肺细针吸取微小组织学与细胞学检查诊断价值的探讨

目的探讨经皮细针肺肿块吸取细胞块和微小碎片组织学(简称微小切片)与涂片细胞学的诊断价值.方法对有组织学对比的187例经皮细针(7号) 肺部肿块吸取资料作微小切片组织学与涂片细胞学比较分析.结果 (1)微小切片组的诊断敏感性88.3%,特异性100%,总准确率89.5%;涂片组分别为87.7%、93.8%和88.8%;涂片结合微小切片则分别为91.6%、93.8%和92.0%.(2)微小切片组对恶性肿瘤的组织分型准确率93.3%(83/89),比涂片组的67.9%(91/134)高(P<0.01).对良性病变分类诊断准确率分别为86.4%(19/22)和 60.0%(18/30) (P<0.05).(3)66.3%的病例获取微小组织切片,其免疫组织化学染色结果与术后病理组织切片的相同.结论微小切片组织学和细胞学的诊断准确性均高,两者结合应用将提高诊断准确性,前者对组织分型、分类诊断接近术后病理诊断,有很高的应用价值.

Diagnostic accuracy of cell-block or tissue-fragment histology and cytology by fine needle lung aspiration

Objective Study on the diagnostic accuracy and value of cell block and tissue fragment preparations collected from lung fine needle aspiration (FNA). Methods A total of 187 FNA (22G) samples from the lungs with matched histological diagnosis were studied. Among them, the diagnosis made by depending on 124 cell block and fragment preparations were analyzed in comparing retrospectively with the diagnosis of 187 cases by smear preparations. Results (1) Of the 124 cell blocks cases,89 cases were true positives,22 cases were true negatives,13 cases were false negatives and no false positives. Of the 187 smears cases,the figure were 136,30,19 and 2 cases respectively.The diagnostic accuracy of cell blocks was 87.3% in sensitivity,100% in specificity,89.5% in overall accuracy.The figures for smears were 87.7%, 93.8% and 88.8% respectively.(2) For malignant tumours, the histological typing accuracy of cell blocks was 93.3% (83/89),and to be 67.9% (91/134) by diagnosis depending on the smears (P<0.01).For the benign lesions,the figures were 86.4% (19/22) and 60%(18/30) respectively (P<0.05).(3) It was possible to obtain many minisections for further studies from cell blocks. Immunoperoxidase staining on minisections was reliable and agreed with those on the surgical specimens.Conclusions The diagnostic accuracy of cell block is high,particularly in histological typing which approaches to that of the diagnosis made depending on the postoperative specimens. A combimed use of smears and cell block is recommended which may raise further the diagnostic accuracy.