液基细胞病理检测结合经支气管针吸活检在非小 细胞肺癌纵隔淋巴结转移诊断中的临床应用
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陈凯,E-mail:chenkailiyajie@163.com

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Clinical application of modified transbronchial needle aspiration in the diagnosis of mediastinal lymph node metastasis in non-small cell lung cancer
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    摘要:

    目的 探讨液基细胞病理检测(LCT)结合经支气管针吸活检(TBNA)对非小细胞肺癌纵隔淋巴结转移诊断的应用价值。方法 回顾性分析2011年8月-2013年12月在宝鸡市中心医院96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(NSCLC)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法检测结合TBNA在NSCLC术前纵隔淋巴结转移诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值。结果 96例患者经TBNA检查7个部位共258组淋巴结,TBNA穿刺成功519针(96.29%,519/539)。LCT法阳性的219组(84.88%,219/258)高于CS法阳性的141组(54.65%,141/258),P <0.01。LCT法与CS法在肺癌纵隔淋巴结转移诊断的的敏感性、特异性、准确性、阳性预测值和阴性预测值分别是96.05%、100%、96.51%、100%及76.92%,和61.84%、100%、66.28%、100%及25.64%,CS法、LCT法在诊断NSCLC纵隔淋巴结转移的ROC曲线下面积分别为0.547和0.867,LCT法在肺癌纵隔淋巴结转移诊断的敏感性、阴性预测性及准确性等方面均明显高于CS法,P <0.01。结论 LCT法结合TBNA能有效提高肺癌纵隔淋巴结转移诊断敏感性、准确性,值得临床推广应用。

    Abstract:

    【Objective】 To investigate the clinical value of liquid-based cytological test (LCT) and transbronchial needle aspiration (TBNA) in the diagnosis of mediastinal lymph node metastasis in non-small cell lung cancer. 【Methods】 The clinical data of 96 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 was performed before operation. TBNA specimens were prepared by conventional smears (CS) and liquid-based cytological test (LCT) smears respectively. All patients subsequently underwent pulmonary resection with mediastinal lymph node dissection. The differences in the cytopathological diagnosis between the two preparation methods of TBNA specimens were compared. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value were evaluated. 【Results】 96 patients with 258 lymph nodes were punctured. TBNA procedures were successfully carried out in 519/539 (96.29%). The positive rate of TBNA specimens by LCTwas 84.88% (219/258), while the positive rate of TBNA specimens by CS was 54.65% (141/258), the difference was statistically significant (P <0.01). No complications happened in the group. Overall diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of cytopathology for mediastinal lymph node metastasis by TBNA of LCT smears were 96.05%,100%,96.51%,100% and 76.92%, while those of CS smears were 61.84%,100%,66.28%,100% and 25.64%. The area under the ROC curve of CS method was 0.547, while that of LCT method was 0.867. The sensitivity, negative predictive value and accuracy of LCT smears were higher than those of CS, the difference was statistically significant (P <0.01). 【Conclusion】 The combined method of LCT and TBNA is a safe and effective technique in diagnosing mediastinal lymph node metastasis of NSCLC, which has certain clinical application value.

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  • 收稿日期:2014-03-19
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  • 在线发布日期: 2015-01-31