支气管镜诊断可见的肺部恶性肿瘤：是否应常规进行细胞学检查？

Bronchoscopic diagnosis of endoscopically visible lung malignancies: should cytological examinations be carried out routinely?

机构信息

Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.

出版信息

Intern Med J. 2009 Dec;39(12):806-11. doi: 10.1111/j.1445-5994.2008.01882.x.

DOI:10.1111/j.1445-5994.2008.01882.x

PMID:20233241

Abstract

BACKGROUND

The aim of this study was to determine the diagnostic yield of flexible bronchoscopy in endoscopically visible malignancies and to evaluate whether cytological examination, including bronchial washings and brushings, increase the diagnostic yield compared with bronchial biopsy alone.

METHODS

We reviewed a series of bronchoscopies over a period of 7.5 years in which an endoscopically visible tumour was identified and which had a definite cytological or histological diagnosis of pulmonary malignancy obtained by bronchoscopy or any other examination.

RESULTS

The criteria were met by 174 bronchoscopies. In 155 bronchoscopies all specimens including bronchial washings, brushings and biopsies were obtained; the overall diagnostic yield was 88%. This compared with a diagnostic yield of 77% for biopsies only (P < 0.001). The individual diagnostic yields for biopsies, brushings and washings were 77, 50 and 38%, respectively. The overall diagnostic yield of cytology was 61%, providing a diagnosis in 95 patients. Of 11 repeat bronchoscopies after an initial non-diagnostic bronchoscopy, 9 were diagnostic.

CONCLUSION

The tumour detection rate with flexible bronchoscopy in endoscopically visible lung malignancies is high. Cytology-based sampling techniques by means of bronchial washings and brushings significantly increase the overall diagnostic yield compared with forceps biopsy only. Repeat bronchoscopies after an initial non-diagnostic bronchoscopy have a relatively high diagnostic yield and should therefore be considered in all patients with endoscopically visible tumour.

摘要

背景

本研究旨在确定在可见的内镜下恶性肿瘤中进行纤维支气管镜检查的诊断率，并评估细胞学检查（包括支气管灌洗和刷检）是否比单纯支气管活检更能提高诊断率。

方法

我们回顾了在 7.5 年的时间里进行的一系列支气管镜检查，这些检查中发现了内镜下可见的肿瘤，并且通过支气管镜或任何其他检查获得了明确的肺癌细胞学或组织学诊断。

结果

174 例支气管镜检查符合标准。在 155 例支气管镜检查中，所有标本（包括支气管灌洗、刷检和活检）均获得；总体诊断率为 88%。与仅活检的诊断率 77%相比（P<0.001），这一诊断率有所提高。活检、刷检和灌洗的单独诊断率分别为 77%、50%和 38%。细胞学的总体诊断率为 61%，95 例患者得到诊断。在初始非诊断性支气管镜检查后进行的 11 例重复支气管镜检查中，9 例为诊断性检查。