经纤支镜刷检新柏氏薄层细胞学技术在肺癌诊断中的应用

目的探讨经纤维支气管镜（以下简称纤支镜）刷检新柏氏薄层细胞学技术在肺癌诊断及分型中的应用价值。方法对比分析397例经纤支镜检查活检或刷检或活检加刷检细胞学与病理确诊为肺癌患者的病理诊断情况。结果397例患者中，经活检确诊肺癌300例，占75．6％，经刷检单独确诊肺癌97例，占24．4％，活检与刷检细胞学及组织学均确诊并完全符合284例（71．5％）；二者不符合113例（28．5％）。经活检确诊肺癌300例中有16例（占4％）与刷检不符合。结论经纤支镜刷检新柏氏薄层细胞学技术对肺癌的诊断及分型有极大的价值，经纤支镜活检联合刷检新柏氏薄层细胞学技术明显提高了肺癌诊断的阳性率。     

多种手段在肺部肿瘤诊断中的应用分析

目的探讨纤维支气管镜(纤支镜)刷检/针吸/活检、肺穿刺组织病理学/细胞学与痰液细胞学在肺部肿瘤诊断中的应用。方法纤支镜在病变部位刷片、针吸或活检;CT引导下肺部病变部位穿刺;取晨痰或新鲜痰液涂片作细胞学检查。结果本组617例患者,经临床或病理学确诊为肺癌患者525例,应用纤支镜、肺穿刺及痰液细胞学诊断肺癌432例,占82.3%;其中纤支镜刷检/针吸/活检阳性318例,占60.6%;肺穿刺阳性108例,占20.6%;痰液细胞学阳性104例,占19.8%(其中痰液细胞学单独阳性者6例,占1.1%)。结论纤维支气管镜刷检/针吸/活检与CT引导下肺穿刺组织病理学/细胞学检查,在肺部肿瘤的诊断中有重要的应用价值;痰细胞学检查简便易行,可作为纤支镜检查阴性和不能耐受纤支镜检查的肺癌患者的补充手段,在肺部肿瘤的筛查中有重要的意义。多种手段联合检查,可进一步提高肺部肿瘤诊断的阳性率。     

纤支镜中多种检查在周围型肺癌的诊断价值

目的探讨非直视经纤支镜肺活检联合细胞学检查在周围型肺癌的诊断价值。方法将本院100例最终确诊为周围型肺癌患者的资料进行总结分析。结果 100例患者中非直视经纤支镜肺活检(TBLB)阳性59例,占59%;支气管肺泡灌洗(BALF)阳性25例,占25%;刷片阳性22例,占22%;痰检阳性12例,占12%。TBLB+BALF+刷片法+痰检法阳性74例,占74%。结论非直视经纤支镜肺活检联合细胞学检查对周围型肺癌有较高诊断价值。     

纤维支气管镜刷检结合液基细胞学检查在肺癌诊断中的价值

目的探讨液基细胞学检查(liquid based cytology test,LCT)在肺癌支气管镜刷检检查中的应用价值。方法分析我院353例肺癌患者,对比气管镜刷检传统涂片细胞学检查和刷检液基细胞学检查和组织学检查,进行分型归纳,计算敏感度和分型符合率。结果液基细胞学诊断肺癌的敏感度为73.65%,传统涂片诊断肺癌的敏感度为60.34%,两者差异有统计学意义。纤支镜刷检液基细胞学诊断肺癌分型与组织学活检病理有较高的一致性。其中鳞癌68.82%,腺癌84.69%,小细胞癌70.75%,大细胞癌75%;均优于传统涂片。结论将液基细胞学技术运用于纤维支气管镜刷检细胞学检查可以提高支气管刷检诊断肺癌的阳性率,而且与肺癌组织学分型的符合率较高。     

