中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

快速现场评价技术在肺占位病变良恶性判断中的作用

查看全文

目的评估快速现场评价(ROSE)技术对肺占位病变良恶性的判断价值,以及对支气管镜活检取材质量的影响。方法2017 年 6 月 1 日至 2017 年 12 月 30 日,在胸部 CT 表现为肺占位性病变的患者中行支气管镜下活检,并留取活检组织开展 ROSE 技术,由经过 3 个月细胞病理学培训的呼吸科专科医师进行 ROSE 判读,判读结果与后续的常规病理检查结果进行比对。回顾性分析同时期 CT 表现为肺占位行支气管镜活检、但未行 ROSE 的病例,比较两组病例常规病理报告提示取材质量的差别。结果共纳入 101 例患者行支气管镜下活检并行 ROSE,呼吸科专科医师的判读结果与后续常规病理结果相比,恶性病变的一致率为 84.1%,良性病变的一致率为 93.8%,一致性检验提示两者具有较好的一致性(κ 值为 0.66,P<0.01)。开展 ROSE 的病例组与未行 ROSE 的病例组相比,最终常规病理报告显示取材满意的比例无显著性差异(98.0% 比 94.5%,P=0.14)。结论ROSE 技术应用在支气管镜活检中能够较好地判断肺占位病变的良恶性。经过短期细胞病理学培训的呼吸科专科医师有能力进行快速现场细胞学评价,从而避免了需要细胞病理医师现场参与诊断的困难。

ObjectiveTo evaluate the role of rapid on-site evaluation (ROSE) in the diagnosis of lung space-occupying lesions.MethodsFrom June 1, 2017 to December 30, 2017, transbronchial biopsies were performed in patients with lung space-occupying lesions on chest CT, and biopsies were taken for ROSE and subsequent routine pathological examination. ROSE interpretation was performed by a pulmonologist who had been trained in cytopathology for 3 months. The interpretation was correlated with the follow-up routine pathological examination. The contemporary cases with lung space-occupying lesions who underwent transbronchial biopsies without ROSE were retrospectively reviewed. The quality assessment of biopsy specimens recorded in pathological reports were compared between cases with and without ROSE.ResultsA total of 101 patients underwent transbronchial biopsies in parallel with ROSE. The interpretation results of the pulmonologist were compared with the follow-up routine pathology, which showed that the consistency rate of malignant lesions was 84.1% and the consistency rate of benign lesions was 93.8%. Consistency test showed good agreement between the ROSE conducted by the pulmonologist and the routine pathological examination by pathologists (κ=0.66, P<0.01). The quality assessment of biopsy specimens showed that there was no significant difference on rate of satisfied biopsy specimens between cases with and without ROSE (98.0%vs 94.5%, P=0.14).ConclusionsThe use of ROSE combining with bronchoscopy allows good preliminary assessment of lung space-occupying lesions. Pulmonologists trained in short-term formal cytopathology are fully capable of performing ROSE, thereby obviating the need for cytopathologists to participate in on-site evaluation.

关键词: 快速现场评价技术; 肺占位; 支气管镜检查; 呼吸科医师

Key words: Rapid on-site evaluation; Lung space-occupying lesion; Bronchoscopy; Pulmonologist

引用本文: 李燕, 蔡后荣, 演欣, 高玉娟, 柏涛, 郑金榆, 代静泓. 快速现场评价技术在肺占位病变良恶性判断中的作用. 中国呼吸与危重监护杂志, 2018, 17(5): 484-487. doi: 10.7507/1671-6205.201803043 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 赵丽娟, 朱辉, 王可, 等. 2670 例肺癌支气管镜下表现与病理类型的关系分析. 中国呼吸与危重监护杂志, 2009, 8(3): 287-289.
2. Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Guidelines of the Papanicolaou Society of Cytopathology for the examination of cytologic specimens obtained from the respiratory tract. Diagn Cytopathol, 1999, 21: 61-69.
3. Koul A, Baxi AC, Shang R, et al. The efficacy of rapid on-site evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses. Gastroenterol Rep (Oxf), 2018, 6(1): 45-48.
4. Naïm C, Karam R, Eddam R Ultrasound-guided fine-needle aspiration biopsy of the thyroid: methods to decrease the rate of unsatisfactory biopsies in the absence of an on-site pathologist. Ultrasound-guided fine-needle aspiration biopsy of the thyroid: methods to decrease the rate of unsatisfactory biopsies in the absence of an on-site pathologist. Can Assoc Radiol J, 2013, 64(3): 220-225.
5. Pak HY, Yokota S, Teplitz RL, et al. Rapid staining techniques employed in fine needle aspirations of the lung. Acta Cytol, 1981, 25(2): 178-184.
6. Davenport RD. Rapid on-site evaluation of transbronchial aspirates. Chest, 1990, 98(1): 59-61.
7. Asano F, Eberhardt R, Herth FJ. Virtual bronchoscopic navigation for peripheral pulmonary lesions. Respiration, 2014, 88(5): 430-440.
8. Zaric B, Stojsic V, Sarcev T, et al. Advanced bronchoscopic techniques in diagnosis and staging of lung cancer. J Thorac Dis, 2013, 5 Suppl 4: S359-S370.
9. Bonifazi M, Sediari M, Ferretti M, et al. The role of the pulmonologist in rapid on-site cytologic evaluation of transbronchial needle aspiration: a prospective study. Chest, 2014, 145(1): 60-65.