ=0.87,P=0.000),诊断正确率分别为92.0%和88.0%,差异无统计学意义(P=0.51)。与钳取标本相比,冻取标本的背景红细胞及坏死细胞减少,恶性细胞排列紧密度下降,细胞体积似有缩小。结论在中央气道恶性病变患者中,钳取标本和冻取标本的病理学结果完全一致,ROSE结果判读的一致性良好,诊断正确率较高,有助于尽早指导患者的进一步诊疗。

Objective To investigate the clinical application of rapid on-site evaluation (ROSE) in malignant lesions located on central airway, and the effect of different biopsy methods on rapid on-site evaluation (ROSE) and pathological results. Methods A total of 50 patients with airway malignant tumor were retrospectively analyzed.All the patients accepted interventional bronchoscopy under general anesthesia.All the 50 patients were sampled by biopsy forceps and cryobiopsy for ROSE and pathological analysis.The morphological changes, the consistency of the ROSE and pathological results between the frozen group and the forceps group were compared. Results In pathological analysis, there was a completely agreement between forceps and cryobiopsy.The agreement between forceps and cryobiopsy was 96%(κ=0.87, P=0.000) in ROSE analysis.According to pathological results, the accuracy of forceps and cryobiopsy was 92.0% and 88.0%, respectively (without significant difference, P=0.51). Compared with the forceps samples, the background red blood cells, inflammatory cells and necrotic cells in cryobiopsy were reduced, the number of nuclear filaments, the density of malignant cells decreased, and the cell volume seemed to be smaller. Conclusions In patients with malignant lesions located on central airway, the pathological results of forceps and frozen specimens are consistent.The results of ROSE were identical with pathological results, which is helpful to guide the further diagnosis and treatment of patients as early as possible.