Thivolet-Béjui F
Laboratoire d'Anatomie et de Cytologie pathologiques, Hôpital de la Croix Rousse, Lyon, France.
Arch Anat Cytol Pathol. 1997;45(5):249-53.
Bronchopulmonary cytopathology is an already old diagnostic method for lung tumours. Its has been the subject of renewed interest following the development of techniques which complete brushing and aspiration by bronchial fibroscopy such as bronchoalveolar lavage, transthoracic pulmonary fine needle biopsy and transbronchial and transtracheal needle biopsy. Diagnostic difficulties depend on both the tumour type and the biopsy technique. Keratinizing squamous cell carcinoma is difficult to distinguish from dyskeratotic cells on aspiration cytology and inflammatory and granulomatous necrosis on transparietal lung biopsy. Non-keratinizing squamous cell carcinoma must not be confused with atypical metaplastic cells on bronchial brushing. Bronchioloalveolar carcinoma must be distinguished from reactivated bronchioloalveolar cells on bronchial aspiration; pulmonary adenocarcinoma must not be confused with atypical bronchiolar cell hyperplasia on transparietal lung biopsy. The naked nuclei of small cell carcinoma on bronchial brushing and transparietal lung biopsy differ from those of malignant small cell lymphoma and carcinoid. Bronchopulmonary cytopathology is able to diagnose the main types of bronchial and pulmonary tumours with a good sensitivity. The overall sensitivity of detection is excellent, ranging between 90 and 92% depending on the method. The false-positive rate is less than 0.5% for experienced cytopathologists.
支气管肺细胞病理学是一种用于诊断肺部肿瘤的古老方法。随着支气管纤维镜检查技术的发展，如支气管肺泡灌洗、经胸肺细针穿刺活检以及经支气管和经气管针吸活检等技术的出现，该方法重新受到关注。诊断困难既取决于肿瘤类型，也取决于活检技术。在针吸细胞学检查中，角化型鳞状细胞癌难以与角化不良细胞区分，在经胸肺活检中难以与炎症和肉芽肿性坏死区分。在支气管刷检中，非角化型鳞状细胞癌绝不能与非典型化生细胞混淆。在支气管针吸检查中，细支气管肺泡癌必须与重新激活的细支气管肺泡细胞区分；在经胸肺活检中，肺腺癌绝不能与非典型细支气管细胞增生混淆。支气管刷检和经胸肺活检中小细胞癌的裸核与恶性小细胞淋巴瘤和类癌的裸核不同。支气管肺细胞病理学能够以较高的敏感性诊断主要类型的支气管和肺部肿瘤。总体检测敏感性极佳，根据方法不同，介于90%至92%之间。对于经验丰富的细胞病理学家来说，假阳性率低于0.5%。
