气管镜针吸术与气管镜毛刷在肺部肿块鉴别诊断中的应用

目的:评价经气管镜针吸术(TBNA)涂片与毛刷涂片(BB)对肺部肿块的诊断价值。方法:对156例肺部肿块患者行支气管镜检查,同时做针吸涂片和BB细胞学检查,结合形态和细胞免疫化学染色做出诊断,与术后病理组织学检查结果或临床诊断进行比较。结果:156例肺部肿块最终确诊为恶性肿瘤132例,非肿瘤性疾病13例,未确诊11例。132例恶性肿瘤中,TBNA诊断准确率为97.7%,而BB只有71.2%,两者差异有统计学意义,P<0.01。TBNA对中心型肺癌、周围型肺癌和纵隔肿瘤诊断准确率分别为98.4%、98.2%和92.3%,毛刷涂片相应数据为91.9%、64.9%和0,后两者差异有统计学意义。24例非肿瘤患者中有11例通过TBNA明确诊断,占最终明确诊断患者的84.6%(11/13),而BB仅确诊2例肺结核。结论:TBNA涂片细胞学检查在肺部肿块的鉴别诊断方面优于BB细胞学检查。

Transbronchial needle aspiration and bronchial brushing in diagnosis of lung diseases

OBJECTIVE:To evaluate the diagnostic value of transbronchial needle aspiration(TBNA)and bronchial brushing(BB)for lung lump masses.METHODS:TBNA and BB examinations were performed in 156 patients with lung lump masses.Cytologic diagnosis based on cell morphology and immunochemistry was made and compared with clinical diagnosis and/or postoperative histological diagnosis.RESULTS:In a total of 156 cases,132 were finally diagnosed as malignant tumor,13 nontumorous disease and 11 undetermined.For 132 cases of malignant tumor,the accuracy of TBNA was significantly higher than that of BB,they were 97.7% and 71.4% respectively.The accuracy of TBNA for central lung cancer,peripherial lung cancer and mediastinal mass were 98.4%,98.2%,92.3% respectively,while those of BB were 91.9%,64.9%,0 respectively.In 24 nonmalignant cases,13 were finally diagnosed and 84.6%(11/13)were finally diagnosed by TBNA.However BB could only determine 2 cases of lung tuberculosis of them.CONCLUSION:TBNA is better than BB in the differential diagnosis of lung lump mass.