CAJ | 학술논문

目的探讨液基细胞学检测(LCT)结合经支气管针吸活检(TBNA)对肺癌纵膈淋巴结分期的应用价值.方法回顾性分析2011年8月至2013年12月间在宝鸡市中心医院呼吸内科32例行常规电子支气管镜检查经组织学确诊的并最终行手术切除的非小细胞肺癌病例,术前均行TBNA纵隔淋巴结分期,穿刺物分别行常规涂片(CS)法与LCT法处理,所有患者行肺癌根治切除术及淋巴结清扫术,分析LCT法结合TBNA在非小细胞肺癌术前纵隔淋巴结分期中病理诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值,同时分析其病理类型的符合率及分期的准确率.结果 LCT法与CS法的敏感性、特异性、准确性、阳性预测值和阴性预测值分别是96.05％、100.00％、96.51％、100.00％、76.92％和61.84％、100.00％、66.28％、100.00％、25.64％.LCT法在肺癌纵隔淋巴结分期的敏感性、阴性预测性、准确性等方面均明显高于CS法(P值均＜0.01).LCT法在判断肺癌TBNA细胞病理学类型与手术组织病理学类型的符合率明显高于CS法(93.10％ vs 58.62％,x2＝12.02,P＜0.01).LCT法c-N分期准确率高于CS法(93.75％ vs 62.50％,x2=9.14,P＜0.01).结论 LCT法结合TBNA能有效提高肺癌纵隔淋巴结分期诊断敏感性、准确性、细胞病理学类型符合率、c-N分期准确率,值得临床推广应用.
목적 탐토액기세포학검측(LCT)결합경지기관침흡활검(TBNA)대폐암종격림파결분기적응용개치.방법 회고성분석2011년8월지2013년12월간재보계시중심의원호흡내과32례행상규전자지기관경검사경조직학학진적병최종행수술절제적비소세포폐암병례,술전균행TBNA종격림파결분기,천자물분별행상규도편(CS)법여LCT법처리,소유환자행폐암근치절제술급림파결청소술,분석LCT법결합TBNA재비소세포폐암술전종격림파결분기중병리진단적민감성、특이성、준학성、양성예측치화음성예측치,동시분석기병리류형적부합솔급분기적준학솔.결과 LCT법여CS법적민감성、특이성、준학성、양성예측치화음성예측치분별시96.05％、100.00％、96.51％、100.00％、76.92％화61.84％、100.00％、66.28％、100.00％、25.64％.LCT법재폐암종격림파결분기적민감성、음성예측성、준학성등방면균명현고우CS법(P치균＜0.01).LCT법재판단폐암TBNA세포병이학류형여수술조직병이학류형적부합솔명현고우CS법(93.10％ vs 58.62％,x2＝12.02,P＜0.01).LCT법c-N분기준학솔고우CS법(93.75％ vs 62.50％,x2=9.14,P＜0.01).결론 LCT법결합TBNA능유효제고폐암종격림파결분기진단민감성、준학성、세포병이학류형부합솔、c-N분기준학솔,치득림상추엄응용.
Objective To investigate the clinical value of liquid-based cytologic test (LCT) and transbronchial needle aspiration (TBNA) in mediastinal staging lung cancer.Methods The clinical data of 32 patients with lung cancer diagnosed by conventional electronic bronchoscopy from August 2011 to December 2013 in our hospital were retrospectively analyzed.Mediastinal staging by TBNA were performed before operation.TBNA specimens were prepared by conventional smears (CS) and LCT respectively.All patients subsequently underwent pulmonary resection with mediastinal lymph node dissection.The differences in the cytopathological diagnosis between the two preparation methods in TBNA specimens were compared.The cytopathological diagnosis and histopathological diagnosis were also compared.Results Overall diagnostic sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of cytopathology for mediastinal staging in TBNA specimens by LCT were 96.05％,100.00％,96.51％,100.00％,and 76.92％,while those by CS were 61.84％,100.00％,66.28％,100.00％,and 25.64％.The sensitivity,negative predictive value,and accuracy of LCT were higher than those of CS (all P ＜0.01).The coincidence rate of cytopathology with histopathology of LCT was higher than that of CS (93.10％ vs 58.62％,x2 =12.02,P ＜0.01).The overall accuracy of c-N staging by TBNA of LCT was higher than that of CS (93.75％ vs 62.50％,x2 =9.14,P ＜0.01).Conclusions Cytopathology by LCT is sensitive and accurate in diagnosing mediastinal staging of nonsmall cell lung cancer in TBNA specimens.The combined method of LCT and TBNA can improve the accuracy of c-N staging of non-small cell lung cancer,which has certain clincical application value.