CT引导下穿刺活检检测EGFR、ALK基因临床价值分析

目的：探讨CT引导下肺癌穿刺活检表皮生长因子受体（ EGFR）、间变淋巴瘤激酶（ ALK）基因检出率及阳性率，并对其临床应用价值进行分析。方法选取临床确诊的肺癌患者280例，保留CT引导下穿刺活检标本，分为2组：观察组（ n ＝200，应用粗针穿刺）和对照组（ n ＝80，应用细针穿刺），2组对临床病理特征与基因突变相关性、阳性率、检出率、肿瘤细胞数量及术后并发症情况比较。结果女性患者EGFR基因突变率为66．04％，男性基因突变患者28．74％，两者比较差异有统计学意义（P ＜0．05），非吸烟患者 EGFR 基因突变率为57．24％，吸烟患者29．63％，差异有统计学意义（P＜0．05）；年龄、病理学分期EGFR基因突变率区别差异无统计学意义（P＞0．05）。腺癌患者EGFR基因突变率显著高于其他类型肺癌（P＜0．05）；ALK基因表达在不同性别、年龄、病理学分化程度，差异无统计学意义（P＞0．05）。其Ⅳ期患者ALK基因突变率较其他期患者高，差异有统计学意义（P＜0．05）。 EGFR、ALK基因检出率、阳性率比较，观察组较对照组高，差异有统计学意义（P＜0．05），观察组检测出平均肿瘤细胞个数多于对照组，差异有统计学意义（P＜0．05）。对照组并发症总发生率高于观察组，差异有统计学意义（P＜0．05）。结论EGFR、ALK基因粗针检出率高于细针检出率，但细针检出率仍有一定临床诊断意义，且并发症发生发生率低于粗针，可以根据患者实际情况进行选择不同的针型，均具有一定的临床诊断价值。

Clinical significance of detection of EGFR and ALK genes by CT guided puncture biopsy

Objective To observe the detection rate and positive rate of epidermal growth factor receptor ( EGFR) and anaplastic lymphoma kinase ( ALK) gene by lung cancer puncture biopsy under CT guidance , and to analyze its clinical application value .Methods Two hundred and eighty specimens from the patients with lung cancer who were treated in our hospital from January 2013 to February 2015 were taken by CT guided puncture biopsy ,which were divided into two groups:observation group ( n =200,thick needle puncture) and control group ( n =80,thin needle puncture).The clinicopathological characteristics, gene mutation correlation,positive rate, detection rate,tumor cell number and postoperative complications were observed and compared between two groups .Results The gene mutation rate of EGFR in female patients was 66.04%, however, which was 28.74%in male patients,there was a significant difference between two groups ( P <0.05).Moreover there was a significant difference in gene mutation rate of EGFR between non-smoking patients and smoking patients (57.24%vs 29.63%, P <0.05).However there were no significant differences in patien ’s age,pathological staging,gene mutation rate of EGFR between two groups ( P >0.05 ).The gene mutation rate of EGFR in patients with lung adenocarcinoma was significantly higher than that in the patients with the other types of lung carcinomas ( P <0.05).There were no significant differences in the expression levels of ALK among different sex and age , pathological differentiation degree ( P >0.05), in which the gene mutation rate of ALK in patients at stage Ⅳwas significantly higher than that in the patients at the other stages ( P <0.05).The detection rate and positive rate of EGFR ,ALK in observation group were significantly higher than those in control group ( P <0.05).The average tumor cell numbers detected in observation group were much more than those in control group ( P <0.05).Besides the total incidence rates of postoperative complications in observation group were significantly higher than those in control group ( P <0.05).Conclusion The detection rates of EGFR ,ALK gene by thick needle puncture biopsy are higher than those by thin needle puncture biopsy , however, thin needle puncture biopsy has still certain clinical significance , moreover,the incidence rates of postoperative complications in thin needle puncture biopsy are lower than those in thick needle puncture biopsy ,thus, both detection methods have certain clinical diagnostic value .