纤维支气管镜技术在肺癌诊断中应用价值的回顾性研究
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摘要
目的:回顾性分析肺癌镜下分型与组织学类型的关系,并探讨纤维支气管镜检查技术对肺癌诊断价值。方法:对2017年6月至2018年10月就诊于我院呼吸内科进行纤维支气管镜检查的158例肺病患者的相关临床资料进行回顾性分析,最终以病理学、细胞学或免疫组织化学确诊作为金标准,计算支气管镜活检(transbronchial biopsy, TBB)、刷检(bronchial brushing, BB)、肺泡灌洗(bronchoalveolar lavage, BAL)或联合取材诊断的阳性率。结果:94例肺癌患者镜下分型依次为:增生型(47.9%, 45/94)、浸润型(21.3%, 20/94)、混合型(20.2%, 19/94)、正常型(9.6%, 9/94)和管外压迫型(1.1%, 1/94)。增生型、浸润型、混合型均以鳞癌最多见,分别占57.8%、35.0%、47.4%,均显著高于腺癌和小细胞癌构成比(均P<0.05)。而正常型以未分型癌(44.4%)和鳞癌(33.3%)多见。TBB的活检总体阳性率为78.8%(63/80),显著高于BB活检总体阳性率(56.3%,45/80,χ~2=9.231,P=0.002)和BAL活检总体阳性率(0.0%,0/2,χ~2=9.804,P=0.002)。鳞癌患者的TBB活检阳性率高于BB活检阳性率(84.1%vs 63.6%,χ~2=4.768,P=0.029),腺癌患者的TBB活检阳性率高于BB活检阳性率(57.1%vs 7.1%,χ~2=8.023,P=0.005);而小细胞癌患者TBB和BB活检阳性率之间差异无统计学意义(81.8%vs 72.7%,χ~2=0.518,P=0.472)。鳞癌、腺癌和小细胞癌患者TBB+BB联合诊断的活检阳性率均明显高于TBB和BB单独诊断(均P<0.05)。结论:纤维支气管镜检查是肺癌主要的诊断方法。为了提高早期肺癌的诊断率,需要合理选择活检技术,必要时需要联合应用多项诊断技术。
Objective: To retrospectively analyze the relationship between endoscopic and histological type of lung cancer, and explore the diagnostic value of fiberoptic bronchoscopy in lung cancer. Methods: We retrospectively analyzed the clinical data of 158 patients with pulmonary diseases who underwent fiberoptic bronchoscopy from June 2017 to October 2018 in the Department of Respiratory Medicine in our hospital. Pathology, cytology or immunohistochemistry was regarded as the gold standard, and the positive rate of transbronchial biopsy(TBB), bronchial brushing(BB), bronchoalveolar lavage(BAL) or combined diagnosis were calculated. Results: A total of 94 cases of lung cancer were classified as proliferative(47.9%, 45/94), infiltrating(21.3%, 20/94), mixed(20.2%, 19/94), normal(9.6%, 9/94) and extraductally compressed(1.1%, 1/94), respectively. Squamous cell carcinoma were mainly proliferative(57.8%), infiltrating(35.0%) or mixed(47.4%). The constituent ratio of squamous cell carcinoma to the 3 types were significantly higher(P<0.05) than those of adenocarcinoma to them and those of small cell carcinoma to them, respectively. The normal type was more common in unclassified carcinoma(44.4%) and squamous cell carcinoma(33.3%). The overall positive rate of TBB was 78.8%(63/80) which was significantly higher than that of BB biopsy(56.3%, 45/80, χ~2=9.231, P=0.002) and that of BAL biopsy(0.0%, 0/2, χ~2=9.804, P=0.002). The positive rate of TBB in squamous cell carcinoma patients was significantly higher than that in those by BB biopsy(84.1% vs 63.6%, χ~2=4.768, P=0.029). The positive rate of TBB in adenocarcinoma patients was significantly higher than that in those by BB biopsy(57.1% vs 7.1%, χ~2= 8.023, P=0.005). There was no statistically significant difference between the positive rates of TBB and BB biopsy in small cell carcinoma patients(81.8% vs 72.7%, χ~2=0.518, P=0.472). The positive rates of TBB + BB biopsy in patients with squamous cell carcinoma, adenocarcinoma or small cell carcinoma were significantly higher(P<0.05) than those in patients by TBB or BB alone, respectively. Conclusion: Fiberoptic bronchoscopy is the main diagnostic method for lung cancer. In order to improve the diagnostic rate of early lung cancer, it is necessary to select biopsy techniques reasonably and apply multiple diagnostic techniques jointly when necessary.
