超声引导下淋巴结细针穿刺活组织细胞学检查在胸部恶性肿瘤放疗前评估中的应用价值

目的:研究在超声引导下淋巴结细针穿刺活组织细胞学检查于胸部恶性肿瘤放疗前评估的效果。方法:将本院肿瘤内科2018年1月至2020年1月的112例胸部恶性肿瘤(食管癌、肺癌)放疗患者作为研究对象,对其进行回顾性分析处理。112例患者中共有150个淋巴结,在超声引导下进行淋巴结细针穿刺活组织细胞学检查,然后将穿刺组织送细胞学制片,实行常规巴氏染色后通过细胞学专家阅片,对是否存在癌细胞转移情况进行分析。结果:放疗胸部恶性肿瘤基线情况中发现肺癌者57例、食管癌者55例;胸部恶性肿瘤的发生和有吸烟史、分期Ⅲ期、有化疗史有关。57例肺癌患者的淋巴结数量、平均短径、血流信号(有/无)分别为88个、(1.25±0.41)cm、79.55%、20.45%;穿刺位置于锁骨上、下颈部、中上颈部、其他位置分别占70.45%、22.73%、2.27%、4.55%;细胞检查结果中阳性、阴性分别占76.14%、23.86%。55例食管癌患者的淋巴结数量、平均短径、血流信号(有/无)分别为62个、(3.21±0.73)cm、77.42%、22.58%;穿刺位置于锁骨上、下颈部、中上颈部、其他位置分别占72.58%、25.81%、0、1.61%;细胞检查结果中阳性、阴性分别占69.35%、30.65%。胸部恶性肿瘤总计淋巴结数量、平均短径、血流信号(有/无)以及穿刺位置于锁骨上、下颈部、中上颈部、其他位置的占比,及细胞检查结果中阳性、阴性分别为150个、(4.46±1.14)cm、78.67%、21.33%、71.33%、24%、1.33%、3.34%、73.33%、26.67%。结论:胸部恶性肿瘤放疗前评估中实行超声引导下淋巴结细针穿刺活组织细胞学检查,安全、可行便于为疾病诊治提供数据支持,所以建议在临床上予以应用和推广。

Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma

AIM: To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma.METHODS: Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures. Fifty-eight consecutive patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between 1995-2005.RESULTS: Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy. The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients). In 20/58 patients (34.5%), diagnosis were obtained by both positive cytology and positive histology, in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology).CONCLUSION: Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.