液基薄层细胞学检查在肺癌诊断中的应用研究
| 作者: |
1刘汉忠,
1王岚,
1何惠华,
1涂珍,
1肖静,
1肖兰,
1李蓓,
1戴一菲
1 湖北省孝感市中心医院病理科，湖北 孝感 432000 |
| 通讯: |
何惠华
Email: 759507630@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2014.06.012 |
| 基金: | 湖北省自然科学基金, 2013CFC088 |
摘要
目的：研究液基薄层细胞学(liquid based cytologic test，LCT)制片技术在肺占位性病变细胞学检查 中的临床应用价值，以期提高肺癌细胞学诊断的准确性。方法：收集肺占位性病变患者细胞学检 查资料完整病例831例，其中经传统涂片诊断295例(35.50%)，经LCT制片诊断536例(64.50%)。比 较LCT制片方法与传统制片方法对采集诊断的细胞保存及制片效果、细胞学特点、获得肿块组织 条的比例、细胞学诊断的敏感性和特异性以及LCT法分型诊断与术后组织学分型诊断符合率等。 结果：831例检查中71.12% (591例)病例通过手术切除或随访结果获得最终诊断。LCT获得肿块组 织条的几率为64.5% (346/536)以及肿块组织条获得组织病理诊断的几率为45.2% (242/536)均显著 性高于传统方法 25.08% (74/295)和7.46% (22/295)，二者统计学有显著性差异(P<0.01)。LCT法检 出肺癌的敏感性为87.64%、特异性为95.45%，传统方法敏感性为38.78%、特异性为95.00%，二者 在肺癌的敏感性统计学上有显著性差异(P<0.01)，有实际临床意义。LCT方法得到细胞学分型诊断 与术后组织学分类诊断符合率较高，总体符合率为98.25%。结论：肺占位性病变液基薄层细胞学 诊断能够保证临床取到的样本得到及时充分的保存与固定，涂片中去除血液黏液等干扰，细胞分 布更均匀，诊断性细胞更集中、细胞形态更清晰，并有助于获得肿块组织条进行石蜡切片组织病 理诊断与组织分型诊断，提高了肺占位性病变细胞学检查诊断准确率，特别是提高了肺癌的阳性 率以及与肺癌组织学分型的符合率，而且操作简单、重复性强，提高了病理医生的诊断效率。
关键词：
肺占位性病变
液基细胞学
分型
The clinical value of liquid based cytologic test in diagnosis of lung space occupying lesions
CorrespondingAuthor: HE Huihua Email: 759507630@qq.com
DOI: 10.3978/j.issn.2095-6959.2014.06.012
Abstract
Objective: To study the clinical value of the liquid-based cytology (the liquid based cytologic test, in LCT) production in CT-guided transthoracic intrapulmonary tumor needle suction cytology in order to improve the efficiency of the clinical and pathological diagnosis, improve lung tumor puncture needle aspiration cytology diagnostic accuracy, especially in line with the rate of positive rate of diagnosis of Lung Space Occupying Lesions. Methods: Collected guide transthoracic intrapulmonary tumor fine needle aspiration cytology (fine the needle aspiration cytology, FNA) with complete data cases of 831 cases of pulmonary tumor patients with CT and 295 cases (35.50%) in conventional smear diagnosis, the diagnosis of 536 cases (64.50%) in LCT system. Compare of LCT producer method with the traditional paper method in collecting diagnostic cell preservation and producer effect, cytological characteristics, the ratio of the mass organizations, the sensitivity and specificity of cytologic diagnosis. Results: About 71.12% of the final diagnosis of 831 cases was obtained by surgical resection or followup results. While LCT mass organizations, the probability was 64.50% (346/536) and mass organizations agreed the chance of histopathologic diagnosis was 45.20% (242/536) were significantly higher than the traditional method of 25.08% (74/295) and 7.46% (22/295), both have statistically significant difference (P<0.01). LCT method detection sensitivity of lung cancer was 87.64%, the sensitivity of traditional method was 38.78%, both have statistically significant difference (P<0.01), have the actual clinical significance. Conclusion: CT guided through the chest wall, lungs tumor puncture liquid-based cytology diagnosis to ensure that clinical take samples to get adequate and timely fixed, remove the interference of blood mucus and other smears, the cell distribution is more uniform, more focused diagnostic cells. cell morphology more clearly, and help get the bar of mass organizations to paraffin sections of pathological diagnosis and histological diagnosis, the lungs of tumor invasive diagnostic rate, especially to raise the positive rate of diagnosis of lung cancer and lung cancer histological type the compliance rate, and simple, repetitive, and improve the efficiency of the pathologist’s diagnosis.