天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (1): 94-97.doi: 10.11958/20200888

• 应用研究 • 上一篇    下一篇

快速现场细胞学评估在肺穿刺活检中的应用

王承志，王咏梅，杨庆婵   

  1. 天津市海河医院病理科，天津市呼吸疾病研究所（邮编300350）
  • 收稿日期:2020-04-09 修回日期:2020-09-12 出版日期:2021-01-15 发布日期:2021-01-15
  • 通讯作者: 王承志 E-mail:wangchengzhi-1123@163.com

The application of rapid on-site cytological evaluation for percutaneous lung biopsy

WANG Cheng-zhi, WANG Yong-mei, YANG Qing-chan   

  1. Department of Pathology, Tianjin Haihe Hospital, Tianjin Institute for Respiratory Diseases, Tianjin 300350, China
  • Received:2020-04-09 Revised:2020-09-12 Published:2021-01-15 Online:2021-01-15
  • Contact: WANG CHENG ZHI E-mail:wangchengzhi-1123@163.com

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摘要： 摘要：目的　探讨快速现场细胞学评估（C-ROSE）在肺穿刺活检中的应用价值。方法　对291例肺内病变的患者行经皮肺穿刺活检，根据术中是否采用C-ROSE分为C-ROSE组148例和非C-ROSE组143例，对比2组间临床资料、穿刺情况及并发症等，同时分析C-ROSE细胞学诊断的敏感度和与最终组织学诊断的一致性。结果　C-ROSE组148例中有137例（92.6%）获得满意标本，最终病理学确诊率93.9%；非C-ROSE组143例中有120例（83.9%）获得满意标本，最终病理学确诊率86.0%。C-ROSE组标本满意程度和最终病理学确诊率均优于非C-ROSE组（均P＜0.05）。C-ROSE组对照最终病理组织学诊断，敏感度为88.0%（81/92），特异度为96.4%（54/56），两者诊断上有较好的一致性（Kappa值为0.819）。C-ROSE组活检时间（15.32±2.81）min，平均穿刺数（1.41±0.55）针，较非C-ROSE组活检时间（14.08±2.33）min，平均穿刺数（1.20±0.40）针有所增多（均P＜0.01）。C-ROSE组出现气胸18例（12.2%），肺部出血14例（9.5%）；非C-ROSE组出现气胸22例（15.4%），肺部出血14例（9.8%），2组患者间并发症差异均无统计学意义（均P＞0.05）。结论　C-ROSE在经皮肺穿刺活检可指导手术医生取材，提高活检成功率和诊断率，同时C-ROSE在细胞学诊断中也有较高的敏感度和与组织学诊断的一致性，值得临床上推广。

关键词: 胸腔穿刺术, 细胞学技术, 现场快速评估, 肺部病变

Abstract: Abstract: Objective　To explore the applicative value of rapid on-site cytological evaluation(C-ROSE) for percutaneous lung biopsy. Methods　A total of 291 patients with intrapulmonary diseases underwent percutaneous lung biopsy were included in this study. Patients were divided into C-ROSE group (n=148) and non- C-ROSE group (n=143) according to whether C-ROSE was used during the operation. Clinical data, puncture conditions and complications were compared between the two groups.The sensitivity of C-ROSE cytological diagnosis and the consistency with the final histological diagnosis were analyzed. Results　In 148 patients of C-ROSE group, 137 cases (92.6%) were received satisfactory specimens, and the final pathological diagnosis rate was 93.9%. Of the 143 non- C-ROSE patients, 120 (83.9%) obtained satisfactory specimens, and the final pathological diagnosis rate was 86.0%. The sample satisfaction and final pathological diagnosis rate were better in the C-ROSE group than those of the non-C-ROSE group (all P＜0.05). The sensitivity and specificity of C-ROSE control for final histopathological diagnosis were 88.0% (81/92) and 96.4% (54/56), with good consistency in diagnosis (Kappa value was 0.819). In the C-ROSE group, the biopsy time was (15.32±2.81) min, and the average number of puncture needles was (1.41±0.55) times. The biopsy time was (14.08±2.33) min in the non- C-ROSE group and the average number of puncture needles was (1.20±0.40) times. The biopsy time and the number of puncture needles were higher in the C-ROSE group than those in the non- C-ROSE group (all P＜0.01). In the C-ROSE group, pneumothorax occurred in 18 patients (12.2%) and pulmonary hemorrhage in 14 patients (9.5%). In the non- C-ROSE group, pneumothorax occurred in 22 patients (15.4%) and pulmonary hemorrhage in 14 patients (9.8%).There were no statistically significant differences in the complications of pneumothorax and pulmonary hemorrhage between the two groups (all P＞0.05). Conclusion　C-ROSE percutaneous lung biopsy can guide surgeons to take materials, improve the success rate and diagnosis rate of biopsy, and C-ROSE also has high sensitivity and consistency with histological diagnosis in cytological diagnosis, which is worthy of clinical promotion.

Key words: thoracentesis, cytological techniques, rapid on-site evaluation, lung lesions