超声支气管镜引导下支气管肺癌穿刺活检假阴性的影响因素

Factors related to false-negative results in ultrasound-guided transbronchial needle aspiration in lung cancer

目的分析肺癌病灶在超声支气管镜引导下经支气管针吸活检(EBUS-TBNA)穿刺病理结果阴性的影响因素。方法回顾性研究2017年1月至2018年2月在上海中医药大学附属第七人民医院行EBUS-TBNA术的25例最终经EBUS-TBNA或其他活检方法病理证实为肺癌患者的临床资料,分别记录病理类型、穿刺病灶的大小和穿刺获取标本的性状,采用卡方检验分析影响EBUS-TBNA假阴性的相关因素。结果25例肺癌患者共穿刺57处病灶,病理类型中小细胞肺癌为57.9%(11/19),明显高于非小细胞肺癌的21.1%(8/38),差异具有统计学意义(P<0.05);穿刺物呈碎渣样改变者为80.0%(12/15),明显高于线样长条改变者的9.5%(4/42),差异具有统计学意义(P<0.05);小细胞肺癌病灶直径>3 cm者为75.0%(9/12),明显高于直径<3 cm者的28.5%(2/7),差异具有统计学意义(P<0.05);穿刺病灶直径>3 cm的小细胞肺癌出现碎渣样改变者58.3%(7/12),明显高于非小细胞肺癌16.7%(2/12),差异具有统计学意义(P<0.05)。结论穿刺物为碎渣样改变者出现假阴性比例高;小细胞肺癌且肿块直径>3 cm,穿刺标本为碎渣样改变,是导致EBUS-TBNA出现假阴性的关键因素。

Objective To discuss the factors related to false-negative results in ultrasound-guided transbronchial needle aspiration in lung cancer.Methods The clinical data of 25 patients finally diagnosed as lung cancer by EBUS-TBNA or other biopsy methods in Shanghai Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were retrospectively reviewed.The pathological types,the size of puncture lesions,and the characteristics of puncture specimens were recorded respectively.Results A total of 57 lesions were punctured in the 25 patients with lung cancer.The proportion of small cell lung cancer was 57.9%(11/19),significantly higher than 21.1%(8/38)of non-small cell lung cancer(P<0.05).The rate of samples in the form of dregs was significantly higher than that of samples in the shape of linear strip:80.0%(12/15)vs 9.5%(4/42),P<0.05.The proportion of lesions bigger than 3 cm in small cell lung cancer was significantly higher than that of lesions smaller than 3 cm in small cell lung cancer 75.0%(9/12)vs 28.5%(2/7),P<0.05.The proportion of dregs sample in small cell lung cancer with the lesions bigger than 3 cm was 58.3%(7/12),significantly higher than 16.7%(2/12)in non-small cell lung cancer(P<0.05).Conclusion Higher false-negative rate was found in samples in the form of dregs.Small cell lung cancer with a mass diameter of more than 3 cm and samples in the form of dregs were the key factors leading to false negative in EBUS-TBNA.