Objective: To retrospectively analyze the relationship between endoscopic and histological type of lung cancer, and explore the diagnostic value of fiberoptic bronchoscopy in lung cancer. Methods: We retrospectively analyzed the clinical data of 158 patients with pulmonary diseases who underwent fiberoptic bronchoscopy from June 2017 to October 2018 in the Department of Respiratory Medicine in our hospital. Pathology, cytology or immunohistochemistry was regarded as the gold standard, and the positive rate of transbronchial biopsy(TBB), bronchial brushing(BB), bronchoalveolar lavage(BAL) or combined diagnosis were calculated. Results: A total of 94 cases of lung cancer were classified as proliferative(47.9%, 45/94), infiltrating(21.3%, 20/94), mixed(20.2%, 19/94), normal(9.6%, 9/94) and extraductally compressed(1.1%, 1/94), respectively. Squamous cell carcinoma were mainly proliferative(57.8%), infiltrating(35.0%) or mixed(47.4%). The constituent ratio of squamous cell carcinoma to the 3 types were significantly higher(P<0.05) than those of adenocarcinoma to them and those of small cell carcinoma to them, respectively. The normal type was more common in unclassified carcinoma(44.4%) and squamous cell carcinoma(33.3%). The overall positive rate of TBB was 78.8%(63/80) which was significantly higher than that of BB biopsy(56.3%, 45/80, χ~2=9.231, P=0.002) and that of BAL biopsy(0.0%, 0/2, χ~2=9.804, P=0.002). The positive rate of TBB in squamous cell carcinoma patients was significantly higher than that in those by BB biopsy(84.1% vs 63.6%, χ~2=4.768, P=0.029). The positive rate of TBB in adenocarcinoma patients was significantly higher than that in those by BB biopsy(57.1% vs 7.1%, χ~2= 8.023, P=0.005). There was no statistically significant difference between the positive rates of TBB and BB biopsy in small cell carcinoma patients(81.8% vs 72.7%, χ~2=0.518, P=0.472). The positive rates of TBB + BB biopsy in patients with squamous cell carcinoma, adenocarcinoma or small cell carcinoma were significantly higher(P<0.05) than those in patients by TBB or BB alone, respectively. Conclusion: Fiberoptic bronchoscopy is the main diagnostic method for lung cancer. In order to improve the diagnostic rate of early lung cancer, it is necessary to select biopsy techniques reasonably and apply multiple diagnostic techniques jointly when necessary.
引文
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[13] 黄世幸.纤支镜检查联合痰液CYFRA21、CEA、CA125对肺癌的诊断价值[J].临床肺科杂志,2017,22(7):1222-1225.
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[15] Yildirim D,Tamam M,Sanli Y,et al.Virtual bronchoscopy using FDG-PET/CT images for the evaluation of lung cancer [J].Eur Rev Med Pharmacol Sci,2012,16(14):1951-1960.
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[17] 王学敏,施琳,李时荣,等.纤维支气管镜刷检液基细胞学检查在肺癌诊断中的价值分析[J].重庆医学,2018,47(8):1040-1043.
[18] 刘荣伟,徐小虎,刘月军,等.胸部CT与纤维支气管镜对肺癌的临床诊断分析 [J].医学影像学杂志,2017,27(10):2022-2025.
[2] 陈万青,孙可欣,郑荣寿,等.2014年中国分地区恶性肿瘤发病和死亡分析[J].中国肿瘤,2018,27(1):1- 4.
[3] 陈万青,李贺,孙可欣,等.2014年中国恶性肿瘤发病和死亡分析[J].中华肿瘤杂志,2018,40(1):5-13.
[4] 李贺,曾红梅,邹小农,等.基于我国中部农村地区28万人群的防癌认知调查分析[J].中华肿瘤杂志,2018,27(8):561-567.
[5] 王静,陈张琴,李瑛,等.纤支镜下液基细胞学检查对肺癌患者的诊断效果[J].临床肺科杂志,2016,21(6):1086-1088.
[6] Rakotomamonjy A,Petitjean C,Salaün M,et al.Scattering features for lung cancer detection in fibered confocal fluorescence microscopy images [J].Artif Intell Med,2014,61(2):105-118.
[7] Andolfi M,Potenza R,Capozzi R,et al.The role of bronchoscopy in the diagnosis of early lung cancer:a review [J].J Thorac Dis,2016,8(11):3329-3337.
[8] Scarlata S,Fuso L,Lucantoni G,et al.The technique of endoscopic airway tumor treatment [J].J Thorac Dis,2017,9(8):2619-2639.
[9] 张杰.介入性呼吸内镜技术[M].北京:人民卫生出版社,2012:117.
[10] 李维华.WHO肺癌组织学新分类(2004)简介及评述[C].中华医学会病理学分会2005年学术年会论文汇编,2005.
[11] 罗红兵,周鹏,青浩渺,等.计算机辅助检测系统在低剂量CT肺癌筛查中非钙化肺结节检出方法的研究[J].肿瘤预防与治疗,2017,30(1):33-38.
[12] 张银.纤支镜刷片病理细胞学和活检病理组织学诊断在肺癌诊断中的临床意义[J].中国社区医师,2018,34(3):103-105.
[13] 黄世幸.纤支镜检查联合痰液CYFRA21、CEA、CA125对肺癌的诊断价值[J].临床肺科杂志,2017,22(7):1222-1225.
[14] 陆红梅,王联明,葛丽萍.纤支镜中多种检查在周围型肺癌的诊断价值[J].中国农村卫生,2015,8(22):55.
[15] Yildirim D,Tamam M,Sanli Y,et al.Virtual bronchoscopy using FDG-PET/CT images for the evaluation of lung cancer [J].Eur Rev Med Pharmacol Sci,2012,16(14):1951-1960.
[16] Herbrik M,Treffert J,Geiger B,et al.Diagnostic accuracy of virtual 18F-FDG PET/CT bronchoscopy for the detection of lymph node metastases in non-small cell lung cancer patients [J].J Nucl Med,2011,52(10):1520-1525.
[17] 王学敏,施琳,李时荣,等.纤维支气管镜刷检液基细胞学检查在肺癌诊断中的价值分析[J].重庆医学,2018,47(8):1040-1043.
[18] 刘荣伟,徐小虎,刘月军,等.胸部CT与纤维支气管镜对肺癌的临床诊断分析 [J].医学影像学杂志,2017,27(10):2022-2025.