纤维支气管镜刷检细胞学检查诊断肺癌的价值及影响因素分析

目的探讨纤维支气管镜（纤支镜）刷检细胞学检查诊断肺癌的敏感性、特异性及相关影响因素。方法以手术切除和（或）经纤支镜钳取活检组织病理学诊断结果为标准,对143例可疑肺癌患者的纤支镜刷检细胞学检查结果、涂片质量及纤支镜下表现等进行分析。结果以高级别异型增生及以上级别报告为阳性结果,纤支镜刷检细胞学检查诊断肺癌的敏感性为66．7％、特异性为96．6％;纤支镜活检和刷检结合肺癌检出率为89．3％,显著高于单纯刷检（P〈0．01）、显著低于组织病理学检查（P〈0．05）;纤支镜刷检肺癌检出率退变标本和未退变标本分别为25．0％．72．0％（P〈0．05）,中央型肺癌和非中央型肺癌分别为72．1％、43．8％（P〈0．05）,增生型、管壁浸润型、管外压迫型和正常型分别为81．4％、70．0％、22．2％、41．7％（P〈0．01）。结论纤支镜刷检细胞学检查简便、快捷,诊断肺癌特异性及敏感性均较高,与纤支镜钳取活检联用可提高肺癌检出率;但纤支镜刷检结果受标本质量、肺癌部位和纤支镜下分型等影响,临床医师要综合分析临床资料、排除假阴性。     

纤支镜下刷检联合液基超薄细胞技术在周围型肺癌中的诊断价值

目的用纤支镜下刷检联合液基超薄细胞技术(TCT)在周围型肺癌临床诊断中的价值进行评价。方法2006年4月至2009年4月对胸片,胸部CT及纤支镜诊断周围型肺占位进行刷检,刷检物进行TCT及普通诊断细胞学分类。结果86例周围型占位经TCT技术发现为肺癌22例,普通刷检巴氏涂片确诊为肺癌4例,前者阳性率22.56%,后者为4.69%。结论TCT技术对周围型肺癌的诊断价值较好,明显优于普通刷检巴氏片镜检。     

纤维支气管镜刷检和/或活检确诊肺癌病人194例分析

目的　探讨纤维支气管镜(纤支镜)刷检、活检和痰检对肺癌的诊断价值。方法　对1 94例肺癌病人的检查结果进行回顾性分析。结果　1 94例肺癌病人,刷检、活检共同确诊1 2 1例,仅由活检确诊33例,仅由刷检确诊40例。纤支镜术后痰检阳性53例,提高阳性率2 1 .7% (2 0 / 92 )。结论　应用纤支镜刷检、活检和痰检等多种手段,可提高肺癌诊断率。     

经纤支镜诊断46例支气管结核临床分析

目的　探讨纤维支气管镜在支气管内膜结核早期诊断中的作用。方法　 1995年 1月～ 2 0 0 2年 12月经纤维支气管镜 (纤支镜 )活检或刷检确诊支气管内膜结核 4 6例患者进行临床特点和纤支镜结果统计分析。结果　 4 6例病人均证实为支气管内膜结核。 8例痰涂片找抗酸杆菌阳性 ,38例行纤支镜刷检找抗酸杆菌阳性 ,11例活检证实为结核。纤支镜检查示炎症浸润型 4 1.3% ,增殖型 13.0 % ,狭窄闭塞型 2 6 .1% ,溃疡型 15 .3% ,正常 4 .3% ,纤支镜刷检阳性率高于痰涂片检查和活检 (P<0 .0 1)。结论　支气管内膜结核缺乏特异性临床表现 ,X- CT诊断价值不高 ,纤支镜检查成为支气管内膜结核早期诊断的主要措施。     

抗酸染色对肺结核的诊断价值

目的 了解结核分枝杆菌抗酸染色对肺结核的诊断价值。方法对98例确诊为继发型肺结核和血行播散型肺结核患者,统计分析痰液及纤支镜刷检液涂片抗酸染色情况。结果98例中抗酸染色阳性38例,阴性60例。10例经纤支镜刷检液涂片抗酸染色中,阳性6例。结论抗酸染色是诊断肺结核的常规方法,纤支镜刷检液涂片明显高于痰涂片法。     

