目的 探讨CT引导下经皮细针穿刺活检在中晚期肺癌表皮生长因子受体(EGFR)基因突变检测中的应用价值.方法 228例不可手术切除的Ⅱ～Ⅳ期肺癌患者,采用18G或30G Chiba针进行CT引导下经皮肺穿刺活检,获得标本进行病理学检测及PCR法EGFR基因突变分析.结果 117例穿刺采用18G Chiba针,111例为20G Chiba针.病理确诊腺癌184例、鳞癌14例、腺鳞癌3例、小细胞癌6例、未分化癌21例.穿刺术后8例(8/228,3.51％)发生气胸,30例(30/228,13.16％)出现针道少许渗血.218例(218/228,95.61％)穿刺取材标本成功进行基因突变检测,共检测到93例基因突变,其中EGFR 18、19、20、21外显子突变分别为2、52、3、36例.135例女性患者中70例(70/135,51.85％)发现突变,93例男性患者中23例(23/93,24.73％)发现突变.184例腺癌中,88例发生突变,3例腺鳞癌中2例突变,21例未分化癌中2例突变,14例鳞癌中1例突变,6例小细胞癌未检测到突变.结论 CT引导下经皮细针穿刺活检可作为中晚期肺癌EGFR基因检测的取材手段.%Objective To investigate the value of CT-guided lung fine needle aspiration biopsy (FNAB) in obtaining tumor tissue for epidermal growth factor receptor (EGFR) mutation analysis in patients with advanced lung cancer. Methods Totally 228 patients with stage Ⅱ -Ⅳ lung cancer underwent CT-guided FNAB with 18G or 20G Chiba aspiration needle. The obtained specimens were detected for histology diagnosis and EGFR mutation analysis. Results CT-guided FNAB was successfully performed in 117 patients using 18G Chiba needle and 118 patients with 20G needle. Histology diagnosed 184 adenocarcinoma, 14 squamous cell carcinomas, 3 adenosquamous carcinomas, 6 small cell carcinomas and 21 undifferentiated carcinomas. Pneumothorax occurred in 8 (8/228, 3. 51%) patients, while minor needle tract bleeding occurred in 30 (30/228, 13. 16%) patients. The obtained tumor samples were adequate for DNA analysis in 218 patients (218/228, 95.61%), with 93 EFGR mutants including 2, 52, 3 and 36 cases of EGFR exon 18, 19, 20 and 21 mutations, respectively. Of 135 female patients, 70 (70/135, 51. 85%) had EGFR mutation, of 93 males, 23 (23/93, 24. 73%) were found with mutation. Mutants occurred in 88 of 184 patients with adenocarcinomas, 2 of 3 adenosquamous cell carcinomas, 2 of 21 undifferentiated carcinomas and 1 of 14 squamous carcinomas. No mutant was detected in 6 patients with small cell carcinoma. Conclusion CT-guided FNAB can be used to obtain lung tumor tissue for EGFR gene mutation analysis in patients with advanced lung cancer.
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