Uchida Junji, Imamura Fumio, Takenaka Akemi, Yoshimura Mana, Ueno Kiyonobu, Oda Kazuyuki, Nakayama Tomio, Tsukamoto Yoshitane, Higashiyama Masahiko, Kusunoki Yoko
Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, Japan.
J Thorac Oncol. 2006 May;1(4):314-8.
Fluoroscopy-guided bronchoscopy is a safe and routine method used to obtain a histologic or cytologic specimen of peripheral lung nodules, but it has low sensitivity in diagnosing malignant tumors. Although feedback from rapid cytology tests are expected to improve diagnostic rates, the value of the routine use of rapid cytology tests has not been established.
We prospectively studied 657 patients with suspected peripheral malignant lung lesions on chest computed tomography who underwent fluoroscopy-guided bronchoscopy between January 2002 and December 2004. Rapid on-site cytopathologic examinations (ROSE) were performed during bronchoscopic examinations. The additional approach to the lesions was performed immediately after conventional bronchoscopic examinations when ROSE was not considered diagnostic.
There were 528 patients diagnosed as having malignant lesions. In 477 of these patients (90.3%), final malignant diagnosis was established by the initial bronchoscopy. Among these, 84 patients (15.9%) were diagnosed only with the additional feedback from ROSE. Of 240 peripheral lesions < or =2 cm, 174 were found to be malignant. Without ROSE, 110 (63.2%) of peripheral malignant lesions were diagnosed by bronchoscopy. The integration of ROSE enabled us to diagnose an additional 40 patients (23.0%) by bronchoscopy. ROSE improved diagnostic yield independent of the site and histology of the lesions and experience of the operators.
ROSE increased the diagnostic yield of bronchoscopy from 74.4% to 90.3% and therefore is an effective reinforcement in bronchoscopic diagnosis of peripheral pulmonary malignancies. The use of ROSE in routine bronchoscopy should be encouraged.
荧光镜引导下支气管镜检查是获取外周肺结节组织学或细胞学标本的一种安全且常规的方法，但在诊断恶性肿瘤方面敏感性较低。尽管快速细胞学检查的反馈有望提高诊断率，但常规使用快速细胞学检查的价值尚未确立。
我们前瞻性研究了2002年1月至2004年12月期间因胸部计算机断层扫描怀疑有外周恶性肺病变而接受荧光镜引导下支气管镜检查的657例患者。在支气管镜检查期间进行了快速现场细胞病理学检查（ROSE）。当ROSE被认为不能诊断时，在常规支气管镜检查后立即对病变采取额外的检查方法。
有528例患者被诊断为患有恶性病变。其中477例患者（90.3%）通过初次支气管镜检查确立了最终的恶性诊断。在这些患者中，84例（15.9%）仅通过ROSE的额外反馈得以诊断。在240个直径≤2 cm的外周病变中，174个被发现为恶性。没有ROSE时，110个（63.2%）外周恶性病变通过支气管镜检查得以诊断。ROSE的应用使我们能够通过支气管镜检查再诊断40例患者（23.0%）。ROSE提高了诊断率，且与病变的部位、组织学类型以及操作者的经验无关。
ROSE将支气管镜检查的诊断率从74.4%提高到了90.3%，因此是外周肺恶性肿瘤支气管镜诊断的一种有效辅助手段。应鼓励在常规支气管镜检查中使用ROSE。