经纤维支气管镜不同取材方法对肺癌的诊断价值

目的评价纤维支气管镜(纤支镜)下不同取材方法对肺癌诊断的价值,探讨纤支镜下联合采用多种取材方法对肺癌诊断的临床意义。方法分析130例肺癌患者的纤支镜检查结果,比较钳检、刷检、经纤支镜肺活检(TBLB)、单纯经纤支镜针吸活检(TBNA)、支气管肺泡灌洗(BAL)及联合取材方法诊断肺癌的阳性率。结果 130例肺癌经纤支镜确诊122例,镜下分为六型:中央增生型、中央浸润型、中央外压型、中央正常型、周围增生浸润型、周围外压正常型;钳检、刷检、TBLB、TBNA、BAL的阳性率分别为83.33%、56.92%、50.00%、67.35%、42.31%,钳检阳性率明显高于另4种单一方法取材(P0.05);不同镜下类型分别采用刷检联合其他4种方法检查的总阳性率为93.85%(122/130),平均阳性率为89.99%;不同取材方法对不同镜下类型肺癌的检出不同。结论根据镜下特点的不同采取不同经纤支镜取材方法、重视钳检、积极开展TBLB、TBNA、联合多种取材方法可提高肺癌的病理学诊断率。     

支气管肺泡灌洗液细胞DNA含量分析在周围型肺癌中的诊断价值

目的探讨支气管肺泡灌洗液细胞DNA含量分析对周围型肺癌的诊断价值。方法采用全自动细胞DNA定量分析系统,对31例周围型肺癌及20例肺良性病变患者的支气管肺泡灌洗液细胞作DNA含量分析,并与纤维支气管镜活检和刷检比较。结果灌洗液细胞DNA含量分析诊断周围型肺癌的敏感性为67．7％,特异性为95．0％,显著高于活检（29．0％）和刷检（32．3％）的阳性率（P均〈0.01）。结论支气管肺泡灌洗液细胞DNA含量分析是诊断周围型肺癌有效的辅助方法。     

多种活检在周围型肺癌诊断中的应用

目的研究CT引导下经皮肺活检（CT-PLB）与经支气管镜肺活检（TBLB）或经支气管针吸活检（TBNA）在周围型肺癌诊断中的应用。方法对143例周围型肺癌患者的诊断方法进行分析,其中137例通过单用或联合采用CT-PLB、TBLB、TBNA等检查手段取得病理学诊断,6例为术后病理学诊断。结果 CT-PLB确诊率为85.4%,TBLB确诊率为68.4%,TBNA确诊率为80%,联合应用总确诊率为95.8%。结论对于肺周围型病变,根据病灶大小、位置、与胸壁距离、有否纵隔淋巴结转移等具体情况选择合适的活检方式可取得病理学诊断,多种方法联合应用可提高检出率。     

Cytological examination of the whole endobronchial brush in bronchoscopic diagnosis of lung cancer

The combination of cytological and histological techniques has significantly increased the accuracy of fibreoptic bronchoscopy (FOB) in the diagnosis of lung cancer. We tested the hypothesis that cytological examination of material obtained from the whole endobronchial brush might increase the diagnostic yield in patients where conventional brush specimens were negative. Fifty patients who had undergone FOB for suspected lung cancer were studied prospectively. Bronchial lavage, bronchial biopsy and conventional brushing were performed. The whole endobronchial brush was then cut off the end of its wire and transported in a universal pot containing Shandon cytospin collection fluid. The material was dislodged from the whole brush using a vortex and the remaining fluid was centrifuged at 2,000 r.p.m. The fluid concentrate was used to maketwo cytopsin preparations. Papanicolaou stain was used. Fifty patients were studied, of which thirty-nine (78%) had endoscopicaly visible tumour. Of those, bronchial biopsy conventional brushing lavage and whole brush were positive for malignant cells in 31 (79.4%), 29 (74.3%), 21 (53.8%), and 16 (41%) of cases, respectively. A diagnosis of lung cancer was confirmed in 35 (89.7%) cases of endoscopicaly visible tumour. Conventional brushing was positive in two out of 11 (18.2%) cases with no visible tumour. Whole brush analysis was not positive in any of the cases with negative conventional brushings and was the least sensitive test in detecting malignancy Whole endobronchial brush analysis has no advantage in bronchoscopic diagnosis of patients with suspected lung cancer.     

