Savjak D, Medenica M
Klinicko-bolnicki centar Crne Gore, Podgorica.
Med Pregl. 1998 Sep-Oct;51(9-10):431-5.
During the last 20 years routine application of various methods of multiple "small biopsies" of the lungs such as forceps, transbronchial, trucut percutaneous and so on, has significantly increased the efficacy of diagnostics of bronchopulmonary and pleural diseases. Tissue samples, not bigger than 3-4 mm, in which diagnostic pathological changes are expected on the basis of previous clinical, radiological and bronchoscopic examinations, can be the basis for making a definite therapeutical decision only if a skillful surgeon has performed the biopsy by correct instruments and from the right place and sent it for histological analysis with other important clinical information. This study is a comment on quality, significance and possibilities of improving clinical-pathological cooperation in this field of clinical pathology.
By correlation of clinical and histological diagnoses we analyzed the diagnostic efficiency of microscopic examinations of "small biopsies" of the respiratory tract in 319 patients (175 bronchial forceps biopsies, 31 transbronchial biopsies, 22 percutaneous needle pleural biopsies and 91 combined forceps and transbronchial biopsies) in whom biopsies were performed during 1996 in the Specialized Hospital for Lung Diseases Brezovik.
Overall concordance between the clinical and histopathological diagnosis was 82.2%. In 99 cases (73.3%) out of 135 clinically "obvious" neoplasms, the histopathological examination confirmed existence of malignant tumor: squamous cell carcinoma in 80%, small cell carcinoma in 9.6% and adenocarcinoma in 5.6% of patients. In other patients it was not possible to perform a more precise classification. Endoscopic specimens of 29 patients (9.1%) were not representative.
The level of diagnostic efficiency (73.3%) of definitive histopathological verification of bronchopulmonary lesions, which have been clinically diagnosed as malignancies, is rather high, but the increase of diagnostic efficiency requires application of more sophisticated histological diagnostic methods (immunohistochemical) and more frequent utilization of bioptic procedures which are more convenient for detection of peripheral pulmonary lesions (transbronchial and percutaneous fine needle aspiration biopsies of the lungs).
在过去20年中，多种肺部“小活检”方法（如钳取活检、经支气管活检、经皮切割活检等）的常规应用显著提高了支气管肺和胸膜疾病的诊断效率。仅当技术娴熟的外科医生使用正确的器械从正确的部位进行活检，并将其与其他重要临床信息一起送检进行组织学分析时，预期基于先前临床、放射学和支气管镜检查会出现诊断性病理改变的不大于3 - 4毫米的组织样本，才能作为做出明确治疗决策的依据。本研究是对临床病理学这一领域中提高临床 - 病理合作的质量、意义及可能性的评论。
通过临床诊断与组织学诊断的相关性分析，我们对1996年在布雷佐维克肺病专科医院接受活检的319例患者（175例支气管钳取活检、31例经支气管活检、22例经皮针吸胸膜活检以及91例钳取活检与经支气管活检联合应用）的呼吸道“小活检”显微镜检查的诊断效率进行了分析。
临床诊断与组织病理学诊断的总体一致性为82.2%。在135例临床“明显”的肿瘤中，99例（73.3%）经组织病理学检查证实存在恶性肿瘤：鳞状细胞癌占患者的80%，小细胞癌占9.6%，腺癌占5.6%。在其他患者中无法进行更精确的分类。29例患者（9.1%）的内镜标本不具有代表性。
对于临床诊断为恶性肿瘤的支气管肺病变，最终组织病理学验证的诊断效率水平（73.3%）相当高，但提高诊断效率需要应用更复杂的组织学诊断方法（免疫组织化学），并更频繁地使用对检测周围肺部病变更方便的活检程序（经支气管和经皮肺细针穿刺活检）。
