CAJ | 학술논문

目的：探讨支气管超声内镜引导下针吸活检（ EBUS-TBNA）结合Surepath液基细胞学制片技术对肺及纵隔淋巴结病变的诊断价值。方法回顾性分析四川大学华西医院病理科2011年12月至2014年6月80例EBUS-TBNA病例，复习细胞学诊断结果并与组织学活检进行对照，同时对比观察液基细胞学制片与传统细胞学涂片，分析液基细胞学制片技术有无提高样本满意率和诊断准确性。结果80例EBUS-TBNA病例包括男性53例，女性27例，男女性别比为1畅96∶1畅00，年龄17～79岁（平均54岁），每位患者穿刺1～4组淋巴结，总共穿刺109组淋巴结，包括气管旁淋巴结57组，隆突下淋巴结34组，气管支气管淋巴结3组，肺内淋巴结7组，肺门淋巴结4组，另有4组纵隔淋巴结具体部位不详。传统涂片标本满意率为90畅0％，液基细胞学制片标本满意率为92畅5％。该组病例包括恶性肿瘤37例，结核9例，结节病2例，原因不明的肉芽肿性炎11例，其他良性病变27例。EBUS-TBNA传统细胞学涂片对诊断肿瘤的敏感性、特异性和准确率分别为86畅5％、97畅7％和92畅5％，阳性预测值和阴性预测值分别为97畅0％和89畅4％，液基细胞学制片诊断肿瘤的敏感性、特异性和准确率分别为89畅2％、97畅7％和93畅8％，阳性预测值和阴性预测值分别为97畅1％和91畅3％，传统涂片联合液基细胞学制片诊断敏感性、特异性和准确率分别为91畅9％、97畅7％和95畅0％，阳性预测值和阴性预测值分别为97畅1％和93畅3％，两种方法比较差异无统计学意义（ P＞0畅05）。结论 EBUS-TBNA是诊断肺及纵隔淋巴结病变的有效手段，Surepath液基细胞学制片可提高样本满意率、诊断的敏感性及准确性，结合免疫细胞化学检测可以进一步区分肿瘤类型，是对组织学活检的有效补充。
목적：탐토지기관초성내경인도하침흡활검（ EBUS-TBNA）결합Surepath액기세포학제편기술대폐급종격림파결병변적진단개치。방법회고성분석사천대학화서의원병이과2011년12월지2014년6월80례EBUS-TBNA병례，복습세포학진단결과병여조직학활검진행대조，동시대비관찰액기세포학제편여전통세포학도편，분석액기세포학제편기술유무제고양본만의솔화진단준학성。결과80례EBUS-TBNA병례포괄남성53례，녀성27례，남녀성별비위1창96∶1창00，년령17～79세（평균54세），매위환자천자1～4조림파결，총공천자109조림파결，포괄기관방림파결57조，륭돌하림파결34조，기관지기관림파결3조，폐내림파결7조，폐문림파결4조，령유4조종격림파결구체부위불상。전통도편표본만의솔위90창0％，액기세포학제편표본만의솔위92창5％。해조병례포괄악성종류37례，결핵9례，결절병2례，원인불명적육아종성염11례，기타량성병변27례。EBUS-TBNA전통세포학도편대진단종류적민감성、특이성화준학솔분별위86창5％、97창7％화92창5％，양성예측치화음성예측치분별위97창0％화89창4％，액기세포학제편진단종류적민감성、특이성화준학솔분별위89창2％、97창7％화93창8％，양성예측치화음성예측치분별위97창1％화91창3％，전통도편연합액기세포학제편진단민감성、특이성화준학솔분별위91창9％、97창7％화95창0％，양성예측치화음성예측치분별위97창1％화93창3％，량충방법비교차이무통계학의의（ P＞0창05）。결론 EBUS-TBNA시진단폐급종격림파결병변적유효수단，Surepath액기세포학제편가제고양본만의솔、진단적민감성급준학성，결합면역세포화학검측가이진일보구분종류류형，시대조직학활검적유효보충。
Objective To explore the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration ( EBUS-TBNA) combined with Surepath liquid-based cytology test for lung and mediastinal lymphadenopathy.Methods Eighty EBUS-TBNA cases in West China Hospital of Sichuan University collected from December 2011 to June 2014 were retrospectively analyzed.The conventional smears and Surepath liquid based preparations were reviewed and compared with histological biopsy.Evaluated whether liquid based preparation could improve the satisfactory rate and diagnostic accuracy.Results This study included 53 men and 27 women, the male to female ratio was 1.96∶1.00; the age ranged from 17 to 79 ( mean 54) years.One to four lymph node groups were aspirated in each patient, resulting in a total of 109 lymph node groups, including 57 paratracheal, 34 subcarinal, three tracheal bronchial, seven pulmonary and four hilar lymph node groups.The definite locations of four other mediastinal lymph node groups were not known.The overall satisfactory rate of conventional smears and liquid-based cytology test was 90.0% and 92.5%, respectively.By histology, there were 37 cases diagnosed as malignant tumors, nine as tuberculosis, two as sarcoidosis, 11 as unexplained granulomatous inflammation, and 27 as other benign lesions.The sensitivity, specificity and accuracy of conventional cytological smears for tumors were 86.5%, 97.7% and 92.5% respectively; the positive and negative predictive values were 97.0% and 89.4% respectively.The sensitivity, specificity and accuracy of the liquid-based preparation were 89.2%, 97.7%and 93.8%respectively;the positive and negative predictive values were 97.1% and 91.3% respectively.Combining the conventional cytological smears and liquid based preparation, the sensitivity, specificity and accuracy were 91.9%, 97.7%and 95.0%respectively;and the positive and negative predictive values were 97.1% and 93.3% respectively.Conclusions EBUS-TBNA is a good method to diagnose lung and mediastinal lymphadenopathy.Surepath liquid based cytology test could improve the sample satisfactory rate, the diagnostic sensitivity and accuracy.If combined with immunocytochemistry it could be useful for further tumor typing.EBUS-TBNA combined with Surepath liquid based preparation is an effective complement for the histologic biopsy.