Zhang L, Gao T, Yu X D, He S, Xun H Y, Wang G Q
Dapartmnet of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Respiration and Critical Care Medicine, Xianyang Central Hospital, Xianyang 712000, China.
Zhonghua Zhong Liu Za Zhi. 2019 Feb 23;41(2):86-90. doi: 10.3760/cma.j.issn.0253-3766.2019.02.002.
To evaluate the diagnostic value of thin-slice CT navigation combined with cytology in routine preoperative bronchoscopy of peripheral pulmonary lesions and compare the diagnostic effects of different cytological sampling methods. The clinical data of peripheral lung cancer patients with preoperative bronchoscopy and cytology sampling guided by thin-slice CT from May 2015 to July 2016 in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. The diagnostic accuracy, sensitivity and specificity of different cytological sampling methods for peripheral pulmonary lesions guided by thin-slice CT were compared, the factors affected the diagnostic sensitivity were analyzed, and the complications induced by these methods were observed. The diagnostic sensitivity of thin-slice CT navigation combined with bronchoalveolar lavage for peripheral pulmonary lesions was 39.1%, and the positive diagnosis rate was 35.1%. The diagnostic sensitivity of thin-slice CT navigation combined with cell brush for peripheral pulmonary lesions was 51.7%, and the positive diagnosis rate was 46.4%. The diagnostic sensitivity of bronchoalveolar lavage combined with cell brush for peripheral pulmonary lesions was 57.5%, and the positive diagnosis rate was 51.5%. The positive diagnosis rate between brush sampling and bronchoalveolar lavage was statistically different (=0.01). No significant difference was observed in the diagnostic rate between cell brush and cell brush combined with bronchoalveolar lavage (=0.06). The factors affected diagnostic sensitivity of brush included the lesion location, size, and the relationship between the lesion and bronchial (all <0.05). When the size of the peripheral lung lesion >2 cm, the diagnostic sensitivity of thin-slice CT navigation combined with cell brush for peripheral pulmonary lesions was 73.6%. Its positive diagnosis rate was 68% and the specificity was 100%, respectively. Two cases of mild bleeding were observed, and hemorrhage was terminated by conservative treatment. Preoperative thin-slice CT navigation combined with cytological examination is an effective method for the diagnosis of peripheral pulmonary lesions, and the diagnostic efficiency of cell brush is higher than that of bronchoalveolar lavage, especially for the lesion size >2 cm.
评估薄层CT导航联合细胞学检查在周围型肺病变术前常规支气管镜检查中的诊断价值，并比较不同细胞学采样方法的诊断效果。回顾性分析2015年5月至2016年7月在中国医学科学院肿瘤医院接受术前支气管镜检查及薄层CT引导下细胞学采样的周围型肺癌患者的临床资料。比较薄层CT引导下不同细胞学采样方法对周围型肺病变的诊断准确性、敏感性和特异性，分析影响诊断敏感性的因素，并观察这些方法引起的并发症。薄层CT导航联合支气管肺泡灌洗对周围型肺病变的诊断敏感性为39.1%，阳性诊断率为35.1%。薄层CT导航联合细胞刷对周围型肺病变的诊断敏感性为51.7%，阳性诊断率为46.4%。支气管肺泡灌洗联合细胞刷对周围型肺病变的诊断敏感性为57.5%，阳性诊断率为51.5%。刷检采样与支气管肺泡灌洗之间的阳性诊断率有统计学差异（P=0.01）。细胞刷与细胞刷联合支气管肺泡灌洗之间的诊断率无显著差异（P=0.06）。影响刷检诊断敏感性的因素包括病变部位、大小以及病变与支气管的关系（均P<0.05）。当周围型肺病变大小>2 cm时，薄层CT导航联合细胞刷对周围型肺病变的诊断敏感性为73.6%。其阳性诊断率和特异性分别为68%和100%。观察到2例轻度出血，经保守治疗出血停止。术前薄层CT导航联合细胞学检查是诊断周围型肺病变的有效方法，细胞刷的诊断效率高于支气管肺泡灌洗，尤其对于病变大小>2 cm的情况。
