转移灶穿刺活检在肺癌诊断中的应用

目的:探讨肺部病灶活检难度大或者肺部活检组织较少等情况下，转移灶穿刺活检的意义。方法:回顾性分析了自2013年10月至2016年12月于南京大学医学院附属鼓楼医院肿瘤中心接受淋巴结、骨、肝脏等转移灶穿刺活检的20例肺癌患者。对转移灶活检的必要性、转移灶活检的手段、准确性、标本质量、病理诊断及相关副作用进行分析。结果:从2013年10月至2016年12月，共20例患者于肿瘤中心行转移灶穿刺，其中行肾上腺转移灶穿刺1例、骨转移灶穿刺3例、肝脏穿刺4例、皮下包块穿刺5例、淋巴结穿刺7例，结合临床及免疫组化均考虑肺来源（其中肺腺癌13例、肺鳞癌2例、肺小细胞癌4例、1例最终只能确定为肺低分化癌）。对非小细胞肺癌患者行分子检测，其中3例患者因穿刺组织较少难以行分子检测，余12例患者分子检测结果显示EGFR敏感突变阳性率75%（9/12）、ALK融合基因阳性率16.7%（2/12）。所有转移灶穿刺患者均未见严重出血、感染或针道种植转移等并发症。结论:对临床高度怀疑肺癌并且伴有远处转移的患者，在肺部病灶活检难度大或活检组织取材不能满足分子检测时，转移灶穿刺活检可作为重要补充手段，达到较好的诊断效能。

Application of needle biopsy of metastasis biopsy in diagnosis medicine of lung cancer

Objective:For some patients，lung biopsies cannot be conducted due to different reasons.In this case，we explored the significance of biopsy of metastatic lesions as it is vital for their treatment planning.Methods:A retrospective analysis from October 2013 to December 2016，the 20 patients who underwent needle biopsy via lymph nodes，bone，liver，and other metastatic lesions in the comprehensive cancer center.The efficacy and safety of biopsy of metastatic lesions for the diagnosis of lung cancer were studied.Results:From October 2013 to December 2016，a total of 20 patients underwent biopsy of metastatic lesions.Of these patients，1 were treated with adrenal metastases biopsy，3 with bone metastases biopsy，4 with liver biopsy，5 with subcutaneous mass puncture，and 7 with lymph node aspiration.Combined with clinical and immunohistochemistry，all patients were lung origin (including 13 cases of adenocarcinoma of lung，2 cases of lung squamous cell carcinoma，4 cases of small cell lung cancer，1 case of lung cancer with low differentiation of lung cancer).We performed molecular testing for patients with non-small cell lung cancer.12 patients were given definite molecular mutations.Among them，EGFR mutation positive rate was 75% (9/12)，ALK fusion gene positive rate was 16.7% (2/12).No serious bleeding，infection，implantation metastasis happened.Conclusion:The biopsy of metastatic lesions is an important alternative supplement means for patients who are highly suspected with lung cancer or have distant metastasis.