肺病专家进行快速现场细胞学评估可提高经支气管超声引导下经支气管活检的诊断准确性。
Rapid on-site cytologic evaluation by pulmonologist improved diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy.
机构信息
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
出版信息
J Formos Med Assoc. 2020 Nov;119(11):1684-1692. doi: 10.1016/j.jfma.2020.01.001. Epub 2020 Jan 18.
BACKGROUND/PURPOSE: Rapid on-site cytologic evaluation (ROSE) has been shown to improve the diagnostic accuracy of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB). However, ROSE by a cytopathologist or cytotechnologist is not always available during the procedure. The purposes of this study were to verify that a pulmonologist, after receiving training in cytology, could accurately assess an EBUS-TBB specimen on-site, and to evaluate the contribution of ROSE to EBUS-TBB.
METHODS
A retrospective chart review of patients who underwent EBUS-TBB for diagnosis of peripheral pulmonary lesions (PPLs) from January 2014 to June 2017 was performed. PPLs without a malignant diagnosis were excluded. The ROSE result determined by a pulmonologist was compared to the formal imprint cytologic report and pathologic report. The diagnostic accuracy of EBUS-TBB was also compared between those with and without ROSE.
RESULTS
Two hundred ninety-three patients who underwent 336 EBUS-TBB procedures for PPL diagnosis and were found to have proven malignancy were enrolled. Eighty-six procedures were performed with ROSE. With the formal imprint cytologic diagnosis as the standard, ROSE had 96.9% sensitivity, 68.2% specificity, 89.9% positive predictive value (PPV), 88.2% negative predictive value (NPV), and 89.5% diagnostic accuracy. With the formal pathologic result as the standard, ROSE had 88.2% sensitivity, 80% specificity, 97.1% PPV, 47.1% NPV, and 87.2% diagnostic accuracy, respectively. The diagnostic accuracy was significantly higher when ROSE was performed during EBUS-TBB (88.4% vs 68.0%, P < 0.001).
CONCLUSION
A trained pulmonologist can interpret adequately cytologic smears on-site and effectively improve the accuracy of EBUS-TBB in the diagnosis of PPLs.
背景/目的：快速现场细胞学评估（ROSE）已被证明可提高经支气管超声引导下经支气管针吸活检（EBUS-TBB）的诊断准确性。然而，在该过程中并非始终有细胞病理学家或细胞技术专家进行 ROSE。本研究的目的是验证经过细胞学培训的肺病专家是否能够准确评估 EBUS-TBB 标本，并评估 ROSE 对 EBUS-TBB 的贡献。
方法
对 2014 年 1 月至 2017 年 6 月期间因周围性肺病变（PPL）接受 EBUS-TBB 检查的患者进行了回顾性图表审查。排除未明确诊断为恶性的 PPL 患者。由肺病专家确定的 ROSE 结果与正式印片细胞学报告和病理报告进行了比较。还比较了有 ROSE 和无 ROSE 的 EBUS-TBB 诊断准确性。
结果
纳入了 293 名因 PPL 诊断而接受 336 次 EBUS-TBB 检查并被证实患有恶性肿瘤的患者。86 例进行了 ROSE。以正式印片细胞学诊断为标准，ROSE 的敏感性为 96.9%，特异性为 68.2%，阳性预测值（PPV）为 89.9%，阴性预测值（NPV）为 88.2%，诊断准确性为 89.5%。以正式病理结果为标准，ROSE 的敏感性为 88.2%，特异性为 80%，PPV 为 97.1%，NPV 为 47.1%，诊断准确性为 87.2%。当在 EBUS-TBB 过程中进行 ROSE 时，诊断准确性显著提高（88.4% vs 68.0%，P<0.001）。
结论
经过培训的肺病专家可以现场充分解读细胞学涂片，并有效地提高 EBUS-TBB 诊断 PPL 的准确性。
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