闭式胸膜活检加胸膜刷检在胸腔积液中的诊断价值

目的探讨闭式胸腔穿刺胸膜活检同时胸膜刷检在渗出性胸腔积液中的诊断价值。方法对87例渗出性胸腔积液患者,同时行闭式胸膜活检术与胸膜刷检术。结果 87例患者,胸膜活检113次,成功率92.9%(105/113),病因诊断阳性率为70.1%(61/87)。胸膜刷检112次,成功率73.2%(82/112),病因诊断阳性率为60.0%(52/87)。胸膜活检病因诊断阳性率虽高于胸膜刷检,但差异无统计学意义(P0.05)。有11例患者胸膜活检病因诊断阴性,胸膜刷检阳性;有20例患者胸膜刷检病因诊断阴性,但胸膜活检阳性。胸膜活检同时胸膜刷检,病因诊断阳性率提高至82.8%(72/87),高于单独胸膜活检及单独胸膜刷检(均P0.05)。87例患者胸膜检查时发生胸膜反应3例(2.7%),气胸4例(3.5%)。结论经皮胸膜活检与胸膜刷检均是渗出性胸腔积液病因诊断的重要手段,相对安全。胸膜活检同时胸膜刷检有更高的病因诊断阳性率,在渗出性胸腔积液的临床诊断中具有重要价值。     

Bronchoscopic Brushing from Central Lung Cancer—Next Generation Sequencing Results are Reliable

The role of bronchoscopic brushing for tumor detection and molecular testing in central lung cancer is unclear. In this study, 50 consecutive subjects with suspected central lung cancer underwent bronchoscopic brushing (31 males, median age 70, 5 never smokers). Histological results were: NSCLC/SCLC/low-grade-NET/granulation tissue in 36/8/2/4 cases. Next generation sequencing (NGS) was feasible in 62% of tumor-positive brush smear samples. In 78% of these cases, NGS displayed identical results compared to histology samples, in 22% NGS from brush smears detected specific mutations, whereas DNA quality from forceps biopsy was insufficient for NGS analysis. Sensitivity, specificity, positive predictive value, negative predictive value of brush smear analysis were 66% (95% confidence interval 50–79), 100% (40–100), 100% (85–100), and 21% (7–46). For the combined analysis of brush smear, brush tip washing and sheath tube content sensitivity was slightly elevated at 69% (53–81). In central lung cancer, bronchoscopic brushing detects tumor cells in about two-third of cases and allows a decision for or against targeted therapy in the majority of tumor-positive cases on the basis of NGS analysis.

     

纤支镜活刷检标本DNA含量的流式细胞仪分析

本文采用纤维支气管镜（纤支镜）技术，对２６例中心型支气管肺癌（肺癌）进行活检和刷检，并将活检和刷检标本制成单细胞悬液，用流式细胞仪测定其ＤＮＡ含量。结果提示，新鲜肺癌组织中异倍体检出率明显增加，异倍体的出现多与恶性肿瘤存在有关。本文认为，行纤支镜活检和刷检中的任何一项检查，多可获得阳性结果；与活检比，刷检操作更简便，对组织损伤小，出血和并发症少，可弥补管壁浸润型肺癌不易获得活检标本之不足，具有相当大的实用价值。     

