Pulmonary Medicine, MIMSR Medical College Latur, Latur, Maharashtra, India,
J Cancer Res Clin Oncol. 2014 May;140(5):809-15. doi: 10.1007/s00432-014-1602-x. Epub 2014 Feb 16.
Lung cancer is the leading cause of cancer deaths around the world. Globally, lung cancer is the largest contributor to new cancer diagnosis and to death from cancer. Various conventional diagnostic techniques (CDTs) such as endobronchial forcep biopsy (FB), bronchial washing (BW) and bronchial brushing (BB), and transbronchial needle aspiration cytology (TBNA) are employed during fiber-optic bronchoscopy.
This is a prospective study conducted between June 2012 and September 2013 at Bronchoscopy unit of MIMSR Medical College Latur, India, to find the role of TBNA in exophytic endobronchial lesions in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BB, BW and FB, and included 150 patients on the basis of clinical and radiological features of malignancy. In exophytic endobronchial lesions, predominant endoscopic findings were cauliflower, polypoidal-like or nodular or multinodular endobronchial growth. TBNA, FB, BB and BW were performed in all the cases during FOB. Histopathological and cytological examinations of specimens were performed at Pathology department. The statistical analysis was done using chi-square test.
Total 150 patients, between age group 24-80 years, mean age was 57.93 years, male population constitutes 86.17 % of total. 76.14 % cases were smoker of them 61.87 % cases having history of >40 pack years. Commoner symptoms were cough (91.33 %), hemoptysis (54.00 %) and chest pain (46.66 %), and mass lesion (40.66 %), hilar opacity (31.33 %) and collapse segmental/lobar (29.33 %) were commoner radiological abnormalities. Yield of TBNA, CDT and TBNA plus CDT in exophytic lesions is 60.66, 79.33 and 84.66 %, respectively, in diagnosis of lung malignancies (P < 0.001). Sensitivity of forcep biopsy and TBNA in diagnosing lung malignancy was 88.18 and 71.65 %, respectively (P < 0.01). FOB-related hypoxemia documented in two cases and minor bleeding in six cases. Other complications such as significant bleeding, pneumothorax and death were not seen. Minor bleeding was seen with forcep biopsy mainly in 4.0 % cases. TBNA has decreased repeat procedure, decreases cost for diagnosis. IHC on TBNA specimens had increased histological-type confirmation.
Transbronchial needle aspiration is a beneficial, safe and minimally invasive bronchoscopic technique with insignificant side effect in the diagnosis bronchogenic carcinoma. TBNA considered safe, especially when fleshy vascular endobronchial growth is present and risk of bleeding is high with forcep biopsy. Inadequate tissue sampling due to the presence of necrosis, blood clot over the lesion and formation of crush artifacts by FB makes TBNA valuable in these lesions. TBNA will definitely decrease need for repeat bronchoscopy.
肺癌是全球癌症死亡的主要原因。在全球范围内，肺癌是新诊断癌症病例和癌症死亡人数最多的癌症。在纤维支气管镜检查期间，使用各种常规诊断技术（CDTs），如支气管内活检钳（FB）、支气管灌洗（BW）和支气管刷检（BB）以及经支气管针吸细胞学（TBNA）。
这是 2012 年 6 月至 2013 年 9 月在印度拉杜尔 MIMSR 医学院支气管镜检查室进行的一项前瞻性研究，旨在探讨 TBNA 在确认肺癌诊断中外生型支气管内病变中的作用，并发现其与 BB、BW 和 FB 等其他技术相比的附加产量，并根据恶性肿瘤的临床和影像学特征纳入了 150 例患者。在外生型支气管内病变中，主要的内镜表现为菜花状、息肉样或结节状或多结节状支气管内生长。在 FOB 期间，所有病例均进行 TBNA、FB、BB 和 BW。标本的组织病理学和细胞学检查在病理科进行。使用卡方检验进行统计分析。
总共 150 例年龄在 24-80 岁之间的患者，平均年龄为 57.93 岁，男性占总人数的 86.17%。76.14%的患者为吸烟者，其中 61.87%的患者吸烟超过 40 包年。常见症状为咳嗽（91.33%）、咯血（54.00%）和胸痛（46.66%），肿块病变（40.66%）、肺门阴影（31.33%）和肺段/肺叶塌陷（29.33%）为常见的影像学异常。TBNA、CDT 和 TBNA 加 CDT 在诊断肺癌中外生病变的检出率分别为 60.66%、79.33%和 84.66%（P<0.001）。钳夹活检和 TBNA 诊断肺癌的敏感性分别为 88.18%和 71.65%（P<0.01）。在 2 例患者中记录到纤维支气管镜检查相关的低氧血症，在 6 例患者中记录到轻微出血。未观察到其他并发症，如严重出血、气胸和死亡。主要在 4.0%的病例中观察到钳夹活检后的轻微出血。TBNA 减少了重复操作，降低了诊断成本。TBNA 标本的免疫组化增加了组织学类型的确认。
经支气管针吸术是一种有益、安全和微创的支气管镜检查技术，对支气管癌的诊断具有轻微的副作用。TBNA 被认为是安全的，特别是当存在肉质血管性支气管内生长且 FB 引起的出血风险较高时。由于存在坏死、病变上的血凝块和 FB 形成的压碎伪影，导致组织取样不足，使 TBNA 在这些病变中具有价值。TBNA 肯定会减少重复支气管镜检查的需要。
