肺癌诊断中支气管刷检和钳取活检的最佳顺序：一项随机对照研究。
The optimal sequence for bronchial brushing and forceps biopsy in lung cancer diagnosis: a random control study.
作者信息
Hou Gang, Miao Yuan, Hu Xue-Jun, Wang Wei, Wang Qiu-Yue, Wu Guang-Ping, Wang En-Hua, Kang Jian
机构信息
1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.
出版信息
J Thorac Dis. 2016 Mar;8(3):520-6. doi: 10.21037/jtd.2016.02.12.
BACKGROUND
Optimizing basic techniques in diagnostic bronchoscopy is important for improving medical services in developing countries. In this study, the optimal sequence of bronchial brushing relative to bronchial biopsy for lung cancer diagnosis was evaluated.
METHODS
A total of 420 patients with visible endobronchial tumors were prospectively and randomly enrolled in two groups: a pre-biopsy brushing group, receiving two brushings before biopsy; two brushings which performed afterwards; were set as self-control and compared with the pre-biopsy brushings as the intra-group comparison; and a post-biopsy brushing group, only receiving two brushings after biopsy, which were compared with the pre-biopsy brushings as the inter-group comparison. Diagnostic yield of brushing was compared before and after biopsy, and as well as for different tumor pathologies and bronchoscopic morphologies. The occurrence of treated bleeding which defined as bleeding needed further intervention with argon plasma coagulation and/or anti-coagulation drugs in two groups was also compared.
RESULTS
Only patients with a definitive cytological or histological diagnosis of lung cancer based on bronchoscopy or other confirmatory techniques were included. Patients were excluded if they had submucosal lesions, extrinsic compressions, pulmonary metastasis of extrapulmonary malignancies or uncommon non-small cell lung carcinoma (NSCLC). A total of 362 patients who met the inclusion criteria were analyzed. Diagnostic yield for pre-biopsy brushing (49.2%, 88/179) was significantly higher than for post-biopsy brushing within the same pre-biopsy brushing group (31.8%, 57/179) (P=0.007) as the intra-group comparison, and significantly higher than for post-biopsy brushing in the post group (30.6%, 56/183) (P<0.001) as the inter-group comparison. No difference in occurrence of treated bleeding for pre- vs. post-biopsy bronchial brushing was found.
CONCLUSIONS
Supplementing bronchoscopic forceps biopsy with brushing improves diagnostic yield in lung cancer. In cases of endobronchial exophytic tumors, pre-biopsy brushing appears to be superior to post-biopsy brushing.
背景
优化诊断性支气管镜检查的基本技术对于改善发展中国家的医疗服务至关重要。在本研究中，评估了支气管刷检相对于支气管活检在肺癌诊断中的最佳顺序。
方法
共有420例可见支气管内肿瘤患者被前瞻性随机分为两组：活检前刷检组，在活检前进行两次刷检；之后进行的两次刷检作为自身对照，并与活检前刷检进行组内比较；活检后刷检组，仅在活检后进行两次刷检，与活检前刷检进行组间比较。比较活检前后刷检的诊断阳性率，以及不同肿瘤病理类型和支气管镜形态的诊断阳性率。还比较了两组中定义为需要氩等离子体凝固和/或抗凝药物进一步干预的治疗性出血的发生率。
结果
仅纳入基于支气管镜检查或其他确诊技术获得明确肺癌细胞学或组织学诊断的患者。如果患者有黏膜下病变、外部压迫、肺外恶性肿瘤的肺转移或罕见的非小细胞肺癌（NSCLC），则将其排除。共分析了362例符合纳入标准的患者。作为组内比较，同一活检前刷检组中活检前刷检的诊断阳性率（49.2%，88/179）显著高于活检后刷检（31.8%，57/179）（P = 0.007），作为组间比较，显著高于活检后刷检组中活检后刷检的诊断阳性率（30.6%，56/183）（P < 0.001）。未发现活检前后支气管刷检的治疗性出血发生率有差异。
结论
支气管镜钳夹活检联合刷检可提高肺癌诊断阳性率。对于支气管内外生性肿瘤，活检前刷检似乎优于活检后刷检。
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