支气管镜冷冻活检在肺癌诊断中的临床研究

目的探讨支气管镜冷冻活检在肺癌诊断中的临床价值及安全性。方法回顾性分析了49例支气管腔内肿瘤病灶经支气管镜冷冻活检的病理结果,并与支气管灌洗、活检针吸、毛刷刷检、活检钳夹的病理结果进行比较,观察冷冻活检与其他传统病理取材方式的出血情况及其处置措施。结果冷冻活检能够获取符合病理检查要求的标本,冷冻活检的肺癌阳性检出率为93.87%,显著高于活检钳夹(P0.05),非常显著高于支气管灌洗、活检针吸、毛刷刷检(P0.001)。冷冻活检的主要风险为冻切创面出血,一般止血措施即能有效控制。结论冷冻活检是支气管腔内肺癌病灶的重要病理取材新技术,肺癌阳性检出率高,可为肺癌确诊提供病理学依据。及时有效防治创面出血,经支气管镜冷冻活检比较安全。     

成人血行播散性肺结核202例临床及影像分析

目的通过对血行播散性肺结核临床资料的分析,提高对该病的认识。方法回顾性分析1998—2008年收治的成人血行播散性肺结核202例的临床资料、影像学特点、误诊情况及治疗反应。结果（1）中青年患者占80.2%, 老年患者占19.8%。（2）痰涂片查抗酸杆菌（AFB)阳性率为20.7%;31例AFB阴性患者中35.5%纤维支气管镜检抗酸杆菌阳性。（3）12.9%X线胸片早期表现为肺间质磨玻璃样改变,51.5%表现为大小、密度、分布均匀的粟粒结节。（4）胸部高分辨CT显示55.0%急性血行播散型表现双肺弥漫分布的大小、密度均匀的粟粒结节;另48例亚急性和慢性血行播散性肺结核表现以上中肺野为主的3～7mm大小、密度及分布不均匀的结节。46.8%的肺野内可见斑片、结节、纤维条索状影;43.1%伴纵隔和/或肺门淋巴结肿大。（5）20例活组织检查60%病理阳性。 （6）44.6%合并肺外结核,常见于脑膜、浆膜腔、淋巴结、脑、肝、脾、骨等。（7）42.1%入院前被误诊为其他疾病。（8）除8例外其余患者抗结核治疗后体温在3d到12周内降至正常。（9）79.7%在抗结核治疗2个月后胸片显示病灶不同程度吸收。结论痰涂片、HRCT、纤维支气管镜及器官组织活检是早期诊断的关键。     

肺癌支气管冲洗液微卫星DNA的检测及意义

目的　探索肺癌支气管冲洗液中微卫星DNA的改变及其在肺癌诊断中的价值。方法　收集肺癌及良性肺病患者支气管冲洗液和外周血 ,提取DNA ,利用聚合酶链反应、变性聚丙烯酰胺凝胺电脉及银染法检测冲洗液中的微卫星DNA改变 ,并与纤维支气管镜活检 ,刷检作比较。结果　肺癌冲洗液中微卫星DNA改变阳性率5 8% ,其中中心型 5 6% ,低于活检及刷检 ;周围型 61% ,高于活检及刷检。良性肺病未发现微卫星DNA改变。结论　肺癌支气管冲洗液微卫星DNA改变的检测阳性率较高 ,特异性好 ,对于肺癌尤其周围型肺癌的早期诊断具有较好的应用价值     

Application of transbronchial brushing for histological diagnosis of lung cancer

In order to improve the preoperative diagnostic rate of lung cancer, histological examination was performed by transbronchial brushing in 35 cases, and diagnostic contribution of brushing specimen was compared with that of transbronchial forceps biopsy (TBFB). Histological structures were well preserved in the histology section of brushing specimens, especially in cases of small cell lung cancer. The positive rate of brushing histology was 46%, which was the same as that of TBFB. The total histological diagnostic rate was 66% with simultaneous examination of bronchial brushing and TBFB specimens. Consequently, the use of brushing specimens for histologic evaluation made an additional contribution to the correct positive histology diagnostic rate. Brushing histology is indicated for all types of lung cancer, because in most TBFB-negative cases, biopsies were performed from inappropriate sites of tumors or their materials wer crushed by forceps. It was suggested that concomitant application of brushing specimen for histology examination, contributed to more accurate preoperative histology diagnosis for lung cancer.