摘要
目的诊断肺癌的常用组织活检技术包括经皮肺穿刺、纤维支气管镜活检以及手术标本活检,而前两者由于取得标本量的局限性以及肿瘤组织的异质性,可能造成诊断上的偏差。文中比较CT引导下经皮肺穿刺肺部占位活检获取的小标本与手术获取的大标本病理结果的差异,探讨CT引导下小标本对不同类型肺癌的诊断价值。方法回顾性分析2008年8月1日至2015年4月1日就诊于南京军区南京总医院呼吸内科及胸外科住院治疗的324例肺癌患者资料。所有患者均在影像学发现肺部占位后,行CT引导下经皮肺穿刺活检获得组织标本病理,并确诊为肺癌后再行手术切除。比较CT引导下经皮肺穿刺小标本和手术大标本肺癌不同病理类型之间的诊断差异。结果 CT引导下经皮肺穿刺活检取得的小标本与手术大标本的病理结果符合率为85.8%(278/324);其中腺癌类型的符合率中最高(96.4%),之后为鳞癌(86.1%)、小细胞肺癌(45.5%);大细胞肺癌和腺鳞癌在CT引导下经皮肺穿刺时较易诊断为腺癌(7/10和6/10);大、小标本对发病率较高的腺癌、鳞癌和小细胞肺癌的分型诊断差异无统计学意义(κ=0.837、P=0.215)。结论 CT引导下经皮肺穿刺活检与手术大标本在肺癌诊断方面有较高的符合率。但根据病理类型的不同,两者的一致率存在差异。
Objective This study was to investigate the diagnostic value of CT-guided percutaneous needle lung biopsy（ PNLB） in different types of lung cancer and compare the pathological results of CT-guided PNLB and surgical specimens. Methods We performed a retrospective analysis of 324 cases of lung cancer,all confirmed by CT-guided PNLB after imaging manifestation of lung-occupying lesion and treated by surgical resection. We compared the pathological results of CT-guided PNLB and surgical specimens. Results The total coincidence rate of the pathological result from CT-guided PNLB with that from surgical specimens was85. 8%（ 278 /324）,with even a higher coincidence rate（ 96. 4%） in adenocarcinoma,followed by squamous cell carcinoma（ 86. 1%）,and small cell lung cancer（ 45. 5%）. Large cell lung cancer and adenosquamous carcinoma were liable to be diagnosed as adenocarcinoma by CT-guided PNLB（ 7 /10 and 6 /10）. Mc NemarBowker test revealed no significant differences in the coincidence rate in adenocarcinoma,squamous cell carcinoma,and small cell lung cancer（ κ = 0. 837,P = 0. 215）. Conclusion CT-guided PNLB has a high coincidence rate with surgical specimens in the pathological diagnosis of lung cancer,but the coincidence rate varies with different pathological types of the tumor.
出处
《医学研究生学报》
CAS
北大核心
2016年第5期500-503,共4页
Journal of Medical Postgraduates
基金
国家自然科学基金(81401903,81302032)
关键词
经皮肺穿刺
肺癌
手术切除
病理分型
Percutaneous needle lung biopsy
Lung cancer
Surgery
Pathological type
