支气管镜检查联合快速现场细胞学诊断的应用

doi:10.3877/cma.j.issn.1674-6902.2022.04.010

目的

分析支气管镜检查联合快速现场细胞学评估(C-ROSE)的应用。

方法

选择我院行支气管镜检查患者240例，分为C-ROSE组79例，非C-ROSE组161例，分析两组的诊断率。

结果

与金标准相比，肺科医师对样本充分性的判读、良恶性病变的鉴别及肺癌诊断高度一致，Kappa值分别为0.904、0.970、0.794。C-ROSE联合支气管镜检查的诊断效能良好，敏感性为100%，特异性为97.83%，诊断准确率98.61%，阳性预测值96.30%，阴性预测值为100%。C-ROSE组恶性疾病诊断率明显高于非C-ROSE组(92.86% vs. 73.21%，P<0.05)，两组的总诊断率和良性疾病诊断率差异无统计学意义。C-ROSE组恶性疾病的二次检查率明显低于非C-ROSE组(7.14% vs. 26.79%，P<0.05)。

结论

经系统培训的肺科医师能掌握C-ROSE技术，在支气管镜检查中能判读样本充分性，区分良恶性病变，提高诊断率、减少二次检查率，具有临床意义。

关键词: 快速现场细胞学评估, 支气管镜检查, 细胞病理学

Objective

To analyze the application of bronchoscopy combined with rapid on-site cytologic evaluation(C-ROSE).

Methods

Retrospective study of 240 cases who were performed with bronchoscopy at the Second Affiliated Hospital of Nanjing Medical University in 2020. There were 79 cases in C-Rose group and 161 cases in non-C-Rose group. The diagnostic yield and the secondary examination rates between C-ROSE group and non C-ROSE group were also compared.

Results

Compared with the gold standard, the pulmonologist′s interpretation of sample adequacy, identification of benign and malignant lesions, and diagnosis of lung cancer were all highly consistent, the Kappa value were 0.904, 0.970, 0.794 respectively. When C-ROSE was applied to bronchoscopy, the diagnostic efficacy was pretty good, the sensitivity was 100%, the specificity was 97.83%, the diagnostic accuracy was 98.61%, the positive predictive value was 96.30% and the negative predictive value was 100%. The diagnostic yield of malignant disease was statistically higher in C-ROSE group than that in non C-ROSE group(92.86% vs. 73.21%, P<0.05). There was no statistical difference between the two groups in the total diagnostic yield and the benign disease diagnostic yield. The secondary examination rate of malignant disease was statistically lower than that in non C-ROSE group(7.14% vs. 26.79%, P<0.05).

Conclusion

Pulmonologists can master C-ROSE technique after short time of systematic training. A trained pulmonologist can reliably carry out C-ROSE to interpret sample adequacy, distinguish between benign and malignant lesions, help improve the diagnostic yield and reduce the secondary examination rate. C-ROSE technique is effective-cost, it worthy of wide use in most hospitals.

Key words: Rapid on-site cytologic evaluation, Bronchoscopy, Cytopathology

表1 两组的支气管镜检查(n)

检查类型	C-ROSE组	非C-ROSE组
Just Brush&BAL	40	83
EBB	16	41
TBLB	4	4
R-EBUS TBLB	2	18
EBUS-TBNA	7	11
EBB+EBUS-TBNA	8	7
TBLB+EBUS-TBNA	1	2
EBB+C-TBNA	1	0
C-TBNA+EBUS-TBNA	1	0

表1 两组的支气管镜检查(n)

检查类型	C-ROSE组	非C-ROSE组
Just Brush&BAL	40	83
EBB	16	41
TBLB	4	4
R-EBUS TBLB	2	18
EBUS-TBNA	7	11
EBB+EBUS-TBNA	8	7
TBLB+EBUS-TBNA	1	2
EBB+C-TBNA	1	0
C-TBNA+EBUS-TBNA	1	0

表2 第一次支气管镜检查结果(n)

诊断结果		C-ROSE组	非C-ROSE组
明确诊断		72	134
恶性病变		26	41
	非小细胞肺癌	15	35
	鳞癌	8	11
	腺癌	5	19
	其他非小细胞肺癌^a	2	5
	小细胞肺癌	9	5
	其他恶性病变^b	2	1
良性病变		46	93
	肺脓肿伴或不伴肺炎	1	5
	真菌	0	3
	肺结核	0	11
	结节病	2	3
	机化性肺炎	2	2
	非特异性炎症	41	66
	其他良性病变^c	0	3
未明确诊断		7	27

表2 第一次支气管镜检查结果(n)

诊断结果		C-ROSE组	非C-ROSE组
明确诊断		72	134
恶性病变		26	41
	非小细胞肺癌	15	35
	鳞癌	8	11
	腺癌	5	19
	其他非小细胞肺癌^a	2	5
	小细胞肺癌	9	5
	其他恶性病变^b	2	1
良性病变		46	93
	肺脓肿伴或不伴肺炎	1	5
	真菌	0	3
	肺结核	0	11
	结节病	2	3
	机化性肺炎	2	2
	非特异性炎症	41	66
	其他良性病变^c	0	3
未明确诊断		7	27

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Application of bronchoscopy combined with rapid on-site cytologic evaluation

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Application of bronchoscopy combined with rapid on-site cytologic evaluation