痰液、纤支镜刷片与肺穿细胞学在肺肿瘤诊断中的价值

目的 探讨痰液、纤支镜刷片与肺穿刺细胞学三者联合检测对肺肿瘤诊断的价值。方法取晨痰或新鲜痰液制作涂片；纤支镜在病变部位刷片；CT引导下肺部病变部位穿刺分别作细胞学检查。结果痰细胞学检查、纤支镜刷片细胞学检查以及肺穿刺细胞学检查的阳性率分别为11．7％、58．8％、70．7％；敏感性分别为32．1％、72．1％、85．9％；特异性分别为99．3％、98．5％、100％；分型符合率分别为93．6％、80．4％、86．9％。三项细胞学互补检查其敏感性为86．1％，均高于痰细胞学检查、纤支镜刷片细胞学检查及肺穿刺细胞学检查。结论痰细胞学的阳性率及敏感性虽然较低，但可以弥补纤支镜取材的不足，还可作为纤支镜刷片阴性和不能耐受纤支镜刷片的肺癌患者的补充检查手段；纤支镜刷片细胞学具有较高的敏感性，特别是对中央型肺癌诊断率较高；CT引导刚市穿刺可弥补纤支镜检查的不足，适用于各部位的肺癌诊断，特别适用于周围型肺癌的诊断。各种取材方法的阳性率、敏感性虽高低不等，但联合多种取材方法行细胞学检查可显著提高肺肿瘤的确诊率。

The value of sputum, bronchoscopy brush tablet and lung paracentesis cytology for lung tumor diagnosis

Objective To investigate the value of sputum, brash cytology and lung paracentesis cytology multi - detection in the diagnosis of lung neoplasms. Methods Made film preparation with morning sputum or fresh sputum; brushed biopsy through bronchofiberscope in diseased region; and lung paracentesis in diseased region guided by CT. All of them were detected with cytological examination. Results The posi- tive rate of sputum , brush cytology and lung paracentesis cytology was 11.7 %, 58.8 % and 70.7 %. The sensitivity was 32.1%, 72.1% and 85.9%. The specificity was99.3 % ,98.5% and 100% .And the typing accuracy was 93.6% ,80.4%and 86.9%. The sensitivity was 86. 1% . while nsirfg the three method higher than sputum cytology, brush cytology or lung paracentesis cytology. Conclusion Though the positive rate and sensitivity of sputum cytology are low, it can make up for the material shortages of bronchofiberscope. In addition, it can also be an important assistant mean in diagnosis while the examination of brush cytology is negative or lung cancer patients are unendurable to brush cytol- ogy. Brush cytology is highly sensitivity, especially central lung cancer. CT guided lung paracentesis can make up for the deficiency of bron- chofiberscope exam and is suitable for all lung eancars, especially peripheral lung cancer. The positive rate and sensitivity of all kinds of methods to obtain samples are inequal, yet the application of multi - methods combined for cytology exam can improve the diagnosis accuracy rate of the lung neoplasms